Evaluating risk: global fees and episodic care

In 1999, two articles in The Physician Executive -- "Part I: Global Theory and the Nature of Risk (July-August)." and "Part II: Towards a Choice-Based Model of Managed Care (October-November)" -- outlined the flaws of orthodox managed care theory and highlighted the unique advantages of moving to a genuinely market-based model, which included the concept of direct contracting for integrated episodes of care. This follow-up focuses on comparing an episode contracting system to a traditional capitated program and outlines the features that make this approach much more attractive to physicians, payers, and most importantly patients.     

A Bayesian approach for generalized linear models with explanatory biomarker measurement variables subject to detection limit: an application to acute lung injury

Biomarkers have the potential to improve our understanding of disease diagnosis and prognosis. Biomarker levels that fall below the assay detection limits (DLs), however, compromise the application of biomarkers in research and practice. Most existing methods to handle non-detects focus on a scenario in which the response variable is subject to the DL; only a few methods consider explanatory variables when dealing with DLs. We propose a Bayesian approach for generalized linear models with explanatory variables subject to lower, upper, or interval DLs. In simulation studies, we compared the proposed Bayesian approach to four commonly used methods in a logistic regression model with explanatory variable measurements subject to the DL. We also applied the Bayesian approach and other four methods in a real study, in which a panel of cytokine biomarkers was studied for their association with acute lung injury (ALI). We found that IL8 was associated with a moderate increase in risk for ALI in the model based on the proposed Bayesian approach.     

Prevention of child abuse and neglect and improvements in child development

The aim of the study was to evaluate the implementation of a section in the Danish Social Assistance Act which encourages local authorities to offer families services in order to support children at risk of child maltreatment. The specific purpose of the present paper is to answer the question: Will the socio‐psychological development of children known to social services be improved when abuse and neglect are reduced? A sample of 1,138 children was drawn at random from new social services cases starting in 1998. Subsequently, about 80 per cent were evaluated by local caseworkers on the basis of a standardised questionnaire covering a period of four years. The most damaging family conditions seemed to be psychological maltreatment, physical/sexual abuse and neglect. Maltreated children were more often in a depressed state, unhappy, socially isolated, or they had an eating disorder, inadequate or under‐nutrition, suicidal tendencies, lack of concentration, or disturbed behaviour, compared to those children who were not exposed to abuse and neglect. If parental behaviour improved, effects on children's well‐being were also observed and positive changes in children's socio‐psychological development were identified. The questionnaire explored the impact of various interventions, including services geared to strengthen the child's network, but results indicated that the child displayed reduced risk of reactive symptoms only when parental behaviour improved and abuse and neglect were reduced. Copyright © 2009 John Wiley & Sons, Ltd.     

A model for predicting dating violence: anxious attachment, angry temperament, and need for relationship control

Structural equation modeling (SEM) was used to test a model incorporating anxious attachment, angry temperament, and attempts to control one's partner as predictors of the severity and frequency of dating violence. To date, these concepts have not been clearly established as having direct or indirect effects on dating violence. It was hypothesized that anxious attachment and angry temperament would influence the need for and attempts to control one's partner which, in turn, would predict a person's actual use of force. College students (213 males; 199 females) completed measures assessing these constructs. Cross-validation was accomplished through using two successive freshmen samples. Statistics indicated the application of the model fit well to both samples. All specified paths were significant except for the direct path from anxious attachment to need for control in the second sample. While exploratory, this model seemed satisfactory for explaining potentially causal relationships of attachment, anger, and attempts to control one's partner leading to dating violence.     

Rethinking twins and environments: possible social sources for assumed genetic influences in twin research

A central sociological problem is the extent to which genetics and the environment influence human behavior. Studies of twins are a core method in attempts to disentangle and to determine the comparative strength of genetic and environmental influences on psychosocial outcomes. A critical assumption of twin studies is that both monozygotic "identical" twins and dizygotic "fraternal" twins share common social environments. Therefore, any greater similarity of monozygotic than dizygotic twins is attributed to genetic influences. This paper tests the equal environment assumption by examining the extent to which greater concordance of adolescent monozygotic compared to dizygotic twins results from social, as well as genetic, influences. Bivariate comparisons indicate that monozygotic twins show greater similarity than dizygotic twins in socially-based characteristics including physical attractiveness, time spent in each other's company, the overlap in friendship networks, and friends' use of alcohol. Multivariate analyses indicate that measures of the social environment sometimes reduce or eliminate apparent genetic effects. In comparison with genetic indicators, social variables are usually stronger predictors of depression and alcohol use and abuse. These findings suggest that past twin studies could overstate the strength of genetic influences because some similarities in behavior among monozygotic compared to dizygotic twins stem from social influences.     

Treatment of incarcerated, sexually-abused adolescent females: an outcome study

This study examined the psychosocial functioning of 100 adolescent females (ages 12-17) sentenced to secure care in a southeastern state and the impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of subjects who reported a history of sexual abuse. The Multidimensional Adolescent Assessment Scale (MAAS) was used to assess psychosocial functioning. Pre-test scores on the MAAS revealed significantly higher scores on 12 of 16 dimensions of psychosocial functioning and higher rates of serious criminal behavior for youth who subsequently disclosed sexual abuse histories as compared to those without such histories. At post-test, statistically significant improvements in psychosocial functioning were observed on 14 of 16 MAAS subscales for those who received the CBT intervention. Thus, incarcerated female adolescents who reported a history of sexual abuse demonstrated more impairment in their functioning as compared to those without a reported history of sexual abuse and responded positively to gender-specific, CBT-based intervention.     

Money as a Tool for Negotiating Separateness and Connectedness in the Therapeutic Relationship

It is nothing new to suggest that money has meaning. Whether or not one accepts Freud's (1908)linkage of money and feces, within our culture money is frequently seen as a direct pathway to feelings of power, agency, self-directedness, and personal satisfaction. Trachtman (1999) states, Money, psychologically speaking, is our projection onto coins, bills, bank accounts, and other financial instruments of our beliefs, hopes, and fears about how those things will affect who we are, what will happen to us, and how we will be treated by others or by ourselves...(Trachtman, 1999, p. 283). Yet this material is often unavailable for therapeutic exploration or understanding until it explodes into the therapy, often in unmanageable and countertherapeutic ways. This article will look at some of the ways in which money can be utilized to negotiate the ever-changing tensions between self and other, object and subject, intrapyschic and interpersonal, connection and separation that appear in every relationship. In particular, it will explore some ways that money issues within the therapeutic relationship can be turned into significant tools for understanding and working with anxieties about connection and separateness, both within and outside the therapeutic dyad.     

College Students' Money Beliefs and Behaviors: An Asian Perspective

The multidimensionality of money was investigated, using exploratory factor analysis (EFA). The respondents, 290 college students from Korea, Japan, and the United States, were administered a survey, which included socio-demographic questions, and Furnham's (1984) Money Beliefs and Behaviors (MBBS) Scale. Through a series of principal components analyses, a three-factor model with 10 MBBS items was identified. The three factors, Power, Security, and Financial Modesty accounted for 53.6% of the variance. The findings have implications for college students and financial management practitioners.