Reporting cumulative proportion of subjects with an adverse event based on data from multiple studies

Experience has shown us that when data are pooled from multiple studies to create an integrated summary, an analysis based on naïvely‐pooled data is vulnerable to the mischief of Simpson's Paradox. Using the proportions of patients with a target adverse event (AE) as an example, we demonstrate the Paradox's effect on both the comparison and the estimation of the proportions. While meta analytic approaches have been recommended and increasingly used for comparing safety data between treatments, reporting proportions of subjects experiencing a target AE based on data from multiple studies has received little attention. In this paper, we suggest two possible approaches to report these cumulative proportions. In addition, we urge that regulatory guidelines on reporting such proportions be established so that risks can be communicated in a scientifically defensible and balanced manner. Copyright © 2010 John Wiley & Sons, Ltd.     

Evidence-based Medicine and Child Mental Health Services

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.     

论中文书目数据库建设中的质量控制

书目数据质量是保证书目数据库整体质量的基础。本文从文献著录标准化、规范化、外来数据源的合理利用、原始编目的著录、加强书目管理以及编目人员应具备的素质等方面,分析了书目数据库建设中的质量控制问题。     

Missing years of abuse in children's homes

This paper reflects upon the historic abuse of young people living in children's homes. Beginning with a recognition of ‘individual abuse’, it explores, first of all, the reasons why young people were abused, including: (1) the status of childhood and being in care; (2) the application of ‘approved’ treatment methods; (3) the failure of managerial, organizational and inspection systems; and (4) the institutional critique and the popularity of preventative policies. Second, by identifying common themes arising from this account, it is suggested we need to rethink the way abuse has been conceptualized. Individual direct abuse, sanctioned abuse, organized systematic abuse and system outcome abuse are discussed. Finally, the paper reviews recent changes in law, policy and practice, including the Children Act 2004, designed to prevent abuses happening again. It is argued that challenges still remain in addressing structural inequalities, improving protection, balancing needs and rights, extending protection to different groups of young people and in having a preventative vision for children's homes.     

To tell or not to tell: lifestyle impacts on whether adolescents tell about violent victimization

Adolescent sexual and physical victimization is an issue of serious social concern in our society. This study examines the predictors of whether juveniles tell about these experiences. We specifically question whether the adolescents' lifestyles inhibit victims from telling anyone about the assault and determine if such predictors vary by sex. Using data from the National Survey of Adolescents, we find that the victims' lifestyles do predict help-seeking but that the importance of these measures varies by the type of victimization and the sex of the adolescent. Lifestyles influence reporting the event more consistently for victims of sexual assaults than physical assaults. In addition, while several lifestyle measures are significant for sexually victimized girls, the context of the event is more important for boys who are sexually victimized. Aspects of the adolescents' lifestyles are not as important for telling about physical victimization.     

Employment transitions for clubhouse members

Using a longitudinal dataset which followed 2195 individuals employed in 3379 separate job placements over a four-year period, this paper explores movement between the employment supports, [Transitional (TE), Supported (SE), and Independent Employment (IE)], offered by clubhouses. Sixty-four percent of employed members held only one job (N=1395) and 36% held multiple jobs during the study (N=791). Patterns of movement were consistent for transitions between the first and second job and subsequent transitions. Forty-six percent of individuals holding multiple jobs moved from one employment type to another. When movement occurred clubhouse members were significantly more likely to move from employment types offering more supports to those that offer less supports.     

Making and Facing Danger: Constructing Strong Character on the River

River guides are those individuals given the extraordinary task of delivering their passengers from the dangers and chaos of white-water rivers. After engaging in what Coffman would call fateful action, river guides emerge with perceived strong character. However, before river guides can achieve such an elevated identity, they must first manage the passengers' view of the rapids as dangerous. In this article, I discuss the various techniques river guides use to construct and enhance danger on the river, how facing such danger is used to demonstrate strong character, and its relevance as a basis for authority in a leisure setting.     

Commentary on the treatment of gender variant and gender dysphoric children and adolescents: common themes and ethical reflections

This commentary offers preliminary ethical reflections on the range of treatments for gender variant and gender dysphoric children, adolescents, and young adults described in the preceding five clinical articles. After clarifying the terminology used to discuss these issues, this commentary reviews several common themes of the clinical articles. Focusing on ethical values of informed consent, full disclosure, the minimization or avoidance of harm, and the maximization of life options, the commentary expresses concerns about various treatment options endorsed by some of the articles. In particular, this commentary focuses on how these practices problematically reproduce social prejudices and stereotypes and how they fail to acknowledge and embrace the multiple pathways for expressing one's gender. It also compares and contrasts the ethical issues related to gender variant and gender dysphoric youths and youths who identify as lesbian, gay, bisexual, or queer.