Prenatal Screening for Down's Syndrome: Parent and Healthcare Practitioner Experiences

This article reviews research on both parent and healthcare practitioner experiences of prenatal screening for Down's syndrome. Whilst studies on Down's syndrome screening are broad in scope and diverge in theoretical and epistemological foundations, their core focus can be classified into two main and intertwining categories: (i) the decision‐making practices of expectant parents and why they do/do not participate in screening and (ii) the interactions between parents and practitioners, particularly the discrepancies of knowledge and the pursuit of “informed choice” and “non‐directive care.” To conclude, I highlight current knowledge gaps and the areas of substantial interest for future critical sociological engagements.     

Give your child and adolescent mental health service a health economics makeover

Specialist child and adolescent mental health services (CAMHS) must make decisions about what treatments to provide to whom, when, where and how, within limited budgets. This raises questions about how services make such decisions, to best meet the mental health needs of their catchment. The methods and practices of Health Economics, a field with considerable expertise in measuring performance in health systems, can help CAMHS make better informed decisions regarding service provision. This paper identifies a process through a set of focused questions to help CAMHS examine and improve their performance. The aspects covered are service profile, costs, conceptualisation of outcomes and identification of value for money. The recommended approach should help CAMHS redirect resources to maximise benefits for their catchment population.     

A comparison of population average and random-effect models for the analysis of longitudinal count data with base-line information

The generalized estimating equation (GEE) approach to the analysis of longitudinal data has many attractive robustness properties and can provide a 'population average' characterization of interest, for example, to clinicians who have to treat patients on the basis of their observed characteristics. However, these methods have limitations which restrict their usefulness in both the social and the medical sciences. This conclusion is based on the premise that the main motivations for longitudinal analysis are insight into microlevel dynamics and improved control for omitted or unmeasured variables. We claim that to address these issues a properly formulated random-effects model is required. In addition to a theoretical assessment of some of the issues, we illustrate this by reanalysing data on polyp counts. In this example, the covariates include a base-line outcome, and the effectiveness of the treatment seems to vary by base-line. We compare the random-effects approach with the GEE approach and conclude that the GEE approach is inappropriate for assessing the treatment effects for these data.     

An ecological investigation of the incidence of cancer in Welsh children for the period 1985–1994 in relation to residence near the coastline

An alarming report from an environmental pressure group raised concerns about childhood leukaemia and the Irish Sea. In response, this ecological study explores the hypotheses that childhood cancer rates are increased by living near the coast of Wales, especially in the north, and in particular near estuaries and mud-flats. Using Poisson regression to adjust for possible confounding variables, no evidence was found for a coastline proximity effect at the level of census wards (5 km). Moreover the rates were significantly lower near estuaries than for the rest of the coast, but there was a small but non-significant increase near mud-flats. Case–control modelling of postcoded cases living within the coastal wards using Stone's method also failed to detect any monotonic reduction in relative risk near the coastline.     

A multivariate von mises distribution with applications to bioinformatics

Motivated by problems of modelling torsional angles in molecules, Singh, Hnizdo & Demchuk (2002) proposed a bivariate circular model which is a natural torus analogue of the bivariate normal distribution and a natural extension of the univariate von Mises distribution to the bivariate case. The authors present here a multivariate extension of the bivariate model of Singh, Hnizdo & Demchuk (2002). They study the conditional distributions and investigate the shapes of marginal distributions for a special case. The methods of moments and pseudo‐likelihood are considered for the estimation of parameters of the new distribution. The authors investigate the efficiency of the pseudo‐likelihood approach in three dimensions. They illustrate their methods with protein data of conformational angles     

Fractal analysis of surface roughness by using spatial data

We develop fractal methodology for data taking the form of surfaces. An advantage of fractal analysis is that it partitions roughness characteristics of a surface into a scale-free component (fractal dimension) and properties that depend purely on scale. Particular emphasis is given to anisotropy where we show that, for many surfaces, the fractal dimension of line transects across a surface must either be constant in every direction or be constant in each direction except one. This virtual direction invariance of fractal dimension provides another canonical feature of fractal analysis, complementing its scale invariance properties and enhancing its attractiveness as a method for summarizing properties of roughness. The dependence of roughness on direction may be explained in terms of scale rather than dimension and can vary with orientation. Scale may be described by a smooth periodic function and may be estimated nonparametrically. Our results and techniques are applied to analyse data on the surfaces of soil and plastic food wrapping. For the soil data, interest centres on the effect of surface roughness on retention of rain-water, and data are recorded as a series of digital images over time. Our analysis captures the way in which both the fractal dimension and the scale change with rainfall, or equivalently with time. The food wrapping data are on a much finer scale than the soil data and are particularly anisotropic. The analysis allows us to determine the manufacturing process which produces the smoothest wrapping, with least tendency for micro-organisms to adhere.     

Psychotherapy of a preschool cancer survivor: Promoting mastery and understanding

The prolonged and invasive treatment common to cancer therapy protocols may lead to precocious defenses which impede the future development of preschool-aged cancer survivors. Focal play therapy offers the young cancer survivor a chance to understand and master the cancer experience. At present there are no accounts in the literature of the psychotherapy of young cancer survivors. This paper presents a detailed account of the therapy of a preschooler who survived a brain tumor, emphasizing the child's perspective on the cancer experience and an intervention approach which stresses mastery of developmental impasses, rather than psychopathology.     

Identifying male college students' perceived health needs, barriers to seeking help, and recommendations to help men adopt healthier lifestyles

Seven focus groups at a university campus were formed to identify college men's health concerns, barriers to seeking help, and recommendations to help college men adopt healthier lifestyles. Content analysis was used to identify and organize primary patterns in the focus-group data. Results of the study revealed that the college men were aware that they had important health needs but took little action to address them. The participants identified both physical and emotional health concerns. Alcohol and substance abuse were rated as the most important issues for men. The greatest barrier to seeking services was the men's socialization to be independent and conceal vulnerability. The most frequently mentioned suggestions for helping men adopt healthier lifestyles were offering health classes, providing health information call-in service, and developing a men's center. Implications of the results are discussed.     

Strategic planning in the Thomas Cook group

Until Midland Bank took control of Thomas Cook in 1972 there were only rudimentary accounts in the Group and no systematic attempt to budget its operations. An immediate priority was to establish an effective finance function and the first planning activities of the Group were centred in this area. At the beginning of the annual planning cycle a Group Strategic Conference at Board level and a Group Planning Conference determine strategies and many territories follow this latter meeting with their own regional conference to discuss Plans, which are finalized and consolidated by computer into the Group Plan, to be ready for the start of the financial year.