A case study in defining developmental costs for quality assurance in mental health center programs

Issues related to the state-of-the-art of ambulatory mental health care review as well as to the resources necessary for planning and operating a quality assurance program may be hampering development of such programs in community mental health centers nationwide. Faced with the problem of responsible and prudent program management, it has become increasingly difficult for CMHC directors to implement innovative, but unproven, and often unpriced programs which have the potential to draw scarce professional resources away from direct service delivery. Pressure to implement CMHC program requirements that are not ordinarily considered revenue-producing in nature, for example, consultation and education services and quality assurance activities, may further create anxiety for mental health program directors, especially during periods when they are ostensibly confronted with the need to maximize CMHC revenues. Before mental health professionals and administrators of mental health programs can be expected to introduce quality assurance programs, they need to have some idea how much the system costs. The figures reported from three North Carolina mental health centers may offer some indication of what other mental health centers might expect to spend in developing a quality assurance program. Salary expenses for multidisciplinary staff participation in quality assurance activities are presented.     

Multiple imputation of a randomly censored covariate improves logistic regression analysis

Randomly censored covariates arise frequently in epidemiologic studies. The most commonly used methods, including complete case and single imputation or substitution, suffer from inefficiency and bias. They make strong parametric assumptions or they consider limit of detection censoring only. We employ multiple imputation, in conjunction with semi-parametric modeling of the censored covariate, to overcome these shortcomings and to facilitate robust estimation. We develop a multiple imputation approach for randomly censored covariates within the framework of a logistic regression model. We use the non-parametric estimate of the covariate distribution or the semi-parametric Cox model estimate in the presence of additional covariates in the model. We evaluate this procedure in simulations, and compare its operating characteristics to those from the complete case analysis and a survival regression approach. We apply the procedures to an Alzheimer's study of the association between amyloid positivity and maternal age of onset of dementia. Multiple imputation achieves lower standard errors and higher power than the complete case approach under heavy and moderate censoring and is comparable under light censoring. The survival regression approach achieves the highest power among all procedures, but does not produce interpretable estimates of association. Multiple imputation offers a favorable alternative to complete case analysis and ad hoc substitution methods in the presence of randomly censored covariates within the framework of logistic regression.     

On the Use of “Intent to...” Variables in Organizational Research: An Empirical and Cautionary Assessment

Organizational research often relies onsurrogate variables. By surrogate we donot refer to family of construct, factor, or latentvariables. Rather, we address the situation where onevariable is literally the substitute for another variablethat is generally unavailable. Consider, for example,the use of intent to turnover orintent to transfer variables commonly usedwhen actual turnover or transfer data are unavailable. Wedemonstrate that reliance on such surrogate variablesmay lead to some misinterpretation. This tendency may beparticularly apparent when the relationship between the surrogate and the actual variable is low. Thismay be further exacerbated when the relationship betweenthe surrogate variable and a third variable is modest aswell.     

Drinking patterns, problems, and motivations among collegiate bisexual women

OBJECTIVE AND PARTICIPANTS: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women). METHODS: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. RESULTS: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. CONCLUSIONS: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.     

Post-lesbian? Not yet

Though some may encourage us to consider ourselves in a 'post-lesbian' era, political cultural and academic realities suggest something quite different. Analyzing specific cases in all three of these arenas can strengthen a resolve to insist on the preservation of both the term and concept embodied by 'lesbian.' Finally, this essay suggests several areas open for future investigation by scholars and activists alike.     

Maternal Interactive Style Across Contexts: Relations to Emotional, Behavioral and Physiological Regulation During Toddlerhood

Sixty-five mothers and their 24-month-old toddlers were observed in a series of laboratory procedures designed to assess relations between maternal interactive style and emotional, behavioral and physiological regulation. Emotional regulation was assessed by examining the child's behaviors (aggression, distraction, object focus) when confronted by three emotion-eliciting tasks. Behavioral regulation was measured by examining children's ability to comply to maternal requests and to inhibit behavior during a delay task. Physiological regulation was derived from children's cardiac vagal tone responses to emotionally-arousing situations. Maternal interactive style was assessed by examining mothers' strategies for child behavior management (negative controlling, positive guidance) during three mother-child tasks. Maternal behavior was related to regulation in each of the three domains. Negative maternal behavior was related to poor physiological regulation, less adaptive emotion regulation, and noncompliant behavior. Positive maternal behavior was correlated with compliance, but not with any of the physiological or emotional measures. These findings are discussed in terms of the adaptive value of self-regulation in early development, and the importance of identifying the causal relations between maternal behavior and child regulation.     

Who are the Supporters of Croatian Membership in the European Union and NATO? Predictive Value of Personal and National Well-Being

Like many other Central and Eastern European countries Croatia has passed through substantial political changes and transition processes from state to liberal market economy in the last two decades. The next important step is accession to EU and NATO, and public opinion about joining these associations is divided. The aim of this study is to investigate the predictive value of subjective well-being measures in explaining attitudes of Croatian citizens toward accession to NATO and European Union. In particular, the prognostic utility of SWB is tested over and above usefulness of basic socio-demographic variables in explaining those political opinions. The research was conducted on a huge and representative sample (N = 4,000) of Croatian citizens in the spring of 2009. As a measure of subjective well-being, Croatian version of International Well-Being Index (IWI; Cummins in International Wellbeing Index, Version 2 [online]. Available from: , 2002) was used. IWI includes National and Personal Well-Being scales where each scale consists of several personal or national well-being domains. Socio-demographic variables used in this survey were gender, age, and level of education. Hierarchical logistic regression was applied to test the unique contribution of National and Personal well-being domains in predicting attitudes toward accession. The results show that National well-being index is useful in predicting attitudes toward accession of Croatia to EU and NATO, and has an even higher predictive value than basic socio-demographic variables. National well-being domains that significantly improve prediction were satisfaction with government and satisfaction with national economic situation. Higher satisfaction with national government is related to support of accession to both alliances, whereas higher satisfaction with national economy is associated solely with supporting the EU membership. The personal well-being index and belonging domains were not useful in this political attitude prediction. Possible theoretical explanation of observed relations between NWI and political opinion were further discussed.     

Perspectives on American Kinship in the Later 1990s

This paper reviews the current status of kinship research in the United States and identifies factors that might account for the declining interest in the subject among family researchers. The analysis uses both structural and cultural factors to illustrate how they can determine the diversity in kinship functioning that ranges from those family systems where kinship relationships flourish and those where they play a small part in family life. The structural and demographic variables determine the numbers and availability of kin, whereas the cultural variables determine the norms that establish the motivation to sustain kinship bonds. To illustrate how these factors operate among subgroups in the United States, I analyze three types of kinship systems: the lineal emphasis in White families of the very old; the collateral emphasis in the families of their Black counterparts; and the egocentric emphasis of White suburban families that are undergoing marital change.     

Newborn Infants' Preference for Attractive Faces: The Role of Internal and External Facial Features

Several previous experiments have found that newborn and young infants will spend more time looking at attractive faces when these are shown paired with faces judged by adults to be unattractive. Two experimental conditions are described with the aim of finding whether the “attractiveness effect” results from attention to internal or external facial features, or both. Pairs of attractive and less attractive faces (as judged by adults) were shown to newborn infants (mean age 2 days, 9 hours), where each pair had either identical internal features (and different external features) or identical external features (and different internal features). In the latter, but not the former, condition the infants looked longer at the attractive faces. These findings are clear evidence that newborn infants use information about internal facial features in making preferences based on attractiveness. It is suggested that when newborn (and older) infants are presented with facial stimuli, whether dynamic or static, they are able to attend both to internal and external facial features.