Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

Forum: social network for the surveillance and prevention of workplace accidents

In 2008, academic researchers and public service officials created a university extension studies platform based on online and on-site meetings denominated "Work-Related Accidents Forum: Analysis, Prevention, and Other Relevant Aspects. Its aim was to help public agents and social partners to propagate a systemic approach that would be helpful in the surveillance and prevention of work-related accidents. This article describes and analyses such a platform. Online access is free and structured to: support dissemination of updated concepts; support on-site meetings and capacity to build educational activities; and keep a permanent space for debate among the registered participants. The desired result is the propagation of a social-technical-systemic view of work-related accidents that replaces the current traditional view that emphasizes human error and results in blaming the victims. The Forum uses an educational approach known as permanent health education, which is based on the experience and needs of workers and encourages debate among participants. The forum adopts a problematizing pedagogy that starts from the requirements and experiences of the social actors and stimulates support and discussions among them in line with an ongoing health educational approach. The current challenge is to turn the platform into a social networking website in order to broaden its links with society.     

Accidents related to the use of products and services in the city of São Luis, Brazil

This article presents a study on the accidents related to the use of products and services, as recorded at two emergency hospitals at the city S?o Luís, Brazil. The goal of the study was to evaluate the main types and causes of unintentional accidents as well as the more frequent injuries for further improvement of products and services. The study evaluated the victims profile (gender and age), the circumstances (activity, local and time) that lead to the accidents and the type of resulted injury. Non-parametric statistics showed that 83.64% of the accidents were related to products (57.6% of them being consumer products) and 8.6% are related to maintenance services. 57.6% of the victims were children under 15 years old, and 58.4% were male. 50.2% of accidents occurred at home, more often (44.7%) in the afternoon. The most common injury was musculoesqueletal (48.6%), 49.0% being cranioencephalic trauma and 15.2% fractures.     

Aggregated functional data model for near-infrared spectroscopy calibration and prediction

Calibration and prediction for NIR spectroscopy data are performed based on a functional interpretation of the Beer–Lambert formula. Considering that, for each chemical sample, the resulting spectrum is a continuous curve obtained as the summation of overlapped absorption spectra from each analyte plus a Gaussian error, we assume that each individual spectrum can be expanded as a linear combination of B-splines basis. Calibration is then performed using two procedures for estimating the individual analytes’ curves: basis smoothing and smoothing splines. Prediction is done by minimizing the square error of prediction. To assess the variance of the predicted values, we use a leave-one-out jackknife technique. Departures from the standard error models are discussed through a simulation study, in particular, how correlated errors impact on the calibration step and consequently on the analytes’ concentration prediction. Finally, the performance of our methodology is demonstrated through the analysis of two publicly available datasets.     

An empirical comparison of EM,SEM and MCMC performance for problematic Gaussian mixture likelihoods

We compare EM, SEM, and MCMC algorithms to estimate the parameters of the Gaussian mixture model. We focus on problems in estimation arising from the likelihood function having a sharp ridge or saddle points. We use both synthetic and empirical data with those features. The comparison includes Bayesian approaches with different prior specifications and various procedures to deal with label switching. Although the solutions provided by these stochastic algorithms are more often degenerate, we conclude that SEM and MCMC may display faster convergence and improve the ability to locate the global maximum of the likelihood function.     

“She foreswore her womanhood”: Psychoanalytic views of female homosexuality

Just as in early psychoanalytic views of female sexual development women's sexual anatomy, psychic development, and object relations were seen relative to male norms and found wanting, in much of psychoanalytic thinking the sexual and psychic development of women in lesbian relationships are seen relative to heterosexual women and found lacking. Various etiological explanations of female homosexuality attempt to isolate a particular developmental arrest or disorder characteristic of female homosexual relations. This paper reviews the major psychoanalytic formulations of female homosexuality and discusses them in terms of two phallocentric assumptions: 1.) A woman who loves a woman must be a man, or be like a man, or must want to be a man; and 2.) A relationship between two women must always remain incomplete compared to the complementarity assumed in a heterosexual relationship. Increased understanding of the sexual desires and experience of women in lesbian relationships would contribute to expanded perspectives about female sexuality and development. The paper offers two paradigms for thinking about homosexual object choice which are not based on analogies to pathological conditions.If you don't know the kind of person I am and I don't know the kind of person you are a pattern that others made may prevail in the world and following the wrong god home we may miss our star. from A Ritual to Read to Each Other, William Stafford