A Reply to Gambino's "An Epidemiologic Note on Verification Bias: Implications for Estimation of Rates"

While two-stage designs in problem gambling research are expensive and relatively difficult to execute, they have the potential to yield more accurate prevalence estimates as well as valuable additional information about gambling and problem gambling in the community. However, gains in precision are heavily dependent on the accuracy of the screening methods used and the sample sizes involved. Sound practice requires reliable information about the variances and confidence levels associated with different screens. In the spirit of contributing to the ongoing dialog about ways to improve the measurement of problem gambling, we examine several reasons to question whether the revised estimates offered by Gambino are in fact an improvement.     

A methodological strategy for a one-number census in the UK

As a result of lessons learnt from the 1991 census, a research programme was set up to seek improvements in census methodology. Underenumeration has been placed top of the agenda in this programme, and every effort is being made to achieve as high a coverage as possible in the 2001 census. In recognition, however, that 100% coverage will never be achieved, the one-number census (ONC) project was established to measure the degree of underenumeration in the 2001 census and, if possible, to adjust fully the outputs from the census for that undercount. A key component of this adjustment process is a census coverage survey (CCS). This paper presents an overview of the ONC project, focusing on the design and analysis methodology for the CCS. It also presents results that allow the reader to evaluate the robustness of this methodology.     

How useful is the term "Cumulative Trauma Disorder"?

Cumulative trauma disorder is a widely accepted construct that refers to illnesses of the soft tissues which supposedly occur due to biomechanical workplace risk factors. However, is the term "cumulative trauma disorder" a useful term for describing the illness attributed to it? This paper will scrutinize this question by specifying the meaning of "cumulative trauma disorder" and examining this construct to see if the belief in it is justified, and if this belief is leading to the elucidation of the phenomenon it is purporting to notate. Anomalous findings will be identified and used to help evaluate the accuracy of the belief system currently surrounding the term. Finally the ability of the construct "cumulative trauma disorder" to provide an adequate foundation for research in this area will be explored. A model of alternate pathomechanisms for this illness is advanced to provide a method of studying the disorders associated with the term.     

Interface: reflections of an ethnic toygirl

This essay interrogates the colonial modernity of Anglo-Australian lesbian hegemony through an experimental text which plays with the aesthetics of cyberspace. Mobilizing the hypertext mark up language (HTML) form of the Internet, it spatializes the creative, the erotic, and the political that landscape the vicissitudes of everyday life for a lesbian of Southeast Asian background living in Australia. "interface" performs as a tryst that drives the queer body politic through the postcolonial in-formations of color, race, gender and identity. This text bears indelible marks from multiple sites and sources: the charges of electronic conversations and etchings on the World Wide Web; the raw pulp of inner-urban graffiti scrawls; passionate voicemails; racist policies in queer venues; fury banner posts; luscious lesbian cinema screenings; sexy fantasy malls; and fleshy style shopping.     

Gender and income in pharmacy: human capital and gender stratification theories revisited

This is a case study of gender and earnings in pharmacy--a profession characterized by its rapid recruitment of female practitioners. We try to account for disparities in earnings between male and female pharmacists in Ontario with the aid of human capital theory and gender stratification theory. Data is drawn from a random sample of 463 Ontario pharmacists. We find a consistent sex gap in earnings regardless of occupational level of practitioners (i.e. owner, manager or employee) and net of such factors as hours worked, commitment to work, hours devoted to childcare, absences from the labour market, and years since graduation. Instead, the main reason why women in pharmacy earn less than males is because they remain employees throughout their careers. However, we are less successful at identifying the additional factors responsible for the depressed earnings of female practitioners. We discuss our findings in light of the claims of gender stratification and human capital theory.     

Exposure of medical students to body fluids

Three hundred forty-two students at 3 Florida medical schools were surveyed concerning occupational exposures to blood and body fluids during their 3rd-year clerkship. The 16-item questionnaire was anonymously returned by 150 students, and differences among groups were assessed at p < .05. Most of the students complied with universal precautions guidelines (UVPG); 62 reported 101 exposures, including 9 with HIV-positive blood and body fluids. Most of the exposed students knew about the guidelines but regarded the incidents as irrelevant to their safety or supervision training. Noncompliant students reported significantly more exposures than compliant students. Time constraints, inconvenience of using gloves during procedures, and belief that patients were at low HIV risk discouraged adherence to the guidelines. Common practices following exposure were "no action" or "washed area only" without medical follow-up. Medical students' UVPG adherence should be increased by workload modification, user-friendly safety products, and supervised practice training in clinical exposure settings.     

Setting up a CLIA-certified laboratory in a student health services clinic

Performing some laboratory tests on site at a student health service clinic may increase efficiency and cut costs for patients. However, with the passage of the Clinical Laboratory Improvement Amendments (CLIA) of 1988, many laboratories in physician offices and clinics have shut down because of increased regulatory requirements. The personnel in one SHS laboratory found that the guidelines proposed by CLIA help assure quality care and are not prohibitive. In this article, the process of applying for and receiving a CLIA certificate in the student health clinic setting is explored.     

Adolescent Women's Recommendations for Enhanced Parent-Adolescent Communication About Sexual Behavior

Family communication about adolescent sexual health and behavior promotes adolescent health and family connectedness. However, few studies seek the perspective of adolescents regarding their recommended strategies for family communication. Findings of a survey of female adolescent family planning patients (n = 249) indicated adolescent recommendations for better family communication included treat teen as an equal, 63%; increase parental knowledge about lifestyle and peer pressures, 61%, and improve parental listening skills, 61%. There were no statistically significant differences according to age, pregnancy history, or school enrollment status for suggested strategies for improved communication with parents. Sexually active adolescent daughters expressed interest in maintaining family connectedness and support with increased time for family activities as well as increased quality and quantity of dialogue between the adolescent girl and her parents.     

Improving performance in a contracted physician network

Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors.