Expanded renal transplantation: a competing risk model approach

Multi-state models (MSMs) are useful to analyze survival data when, besides the event of main interest, one or more intermediate states of the individual are identified. These models take the several existing states and the possible transitions among them into account. At the same time, covariate effects on each transition intensity may be investigated separately and, therefore, MSMs are more flexible than the standard Cox proportional hazards model. In this work, we use MSMs to investigate the impact of the quality of a transplanted kidney for a group of patients at the Hospital Universitario Central de Asturias. Specifically, we use an illness-death model to study the evolution of patients with kidney disease who received a renal transplant after a dialysis period. The intermediate state is defined as the failure of the received organ, while the terminating state is the death of the patient. In order to increase the potential number of organs available for transplant, the standards of quality for the transplanted kidneys were relaxed (the new criteria are labeled expanded criteria), and these ‘expanded kidneys’ were transplanted in appropriate candidates (older patients, with higher prevalence of diabetes mellitus). Results suggest that the expanded kidneys have a minor effect on survival, while both the kidney mortality and the risk of death increase with the patient's age and the serum creatinine and serum hemoglobin levels.     

Aging and Gender Health Gap: A Multilevel Analysis for 17 European Countries

Social Indicators Research - The European population is aging and their declining capacity makes older Europeans more dependent on the availability of care. Male and female health needs at older...     

Nonparametric estimation of the conditional distribution function in a semiparametric censorship model

In this paper we propose a new nonparametric estimator of the conditional distribution function under a semiparametric censorship model. We establish an asymptotic representation of the estimator as a sum of iid random variables, balanced by some kernel weights. This representation is used for obtaining large sample results such as the rate of uniform convergence of the estimator, or its limit distributional law. We prove that the new estimator outperforms the conditional Kaplan–Meier estimator for censored data, in the sense that it exhibits lower asymptotic variance. Illustration through real data analysis is provided.     

Economic burden of tuberculosis and its coping mechanism at the household level in Pakistan

Despite the availability of free medicines under the Directly Observed Treatment Short-course (DOTS) strategy, the treatment of tuberculosis (TB) still involves high costs that push people into poverty. This study aims to assess the resulting economic burden of TB and examine the coping mechanisms practiced at the household level in Pakistan. A cross-sectional study was conducted at TB centers by interviewing 269 patients. Statistical tests and binary logistic regression were used to explore the relationship between catastrophic health expenditures (CHE) and socio-economic factors. Results show that the incidence and intensity of CHE were higher for households in the lower income-quintile. Several coping strategies were practiced and varied among the different income-quintiles. The independent determinants of CHE were as follows: age >40 years, male-patient, location, earner-ratio, patient as the earner, caretaker visits, treatment delay, and co-morbidity. It is recommended that health policymakers develop post-MDGs TB-control strategies to ensure free TB-services with financial protection around the globe.     

Book review

How to Conduct Self‐administered and Mail Surveys, L. B. Bourque and E. P. Fielder, London, Sage Publications, 1995, 223 pp, £17.50     

On the adjudication of conflicting claims: an experimental study

This paper reports an experimental study on three well-known solutions for problems of adjudicating conflicting claims: the constrained equal awards, the proportional, and the constrained equal losses rules. We first let subjects play three games designed such that the unique equilibrium allocation coincides with the recommendation of one of these three rules. In addition, we let subjects play an additional game that has the property that all (and only) strategy profiles in which players coordinate on the same rule constitute a strict Nash equilibrium. While in the first three games subjects’ play easily converges to the unique equilibrium rule, in the last game the proportional rule overwhelmingly prevails as a coordination device, especially when we frame the game as an hypothetical bankruptcy situation. We also administered a questionnaire to a different group of students, asking them to act as impartial arbitrators to solve (among others) the same problems played in the lab. Also in this case, respondents were sensitive to the framing of the questions, but the proportional rule was selected by the vast majority of respondents.     

Peer relationships during late childhood in internationally adopted and institutionalized children

The aim of this study was to analyse the interpersonal relationships in the school context of children living in different care settings (adoptive families, residential care centres, birth families). Participants were 76 children between eight and fourteen years of age (M = 10.78, SD = 1.38), belonging to one of three groups: international adoptees, children living in residential care in Spanish institutions, and a comparison sample of Spanish children living with their birth families with no connection with child protection. Sociometric information was collected in the classroom of each child during school hours. Internationally adopted children from Russia showed considerable difficulties in their relationships with peers; they were more likely to be rejected and their peers described them as less prosocial and somewhat more aggressive. With a better sociometric position than the adoptees, children in residential care were rated by their peers as more aggressive and less prosocial than the normative population. Coordination and integrated work between the family, protection centres, schools, and other social services should be a strategic priority in the promotion of healthy social development in these groups of children.     

Puerto rican drug users’ experiences of physical and sexual abuse: Comparisons based on sexual identities

This study integrates the results of quantitative and qualitative methods to elucidate the association between sexual identity and physical and sexual abuse among Puerto Rican drug users. A structured questionnaire was administered to 800 subjects in New York and 399 in Puerto Rico. A total of 93 subjects (7.9%) self‐identified as homosexual or bisexual. Gay males were significantly more likely than heterosexual males to report first occurrence of physical abuse by a family member in childhood. Both gay and bisexual males were more likely than their heterosexual counterparts to report first experiencing unwanted sex in childhood and intimate partner physical abuse later in life. Lesbians were more likely than female heterosexuals to report unwanted sex in childhood. Qualitative data were collected through in‐depth life histories with 21 subjects and suggest that gay and lesbian subjects perceive antihomosexual prejudice on the part of family members as one cause of childhood physical and sexual abuse.     

How Couples Manage Interracial and Intercultural Differences: Implications for Clinical Practice

This study focused on how couples managed their interracial and intercultural differences. To understand their experiences, a qualitative grounded theory analysis was used (n = 17). Analysis revealed that couples experienced most issues as cultural issues; race only occurred during their interactions with “others.” They appeared to organize their responses according to four relationship structures: Integrated, Singularly Assimilated, Coexisting, and Unresolved. Couples in each of these structures managed daily process through four sets of relationship strategies: (a) creating a “we,” (b) framing differences, (c) emotional maintenance, and (d) positioning in relationship to familial and societal context. These findings are a step toward a strength‐based and research‐informed education and clinical interventions for this population. Video Abstract