Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

Studying the Effects of the Audience on Verbal Behavior

The Analysis of Verbal Behavior -     

Gender and the 'New Paradigm' of Health

This article provides a critical review of literature on the relationship between gender and the 'new paradigm' of health. An overview of the feminist critique of health is given, from the Women's Health Movement of the late 1960s and early feminist debates about medicalisation, to more recent discussions about structural inequalities between men and women, eating disorders, and AIDS. I then go on to explore the feminist response to the so-called 'new paradigm' of health (an approach that emphasises health promotion, individual responsibility for health, and body-monitoring). Arguments that health promotion initiatives target women and confirm their position as principal guardians of health within the family are considered, as well as literature on the breast cancer awareness campaign. I then explore the growing body of literature on masculinity and health, and its account of the relationship between gender and current ideas about healthiness. Finally, I offer up some suggestions for the direction a new feminist critique of health might take.     

From critical sociology to public intellectual: Pierre Bourdieu and politics

By the late 1990s, Pierre Bourdieu had become the primary public intellectual of major social scientific status at the head of the anti-globalization movement that emerged in France and in other Western European countries. This article discusses how Bourdieu became a leading public intellectual, a role that seems to contrast with his early years as a professional sociologist. It explores what seemed to change in Bourdieu’s activities and outlook as sociologist and what seems to have remained constant. It identifies several institutional conditions that seemed necessary for Bourdieu to be able to play the kind of public intellectual role he did in his later years. Bourdieu’s movement from a peripheral position to a central location in the French intellectual field, the changing character of the field itself, the growing influence of the mass media in French political and cultural life, the failures of the French Socialists in power, a cultural legacy of leading critical intellectuals in France, a unifying national issue of globalization, and the political conjuncture in 1995 all intersected in ways that opened a path for Bourdieu to choose new and more frequent forms of political action. His responses to that combination of factors at different moments reveal both a striking continuity in desire to preserve the autonomy of intellectual life and a change in view and strategy on how best to do that. The article concludes with a brief evaluation of Bourdieu’s public intellectual role.     

Projective Identification as a Contributor to Domestic Violence

Many explanations have been given as to why men batter. Rarely are deep unconscious intrapsychic processes identified as contributing reasons. One way that violent men may use their partner to fill emotional needs is through the primitive defense of projective identification. Projective identification may be invoked by men to induce the other partner to carry split off threatening parts of the self that are too anxiety provoking to retain. The occurrence of projective identification could therefore be an important intrapsychic and interpersonal dynamic that contributes to the escalation of tension prior to the violent episode.