Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

Measuring Loneliness Among Middle-Aged and Older Adults: The UCLA and de Jong Gierveld Loneliness Scales

This study examined the measurement and invariance properties of the R-UCLA and de Jong Gierveld loneliness scales for research involving middle-aged and older adults. Confirmatory factor analyses (CFAs) of data from interviews with adults aged 45–84 revealed limited support for the unidimensionality of either scale while subsequent analyses indicated the multidimensionality of both. However, method effects associated with positive and negative item wording were also evident. Multiple group CFAs provided limited support for assumptions of measurement invariance across age groups and from baseline to follow-up with regard to the R-UCLA scale. In contrast, strong measurement invariance across age groups and successive measurements was established for the bi-dimensional dJG scale. Overall, the findings supported the relative utility of the dJG scale for research involving middle-aged and older adults but suggested a need for attention to the implications of method effects associated with item wording and lack of measurement invariance with respect to item residuals.     

A Deprivation Analysis for Andalusia (Spain): An Approach Based on Structural Equations

The study of deprivation, as a social indicator, is basic in the design and development of public policies because it allows decision makers to identify and analyse needy areas in order to improve their citizens’ well-being. The methodological approach proposed for the development of a new deprivation index is based on the Causal Theory whose conceptual model is analysed using Structural Equations. The domains selected for the deprivation index are: education, employment, income, housing, infrastructures and health. A structural equation model based on variance is the exploratory method used to obtain the indices pertaining to the above mentioned areas; the results obtained are seen to be quite reliable. There is a positive connection between the areas of education, employment and income while the relations between infrastructures and health are found to be negative. The results can be projected at a local level and show basic territorial deficiencies. The spatial units studied are the Andalusian (south of Spain) municipalities (770). The spatial projection of the indices obtained for the domains of deprivation highlights the existence of geographical areas which could be a potential target for public action.     

Bayesian Treatment of Model Uncertainty for Partially Applicable Models

This article discusses how analyst's or expert's beliefs on the credibility and quality of models can be assessed and incorporated into the uncertainty assessment of an unknown of interest. The proposed methodology is a specialization of the Bayesian framework for the assessment of model uncertainty presented in an earlier paper. This formalism treats models as sources of information in assessing the uncertainty of an unknown, and it allows the use of predictions from multiple models as well as experimental validation data about the models’ performances. In this article, the methodology is extended to incorporate additional types of information about the model, namely, subjective information in terms of credibility of the model and its applicability when it is used outside its intended domain of application. An example in the context of fire risk modeling is also provided.     

Observed and parent‐reported conscience in childhood: Relations with bullying involvement in early primary school

This exploratory study aimed to examine which components of early childhood conscience predicted bullying involvement around school entry. In the population‐based Generation R Study, teacher reports of bullying involvement and parent reports of conscience were available for 3,244 children (M age = 6.7 years). Higher levels of overall conscience predicted lower bullying perpetration scores, independently of intelligence quotient, temperamental traits and sociodemographic characteristics. Particularly, the subscales guilt, confession, and internalized conduct, and to a lesser extent empathy, predicted bullying perpetration. Conscience was not related to victimization. Similar results were found using observations during so‐called ‘cheating games’ (subsample N = 450 children). Findings suggest that improving children's understanding of moral standards and norms may be a potential target for bullying intervention programs in early primary school.     

Social network effects on academic achievement

How peer groups contribute to educational outcomes has long interested researchers. However, the possibility that peer groups dominated by either low- or high-achieving youth can have substantively different effects on achievement has been largely ignored. In this paper, we show that while being embedded in a high-achieving network of friends is not associated with increased own achievement, being embedded in a low-achieving network is associated with decreased own achievement. In additional analyses, we present evidence that these associations are at least in part due to influence, as opposed to only selection effects or shared environment. We also examine whether the structure of the network in which a student is embedded might affect their educational achievement. We show that achieving at higher levels positively predicts how centrally located a student is in their network, but being more centrally located does not predict concurrent achievement. This finding suggests that the behavior of individuals is affecting the formation of network structure and not the reverse.