Gender Mainstreaming in Theory and Practice

This article utilizes the findings of a recently completed,eight-country research project to visit some key issues in thetheory and practice of gender mainstreaming. The research resultsindicate that gender mainstreaming is a diverse entity whenlooked at from a cross-national perspective but rather hollowwhen considered within the national setting. To the extent thatthere is a "common core" to gender mainstreaming in action acrosscountries, it lies in the tendency to apply the approach ina technocratic way and to be nonsystemic in compass. The argumentis advanced that this is at least in part attributable to particularitiesin the development of mainstreaming. The article suggests thatgender mainstreaming is underdeveloped as a concept and identifiesa need to elaborate further on some fundaments. In particular,the conceptualization of mainstreaming needs to be rethoughtwith special attention devoted to the understanding of the problematicof gender inequality that underlies it and the articulationof the relationship between gender mainstreaming and societalchange.     

Propensity score prediction for electronic healthcare databases using super learner and high-dimensional propensity score methods

ABSTRACT

The optimal learner for prediction modeling varies depending on the underlying data-generating distribution. Super Learner (SL) is a generic ensemble learning algorithm that uses cross-validation to select among a ‘library’ of candidate prediction models. While SL has been widely studied in a number of settings, it has not been thoroughly evaluated in large electronic healthcare databases that are common in pharmacoepidemiology and comparative effectiveness research. In this study, we applied and evaluated the performance of SL in its ability to predict the propensity score (PS), the conditional probability of treatment assignment given baseline covariates, using three electronic healthcare databases. We considered a library of algorithms that consisted of both nonparametric and parametric models. We also proposed a novel strategy for prediction modeling that combines SL with the high-dimensional propensity score (hdPS) variable selection algorithm. Predictive performance was assessed using three metrics: the negative log-likelihood, area under the curve (AUC), and time complexity. Results showed that the best individual algorithm, in terms of predictive performance, varied across datasets. The SL was able to adapt to the given dataset and optimize predictive performance relative to any individual learner. Combining the SL with the hdPS was the most consistent prediction method and may be promising for PS estimation and prediction modeling in electronic healthcare databases.     

The Effect of Chair Yoga on Biopsychosocial Changes in English- and Spanish-Speaking Community-Dwelling Older Adults with Lower-Extremity Osteoarthritis

Chair yoga (CY), a mind-body therapy, is a safe nonpharmacological approach for managing osteoarthritis (OA) in older adults who cannot participate in standing exercise. However, there is no linguistically tailored CY program for those with limited English proficiency (LEP). This 2-arm randomized controlled trial compared the effects of a linguistically tailored yoga program (English and Spanish versions) on the outcomes of pain, physical function, and psychosocial factors compared to the effects of a linguistically tailored Health Education Program (HEP; English and Spanish versions). Participants with lower-extremity OA, recruited from 2 community sites, completed the Spanish (n = 40) or English (n = 60) version of twice-weekly 45-min CY or HEP sessions for 8 weeks. Data were collected at baseline, 4 weeks, 8 weeks, and 1- and 3-month follow-ups. English and Spanish CY groups (but neither HEP language group) showed significant decreases in pain interference. Measures of OA symptoms, balance, depression, and social activities were not significantly different between English and Spanish versions of CY and English and Spanish versions of HEP. It was concluded that the Spanish and English versions of CY and HEP were equivalent. Linguistically tailored CY could be implemented in aging-serving communities for persons with LEP.     

Parenting interventions in shelter settings: a qualitative systematic review of the literature

The aim of this literature review was to critique the state of the research on the effects of implementing parenting programmes in shelters for homeless families. A comprehensive search of multiple databases yielded 12 studies for inclusion. The methodological sophistication of the studies varied, with most investigations based on very small samples and one‐group pre‐post designs. Results indicated that parents generally viewed the interventions as enjoyable and informative, and attendance was good. Incentives were often used to encourage attendance. Evidence was limited in terms of effectiveness of the interventions, but the few studies of evidence‐based parenting programmes showed changes in parenting and child functioning. Suggestions are provided for future investigations in this important yet challenging field of study.     

A case study in identifying targeted patients population in major depressive disorder by enhanced enrichment design

Despite advances in clinical trial design, failure rates near 80% in phase 2 and 50% in phase 3 have recently been reported. The challenges to successful drug development are particularly acute in central nervous system trials such as for pain, schizophrenia, mania, and depression because high‐placebo response rates lessen assay sensitivity, diminish estimated treatment effect sizes, and thereby decrease statistical power. This paper addresses the importance of rigorous patient selection in major depressive disorder trials through an enhanced enrichment paradigm. This approach led to a redefinition of an ongoing, blinded phase 3 trial algorithm for patient inclusion (1) to eliminate further randomization of transient placebo responders and (2) to exclude previously randomized transient responders from the primary analysis of the double blind phase of the trial. It is illustrated for a case study for the comparison between brexpiprazole + antidepressant therapy and placebo + antidepressant therapy. Analysis of the primary endpoint showed that efficacy of brexpiprazole versus placebo could not be established statistically if the original algorithm for identification of placebo responders was used, but the enhanced enrichment approach did statistically demonstrate efficacy. Additionally, the enhanced enrichment approach identified a target population with a clinically meaningful treatment effect. Through its successful identification of a target population, the innovative enhanced enrichment approach enabled the demonstration of a positive treatment effect in a very challenging area of depression research.