Cross-validation of the screening scale in an adult protective services sample

Adult Protective Services (APS) professionals are often called on to assess decision-making capacity when investigating financial exploitation. Previous research found that in consecutive APS cases, a decision-making screening scale (LFDSS) also detected financial exploitation. The purpose of this study was to apply the clinical cutoff scores derived from the previous study to a new sample of APS cases. Using a sample of 105 participants, from APS workers across 5 counties this study investigated the clinical utility of the LFDSS to detect financial exploitation based on ratings by APS professionals using the scale. Results demonstrate that the LFDSS has excellent internal consistency and clinical utility properties. This paper provides support for use of the LFDSS as a reliable and valid instrument. Instructions for use of the LFDSS are included in the article, along with information about online support tools.     

Conceptualizing and Measuring Financial Resilience: A Multidimensional Framework

Financial inclusion has become a policy priority. For many countries, this has meant focusing on the delivery and practical aspects of financial products and services. This paper argues that this approach is not sufficient to improve financial wellbeing more broadly. It suggests a more comprehensive approach moving away from asking whether people are excluded or not to asking whether they have access to accessible, acceptable and appropriate resources and supports in adverse financial circumstances. A better understanding of individuals’ financial resilience: how they bounce back from adverse financial events and the resources and supports they draw on; could help determine where resources can and should be invested to assist people to cope with financial adversity, assist the development of effective policy and, ultimately, improve financial wellbeing. This paper puts forward a definition of financial resilience and a methodology for measuring it. Australia is used as a case country from which to draw conclusions using a survey of 1496 representative adults (18+). The findings indicate that over 2 million Australian adults experienced severe or high levels of financial vulnerability raising very real concerns about financial wellbeing. Implications for academics and policy makers are presented.

     

Families,meals and synchronicity: eating together in British dual earner families

Based on a sample of British dual earner families with young children drawn from the National Diet and Nutrition Survey, the paper examines their food practices, in particular the conditions under which families are able to eat together or not during the working week. The concept of synchronicity is drawn upon to shed light on whether meals and meal times are coordinated in family life and the facilitators and constraints upon coordination. The paper suggests that whether families eat together is not only influenced by parents' work time schedules but also children's timetables relating to their age and bodily tempos, their childcare regimes, their extra-curricular activities and the problem of coordinating different food preferences and tastes.     

Effects of unmeasured heterogeneity in the linear transformation model for censored data

We investigate the effect of unobserved heterogeneity in the context of the linear transformation model for censored survival data in the clinical trials setting. The unobserved heterogeneity is represented by a frailty term, with unknown distribution, in the linear transformation model. The bias of the estimate under the assumption of no unobserved heterogeneity when it truly is present is obtained. We also derive the asymptotic relative efficiency of the estimate of treatment effect under the incorrect assumption of no unobserved heterogeneity. Additionally we investigate the loss of power for clinical trials that are designed assuming the model without frailty when, in fact, the model with frailty is true. Numerical studies under a proportional odds model show that the loss of efficiency and the loss of power can be substantial when the heterogeneity, as embodied by a frailty, is ignored. An erratum to this article can be found at     

A computationally simple bivariate survival estimator for efficacy and safety

Both treatment efficacy and safety are typically the primary endpoints in Phase II, and even in some Phase III, clinical trials. Efficacy is frequently measured by time to response, death, or some other milestone event and thus is a continuous, possibly censored, outcome. Safety, however, is frequently measured on a discrete scale; in Eastern Cooperative Oncology Group clinical trial E2290, it was measured as the number of weekly rounds of chemotherapy that were tolerable to colorectal cancer patients. For the joint analysis of efficacy and safety, we propose a non-parametric, computationally simple estimator for the bivariate survival function when one time-to-event is continuous, one is discrete, and both are subject to right-censoring. The bivariate censoring times may depend on each other, but they are assumed to be independent of both event times. We derive a closed-form covariance estimator for the survivor function which allows for inference to be based on any of several possible statistics of interest. In addition, we derive its covariance with respect to calendar time of analysis, allowing for its use in sequential studies.     

Family Therapy for Kids Without Families: Working Systemically With Children and Young People in Residential Care

A significant proportion (4%, Australian Institute of Health and Welfare, 2008) of children and young people in Australia live in some form of residential care, usually in small group‐homes staffed by residential care workers in shifts. However, as Hawkins‐Rodgers (2007) points out, these placements are often not resourced to heal the effects of trauma and multiple attachment disruptions in their residents. The lack of an archetypal ‘family’ has led in the past to family therapists considering that there is little work to be done with such clients. This leaves such placements to be supported most frequently by clinicians who specialise in behaviour management and other linearly founded models of practice. The Alternate Care Clinic (ACC) is the first mental health service in New South Wales dedicated entirely to children and young people in out of home care with a high level of complex needs. This article examines the systemic therapeutic model the clinic has developed in the last two years. In particular, the article seeks to explore the importance of ‘meaning making’ in a diffuse parental system, particularly with regards to the term ‘family’. The complexities of working in this area and possible ways forward are illustrated with a closely worked case study.     

Low‐Income Mothers’ Private Safety Nets and Children’s Socioemotional Well‐Being

Using longitudinal data from the Fragile Families and Child Well‐being Study (N = 1,162) and the National Evaluation of Welfare‐to‐Work Strategies (N = 1,308), we estimate associations between material and instrumental support available to low‐income mothers and young children’s socioemotional well‐being. In multivariate OLS models, we find mothers’ available support is negatively associated with children’s behavior problems and positively associated with prosocial behavior in both data sets; associations between available support and children’s internalizing and prosocial behaviors attenuate but remain robust in residualized change models. Overall, results support the hypothesis that the availability of a private safety net is positively associated with children’s socioemotional adjustment.     

Impact of metabolic status on the association of serum vitamin D with hypogonadism and lower urinary tract symptoms/benign prostatic hyperplasia

Objective: The objective of this study is to investigate the impact of metabolic status on associations of serum vitamin D with hypogonadism and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).

Patients and methods: A total of 612 men underwent physical examination, biochemical/hormonal blood testing, and transrectal prostate ultrasound. Moreover, the subjects filled out standard questionnaires for identification and grading of LUTS and hypogonadism symptoms. Parameters were statistically compared with independent t-tests and correlation analyses.

Results: Vitamin D levels positively correlated with total testosterone (TT) but not with prostate volume or International Prostate Symptom Score (IPSS). Patients with metabolic syndrome had significantly lower vitamin D levels, which were not correlated with TT, prostate volume, or IPSS. However, vitamin D was positively correlated with TT, and negatively correlated with prostate volume and quality-of-life IPSS in subjects without metabolic syndrome.

Conclusion: The clinical usefulness of vitamin D for treatment of hypogonadism or LUTS/BPH varies according to metabolic status.