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.     

Editorial—On the role of the humanities in urban ecology: The case of St. Petersburg

Urban ecology is increasingly interdisciplinary, with biophysical and social scientists joining forces to study how human and built environments and processes interact with non-human nature. Humanistic disciplines that study high culture and intellectual currents also bear upon urban ecology, since cities are not simply aggregates of human and non-human factors but seats of civilization and loci of concentrated creative energy. The Russian city of St. Petersburg, which Dostoevsky called the most abstract and intentional city in the world, offers an example of the way individual acts of intellectual and artistic creation affect the energy balance of a city and its interaction with ecological forces. Such concentrated creative energy may be a key to making cities sustainable, and it should not remain outside the calculus of urban ecology.     

Problem-solving communication in foster families and birthfamilies

This study assessed child behavior problems and parent-child communication behaviors during problem solving in three groups of families with adolescent children: foster families, birthfamilies with a child at risk for behavior problems, and birthfamilies with a child not at risk. Levels of positive and negative communication behaviors in the foster families were similar to those in the lower-risk families and were significantly related to foster child behavior problems.     

Events and experiences impacting the development of clinical self confidence: a study of the first year of client contact

Research was conducted to identify the events and experiences influencing the development of clinical self-confidence during the first year of client contact for beginning marriage and family therapists. Thirty-nine recent graduates of a master's degree training program participated in a semistructured interview in which they were asked to describe the influences on their clinical self-confidence. Through qualitative analysis, four event and experience categories emerged as exerting the most influence on confidence at this stage of professional development: supervision, contact with clients, contact with peers, and personal life stress. The authors recommend providing strength-focused supervision, acknowledging the effects of client contact, encouraging peer contact, and attending to personal life stress.     

The effects of a continuous passive motion device on myoelectric activity of the erector spinae during prolonged sitting at a computer workstation

Continuous passive motion (CPM) has been proposed as a method to help individuals with low back pain cope with prolonged sitting. The purpose of this study was to investigate the effects that a commercially available CPM device had on lumbar and thoracic erector spinae (ES) muscle activation (using surface electromyography, "EMG"), and on subjective discomfort during prolonged seated computer work with and without the use of the CPM device. There were no significant differences in average ES muscle activation levels, amplitude probability distribution functions, and EMG gaps number and length when sitting with the CPM device was compared to sitting normally. Subjective ratings of discomfort were also not significantly different between the two sitting conditions. The results indicated that there were no clear mechanisms by which the CPM device may reduce ES muscle pain and fatigue for the tasks and pain-free individuals studied.     

Clinical trials integrity: a CRO perspective

When contract research organizations (CROs) were first formed, pharmaceutical companies outsourced to them only certain aspects of the conduct of their clinical trials. At first CROs were highly specialized entities, providing, for example, either biostatistical advice, clinical research associates who monitored investigational sites for regulatory compliance, or regulatory support. Gradually, full service CROs emerged, offering a full range of services for clinical trials, including the selection of investigators and investigational sites, assistance with patient recruitment, safety surveillance and reporting, site audits, and data management and biostatistics. This evolving relationship between CROs and the pharmaceutical and medical device industries has resulted in CROs assuming more and more of the regulatory and ethical risks and responsibilities inherent in the conduct of clinical trials. In this full service role, CROs, unlike sponsors, are not interested in the outcome of study, but like sponsors, are subject to heavy regulation by the federal government, must follow applicable state laws, must respect international guidelines, and are obliged to follow their own operating procedures. Moreover, they are judged by the industry on the basis of the scope and quality of services provided, including the degree of adherence to the research protocol, regulatory requirements, and timelines; the quality of the professional working relationships with investigators and institutions, both academic and community-based; and the validity of the data. Further, CROs are subject to comprehensive audits by sponsoring companies, FDA, and other regulatory authorities. For all these reasons, CROs are being tasked with strict vigilance of all stages of the clinical trial process to ensure that the laws, regulations, and industry standards designed for the protection of human subjects and data integrity are maintained.     

Individual and crossover effects of stress on adjustment in medical student marriages

High-stress individuals may benefit from social support, although their support providers may be adversely affected via stress crossover effects. Individual and crossover effects of perceived stress within medical student marriages (n = 30) were investigated. Perceived spousal support was positively associated with individuals' own marital and emotional adjustment, attenuating stress effects. With regard to crossover effects, medical students' perceived stress was significantly associated with their spouses' emotional adjustment. Further, medical students' own emotional adjustment fully mediated this crossover effect. Results suggest that the contagion of negative affect may serve as a key mechanism through which stress crossover effects operate in marriage.     

The Right to Take Risks: Alcohol and Older People

This paper examines policy and practice regarding the purchase of alcohol for older clients of home carers in three local authorities in the Greater London area. Data were gathered from interviews with home carers and their managers, focus group discussions, and a postal survey. None of the local authorities had a written policy or written guidance on alcohol purchase or on appropriate responses to the identification of problematic drinking in older clients. The findings illustrate the problem of balancing "rights" and "risks" within a philosophy of community care which emphasizes client choice and autonomy, and show how policy and practice are "tailored" by local contexts. It is suggested that both home carers and other domiciliary workers, as well as their older clients, could benefit from a clear code of practice regarding responses to alcohol consumption and problematic drinking by older people.