Use of an Online Community to Provide Support to Caregivers of People With Dementia

One challenge faced by many family members caring for persons with dementia is lack of information about how to take care of others and themselves. This is especially important for persons from ethnic minority groups, because linguistically and culturally appropriate information is often not available. In response to these needs, we developed a web site for Spanish-speaking caregivers. Cuidatecuidador.com provides bilingual information on dementia and caregiver issues. Content was developed and then evaluated by caregivers residing in 3 countries. Findings suggest trends that exposure to information may be related to a higher sense of mastery and a reduction of depressive symptomatology.     

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis

ABSTRACT

This article explores recent changes in long-term care (LTC) for older persons in Malta, resulting from restructuring or other contextual factors related to the international financial crisis. The ageing population continues to grow, while traditional ways of providing care for the ageing population are progressively dwindling. Waiting lists for residential care have grown longer, although public-private partnerships have served to shorten these lists to some degree. Community care services are not keeping pace with need, and the frail elderly wishing to remain in their own homes often cannot do so without significant assistance from other sources.

Service recipients fall into four groups: those affording private residential care; those granted a government-subsidized residential bed; those cared for at home by relatives; and those similarly cared for by nonfamily live-in caregivers with (or without) input from family members. Existent data are reviewed and analyzed along with a focus group of 30 stakeholders to explore this topic further. Future recommendations are made and consequences are explored as caregiving options move away from the responsibility of the traditional family system toward greater pressure on state-provided care, use of expensive private care, and waiting lists to secure services.     

Missing data: Discussion points from the PSI missing data expert group

The Points to Consider Document on Missing Data was adopted by the Committee of Health and Medicinal Products (CHMP) in December 2001. In September 2007 the CHMP issued a recommendation to review the document, with particular emphasis on summarizing and critically appraising the pattern of drop‐outs, explaining the role and limitations of the ‘last observation carried forward’ method and describing the CHMP's cautionary stance on the use of mixed models. In preparation for the release of the updated guidance document, statisticians in the Pharmaceutical Industry held a one‐day expert group meeting in September 2008. Topics that were debated included minimizing the extent of missing data and understanding the missing data mechanism, defining the principles for handling missing data and understanding the assumptions underlying different analysis methods. A clear message from the meeting was that at present, biostatisticians tend only to react to missing data. Limited pro‐active planning is undertaken when designing clinical trials. Missing data mechanisms for a trial need to be considered during the planning phase and the impact on the objectives assessed. Another area for improvement is in the understanding of the pattern of missing data observed during a trial and thus the missing data mechanism via the plotting of data; for example, use of Kaplan–Meier curves looking at time to withdrawal. Copyright © 2009 John Wiley & Sons, Ltd.     

Modeling sensitivity and specificity with a time-varying reference standard within a longitudinal setting

Diagnostic tests are used in a wide range of behavioral, medical, psychosocial, and healthcare-related research. Test sensitivity and specificity are the most popular measures of accuracy for diagnostic tests. Available methods for analyzing longitudinal study designs assume fixed gold or reference standards and as such do not apply to studies with dynamically changing reference standards, which are especially popular in psychosocial research. In this article, we develop a novel approach to address missing data and other related issues for modeling sensitivity and specificity within such a time-varying reference standard setting. The approach is illustrated with real as well as simulated data.     

Developing and using local community wellbeing indicators: Learning from the experience of Community Indicators Victoria

The recent upsurge of interest in local community wellbeing indicators in Australia and internationally reflects growing awareness of their importance as a platform for citizen engagement, community planning, and evidence based policy making. More broadly community wellbeing indicators are part of an international movement towards rethinking the ways in which political priorities are debated and in which progress and wellbeing are defined and measured. This article documents the establishment of Community Indicators Victoria (CIV), a local community wellbeing indicators initiative in Victoria, Australia. The article begins by locating the CIV initiative in the broad historical and international context of work on wellbeing, progress and sustainability indicators as well as the Australian and Victorian policy context. We then outline the steps involved in the establishment of CIV, critical partnerships and initial outcomes. We conclude with some reflections on lessons from the CIV experience to date and on future research and policy development priorities.     

Adolescent females who have sexually offended: comparisons with delinquent adolescent female offenders and adolescent males who sexually offend

Very little is known about adolescent females who commit sexual offenses. In this two-part exploratory study, a sample of 11 adolescent females with sexual offense histories is described. In Study I, the sample is compared to an age-matched sample of 11 adolescent females with non-sexual victim-involved offense histories. The sexually offending group had significantly fewer antisocial behavior problems, such as alcohol or drug use problems, problems with fighting, or problems at school. They began their offense behaviors at younger ages than their non-sex offending delinquent peers. Few differences emerged with respect to attitudes about offense behaviors, such as level of denial. In Study II, the same sample of females with sex offense histories was compared with a group of age-matched adolescent males with sex offense histories. The two sex-offending groups were found to be remarkably similar. There were few differences with respect to psychosocial and criminal histories, antisocial behavior, and variables related to clinical presentation and treatment (e.g., level of denial about offense). Likewise, the two groups are remarkably similar with respect to specific sex offense behaviors. The females, however, appear to have experienced more severe and pervasive abuse compared to the males.     

Building the San Francisco Beacons

San Francisco's Beacon Initiative is designed to foster youth development on a large scale. Its intermediary, Community Network for Youth Development, used a theory of change process to forge consensus and create a road map to guide this large collaborative toward its long-term goals.     

Pregnancy,the Family,and Work: An Historical Review and Update of Legal Regulations and Organizational Policies and Practices in the United States

In spite, or sometimes because, of extensive employment legislation, women have still not achieved economic equality. Traditionally, pertinent employment legislation either singled women out for less-preferential treatment (treating women very differently from men) or treated them exactly the same as men. Both extremes may be based on the idea that the workplace is essentially male, and women should either be prohibited from entering the workplace, or should accept standards designed around male employees. An historical review of the issue of pregnancy/family leave examines the impact of such gendering. Recent legal developments are described. Finally, additional changes that would help create a more gender-neutral workplace are identified and discussed.     

Assessing parents with learning disabilities: The parental skills model

Definitions of what constitutes adequate or inadequate parenting continue to be unclear. Not surprisingly, professionals who are required to formulate opinions regarding parental competency often experience difficulties with this task. These difficulties are further compounded when the assessment involves parents with learning disabilities. They comprise a heterogeneous population many of whom have varying deficits and skills. The Parental Skills Model outlined in this paper is offered as a guide to professionals in their assessment of such parents. The model focuses on three primary areas which have been identified as crucial to parenting, namely, parents' life skills, familial history and access to support/resources. When difficulties are encountered by parents with learning disabilities in any of these three areas it appears to have a direct and indirect effect on the child's care and development. A model of good practice is proposed and illustrated with a case study.     

What's the Use of Family Therapy?

This paper, a plenary address to the Australian Family Therapy Conference, is concerned with the role of family therapy in society and the abuse of professional power. It is argued that family therapy is part of the medicalisation of marriage and the family, through which problems are defined — often inappropriately — as relationship problems and experts (therapists) are created. Aspects of professional power are identified; its pursuit is not in the interests of families, especially those with greatest needs. Proposals to tackle these obstacles are made regarding practice and training in therapy, and the management of professional power.