The Single Assessment Process in Primary Care: Older People's Accounts of the Process

Recent government policies have been active in addressing socialinclusion and active participation of older people in many aspectsof societal life. Independence and well-being animate thesedevelopments and are evident in the emphasis on person-centredservices within the single assessment process for older people(Department of Health, 2002b). Drawing on a feasibility study of the Single Assessment Processas a ‘case-finding’ approach, this paper presentsfindings drawn from older people’s accounts of this experience.These accounts indicate the potential of the process for identifying‘low-level’ need, whilst raising issues of accessto formal services and resource constraint; also they underlinethe importance of understanding how older people seek ways ofmanaging their own health and well-being, whilst continuingto contribute to the social cohesion of society by providingsupport to their peers and to younger generations. Interdependence, it is suggested, rather than dependence shouldunderlie any approach to assessing older people’s needs,if we are to appreciate and build upon the complexity of olderpeople’s strategies for actively managing their lives.     

Evidence of fertility regulation among rural French villagers, 1749–1789

The statistical results obtained in this second part form a strong case against the ‘natural fertility’ characterization of the demographic regime that prevailed in rural France immediately before the Revolution of 1789. There are clear indications that marital fertility was being regulated in congruence with the differential valuations placed upon children, according to their gender and age. A complex pattern is found in the non-biological responses of couples' fertility to both non-familial and familial experience of infant deaths, which take the form of ‘hoarding’ and ‘replacement effects’, respectively. Evidence is present bearing upon the suspected endogeneity of infant deaths, and its relationship to the adoption of preventive methods of limiting family size.     

An Evaluation of the Rai and Van Ryzin Dose-Response Model in Teratology

The underlying assumptions of the Rai and Van Ryzin dose-response model for reproductive toxicological data are evaluated on the basis of existing experimental data. The model under consideration is unusual in its use of litter size to completely account for extra-binomial variation in the data by associating litter size with reproductive outcome. The experimental data show that controlling litter size is not sufficient to account for the litter-to-litter variability in responses. It is also shown that the two linear components of the Rai and Van Ryzin model are inappropriate. For the component which applies to the dam, the data suggest a strong nonlinearity, supported by rejection of the linear model via statistical hypothesis tests. In the component involving litter size, a relationship with dose is not apparent. The litter size parameters offer considerable potential for bias in estimation; bias which is at least partly masked by the model having good prediction characteristics due to the increased number of parameters. A simulation study is presented to illustrate how the Rai and Van Ryzin model can exaggerate litter size effects on the probability of response when the simulated data arise from a model involving a nonlinear dam component, common to this type of data, and no effect of litter size.     

THE IMPACT OF BAD WRITING IN ECONOMICS

We find significant style differences between articles written by economists for their professional journals and articles by the same economists in the Wall Street Journal. We find no evidence that style influences the professional success of economists, which suggests that the private rewards to improving the quality of writing are low. Indeed, each community of scholars has probably adopted a "professionally correct" writing style, from which its members diverge little. However, scholars do alter their rhetorical style to communicate effectively with audiences other than the professional community. This suggests that intra- and inter-group (written) communication by economists is efficient.     

Delinquency among pathological gamblers: A causal approach

In a comprehensive research project on gamblers in self-help groups in West Germany one object of investigation was the question of whether or not pathological gambling has a criminogenic effect. 54.5% of the 437 members of Gamblers Anonymous interviewed stated that they had committed illegal actions in order to obtain money for gambling. Comparisons of this sub-group with those interviewees who did not admit having committed criminal offences show distinct differences: Those who admitted illegal action were more excessive in their gambling behavior and experienced a higher degree of subjective satisfaction through gambling. They also showed a more pronounced problem behavior and more psychosocial problems because of gambling. A multiple regression within the framework of path analysis was computed in order to explore causal links between pathological gambling and delinquency. The results support the hypothesis that pathological gambling can lead to delinquent behavior. Forensic implications are discussed.This article is a revised version of a paper presented at the Eighth International Conference on Risk and Gambling in London, U.K., August 15–17, 1990.The content and presentation of this article has benefited from the comments of Agnes Roemer, Department of Psychology, University of Bremen.     

The future of unions as political organizations

I am grateful to Peter Feuille and Susan Schwochau for helpful comments on an earlier draft.     

AN ETHNOGRAPHIC STUDY OF CLIENT AND THERAPIST PERCEPTIONS OF THERAPY EFFECTIVENESS IN A UNIVERSITY-BASED TRAINING CLINIC

The purpose of this study was to explor client and therapist evaluations of direct practice in a university-based training center using an ethnographic research methodology. Client and therapist perceptions about the strengths and limitations of ethnographic practice evaluation were also analyzed. A domain analysis was performed on postsession interviews with both clients and practitioners over a 4- month period. Six core categories of client and therapist perceptions of therapy effectiveness emerged from a domain analysis: (a) changes associated with counseling, (b) important practitioner qualities, (c) effective interventions or techniques, (d) ineffective interventions or techniques, (e) recommendations for future sessions, and (f) strengths and limitations of ethnographic practice evaluation. Implications of this study for clinical practice, training, and future research are discussed.     

BUILDING ON FAMILY STRENGTH: A STUDY OF FAMILIES WITH POSITIVE ADJUSTMENT TO THE BIRTH OF A DEVELOPMENTALLY DISABLED CHILD*

This research was based on the assumption that much could be learned from families that had adapted well to the birth of a child with developmental disabilities. It was of interest to explore what made these families strong and if consistent patterns of coping and adjustment could be observed. Positive adaptation seemed unrelated to degree of the child's disability or level of soothability, and further, did not seem directly linked to family income level. However, it appeared that two-parent families with few children were at a distinct advantage. Positive family adaptation appeared to be tied to functioning of the parental subsystem and the skillful utilization by parents of family and friendship network resources.     

Approximations for marginal densities of M-estimators

We develop a saddle-point approximation for the marginal density of a real-valued function p(), where is a general M-estimator of a p-dimensional parameter, that is, the solution of the system {n^-1_ljl (Y_l,) = 0}_j=1,…,p. The approximation is applied to several regression problems and yields very good accuracy for small samples. This enables us to compare different classes of estimators according to their finite-sample properties and to determine when asymptotic approximations are useful in practice.