Vaginal douching among university women in the southeastern United States

OBJECTIVE: The authors assessed the knowledge, beliefs about, and practices of vaginal douching among women attending 2 universities in the southeastern United States. PARTICIPANTS: There were 416 participants in this study; 46.9% were black and 44.5% were white. METHODS: The authors administered a 30-item questionnaire to women enrolled in health-related and social science courses at 2 southeastern universities. RESULTS: Approximately 38% of participants reported vaginal douching, mostly for hygienic reasons (70.7%). Most women first learned about douching from their mother. Douching was more common and more frequent among black women (48%) than among white women (27%). Age of first douche correlated positively with age of first sexual intercourse and age of first period. CONCLUSION: Women who had been informed not to douche by a healthcare professional were less likely to have douched within the past 6 months than were women who were not given this information. Misconceptions about douching are common and should be addressed by healthcare professionals.     

Using Subsidies to Promote the Adoption of Children from Foster Care

Since 1978 the federal government has implemented a variety of programs to promote the adoption of children from foster care. A key part of these programs has been the use of subsidies to lower the cost of adopting and parenting children who have been in foster care. Although subsidies are a key part of federal policy, there has been little empirical research on the effect of subsidies on adoption rates. This paper uses data from the Adoption and Foster Care Analysis and Reporting System to estimate the impact of subsidy rates on adoption rates. Subsidies to families have a positive and statistically significant effect on adoption rates.

Using Standardized Clients to Train Social Workers in Intimate Partner Violence Assessment

Evidence-based assessment in intimate partner violence (IPV) is critical to the accurate understanding of risk and to the development of interventions that increase safety. In this study standardized clients (actors) were used to train Army civilian social workers in evidence-based assessment of IPV and in the evaluation of the curriculum's effectiveness. Participation in this training curriculum increased the following: the participants' knowledge about the empirical basis for content areas explored in IPV assessment, their exploration of content critical to an IPV assessment interview, and their interviewing process skills. The results support the effectiveness of using standardized clients in IPV assessment training and evaluation.     

Heterogeneous Symptom Patterns of Sexually Abused Children in Treatment: Understanding the Complexity of the Problem

A major challenge for clinicians and researchers is the heterogeneity of the severity and type of symptoms presented by sexually abused youth, including those who are subclinical on traditional clinical measures but still present to treatment. Most research continues to treat sexually abused youth as a single population and has not assessed the outcomes or symptom trajectories of various groups of sexually abused youth. Participants included 107 sexually abused children and their nonoffending parents presenting to a cognitive-behavioral group treatment. A cluster analysis using child- and parent-report measures revealed four profiles, including Subclinical, Highly Distressed, Problem Behaviors, and Self-Reported Distress clusters. Hierarchical linear modeling was used to create separate child- and parent-report models of weekly symptomatology to examine differential change over the course of treatment. Contrary to expectation, there was little variation in the weekly rates of change for the different symptom groups; however, all groups evidenced a decrease in symptoms over the course of treatment, including the Subclinical cluster.     

Medical Specialty Referrals from a Student Health Service

Abstract

During a 10-week period, 51 referrals resulted from 3171 visits to the Student Health Service, a referral rate of 1.6%. Specialties receiving the most frequent referrals were orthopedics (31%), ophthalmology (16%), general surgery (10%), and gynecology (10%). Data from this study suggest that specialty referrals occur infrequently in the Student Health Service. It would appear that this low referral rate, along with a relatively small student population, would not justify provision of in-house specialty consultation in the Student Health Service.

“The Prognosis of Inflammatory Bowel Disease,” DAVID J. SALES AND JOSEPH B. KIRSNER. The complications of ulcerative colitis generally develop during the first two years of disease. The mortality is higher than expected and the highest likelihood of colectomy also occurs early in the disease. Mortality in Crohn's disease is greater than expected, especially in males. For both conditions, the overall mortality has decreased steadily, and currently is less than 5%. Ulcerative colitis is curable with proctocolectomy and lieostomy. In Crohn's disease, intestinal resection and reanastomosis is followed by recurrence in the majority of patients. The recurrence rate after proctocolectomy and lieostomy for Crohn's disease of the colon also is considerable, ranging from 20% to 35%. In ulcerative colitis, the more colon involved, the more frequent and more serious are the complications. In Crohn's disease, the anatomic pattern of disease tends to predict the type and extent of complications. Both ulcerative colitis and Crohn's disease appear to follow a more severe course in children and adolescents with “inflammatory bowel disease.” Patients with either ulcerative colitis or Crohn's disease are at increased risk for the later development of cancer. In ulcerative colitis, the excess risk is limited to colorectal cancer. Patients with Crohn's disease have increased cancer rates for both the small and large bowel. Finally, most patients with these diseases are able to maintain normal occupations and enjoy reasonably stable social and economic situations. The successful adaptation of patients with inflammatory bowel disease is influenced by a hopeful, optimistic personality and by an encouraging, supportive physician.     

Sparse Models and Methods for Optimal Instruments With an Application to Eminent Domain

We develop results for the use of Lasso and post‐Lasso methods to form first‐stage predictions and estimate optimal instruments in linear instrumental variables (IV) models with many instruments, p. Our results apply even when p is much larger than the sample size, n. We show that the IV estimator based on using Lasso or post‐Lasso in the first stage is root‐n consistent and asymptotically normal when the first stage is approximately sparse, that is, when the conditional expectation of the endogenous variables given the instruments can be well‐approximated by a relatively small set of variables whose identities may be unknown. We also show that the estimator is semiparametrically efficient when the structural error is homoscedastic. Notably, our results allow for imperfect model selection, and do not rely upon the unrealistic “beta‐min” conditions that are widely used to establish validity of inference following model selection (see also Belloni, Chernozhukov, and Hansen (2011b)). In simulation experiments, the Lasso‐based IV estimator with a data‐driven penalty performs well compared to recently advocated many‐instrument robust procedures. In an empirical example dealing with the effect of judicial eminent domain decisions on economic outcomes, the Lasso‐based IV estimator outperforms an intuitive benchmark. Optimal instruments are conditional expectations. In developing the IV results, we establish a series of new results for Lasso and post‐Lasso estimators of nonparametric conditional expectation functions which are of independent theoretical and practical interest. We construct a modification of Lasso designed to deal with non‐Gaussian, heteroscedastic disturbances that uses a data‐weighted ℓ₁‐penalty function. By innovatively using moderate deviation theory for self‐normalized sums, we provide convergence rates for the resulting Lasso and post‐Lasso estimators that are as sharp as the corresponding rates in the homoscedastic Gaussian case under the condition that logp = o(n^1/3). We also provide a data‐driven method for choosing the penalty level that must be specified in obtaining Lasso and post‐Lasso estimates and establish its asymptotic validity under non‐Gaussian, heteroscedastic disturbances.     

The forecasting performance of mortality models

Mortality projections are of special interest in many applications. For example, they are essential in life insurances to determine the annual contributions of their members as well as for population predictions. Due to their importance, there exists a huge variety of mortality forecasting models from which to seek the best approach. In the demographic literature, statements about the quality of the various models are mostly based on empirical ex-post examinations of mortality data for very few populations. On the basis of such a small number of observations, it is impossible to precisely estimate statistical forecasting measures. We use Monte Carlo (MC) methods here to generate time trajectories of mortality tables, which form a more comprehensive basis for estimating the root-mean-square error (RMSE) of different mortality forecasts.     

Long‐Term Risk: An Operator Approach

We create an analytical structure that reveals the long‐run risk‐return relationship for nonlinear continuous‐time Markov environments. We do so by studying an eigenvalue problem associated with a positive eigenfunction for a conveniently chosen family of valuation operators. The members of this family are indexed by the elapsed time between payoff and valuation dates, and they are necessarily related via a mathematical structure called a semigroup. We represent the semigroup using a positive process with three components: an exponential term constructed from the eigenvalue, a martingale, and a transient eigenfunction term. The eigenvalue encodes the risk adjustment, the martingale alters the probability measure to capture long‐run approximation, and the eigenfunction gives the long‐run dependence on the Markov state. We discuss sufficient conditions for the existence and uniqueness of the relevant eigenvalue and eigenfunction. By showing how changes in the stochastic growth components of cash flows induce changes in the corresponding eigenvalues and eigenfunctions, we reveal a long‐run risk‐return trade‐off.     

Coexisting principles and logics of elder care: Help to self‐help and consumer‐oriented service?

Healthy and active ageing has become an ideal in Western societies. In the Nordic countries, this ideal has been supported through a policy of help to self‐help in elder care since the 1980s. However, reforms inspired by New Public Management (NPM) have introduced a new policy principle of consumer‐oriented service that stresses the wishes and priorities of older people. We have studied how these two principles are applied by care workers in Denmark. Is one principle or logic replacing the other, or do they coexist? Do they create tensions between professional knowledge and the autonomy of older people? Using neo‐institutional theory and feminist care theory, we analysed the articulation of the two policy principles in interviews and their logics in observations in four local authorities. We conclude that help to self‐help is the dominant principle, that it is deeply entrenched in the identity of the professional care worker and that it coexists with consumer‐oriented service and without major tensions in the logics identified in their practices.