生活在安第斯山区的土著是否明显地存在因缺氧而造成的生育力下降的问题——对戈尔斯坦、查隆和比尔的回应

在最近的文章中(见1983出版的<美国人类学家>期刊,总第85期,第28-49页),戈尔斯坦、查隆和比尔对埃伯尔森、贝克、达特和我引申出来的一个假说--缺氧引起安第斯山区土著的生育力下降--提出了批评.     

Studying the Motivations Behind Sexual Agreements: A First Look at the Motivations Behind Agreement (MBA) Scale for Male Couples

Sexual agreements are ubiquitous among male couples, yet little is known about motivations behind agreements and their association with sexual risk for human immunodeficiency virus (HIV). Qualitative interviews with 39 couples informed the development of the items in the Motivations Behind Agreement (MBA) scale. The scale was validated via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) using quantitative data from two (790 and 882 men) independent samples of couples. The EFA yielded two factors: relationship quality enhancement motive (RQEM) and sex life enhancement motive (SLEM). The CFA indicated satisfactory global model data fit. Finally, in predicting sexual risk, RQEM and SLEM showed significant interactions with agreement type. For men with monogamous agreements, higher RQEM was associated with less condomless anal sex (CAS) with an outside partner of discordant or unknown serostatus (aOR = 0.15; 95% CI = 0.05, 0.46). For men with nonmonogamous agreements, higher RQEM was associated with less CAS (aOR = 0.76; 95% CI = 0.60, 0.97) while higher SLEM was associated with greater odds of CAS (aOR = 1.57; 95% CI = 1.18, 2.08). Men whose agreements were highly motivated by relationship enhancement were less likely to engage in sexual risk with outside partners regardless of agreement type. HIV-prevention interventions targeting male couples will benefit from incorporating an understanding of couples’ agreement motivations.     

Thriving and surviving in a new medical career: the case of hospitalist physicians

Managed care is cultivating a variety of new work careers within the medical profession, and it is worth asking whether they will function as long- or shorter-term career options for the individuals who participate in them. This paper uses the specific case of hospitalist physicians to explore how the surrounding social and economic work contexts contribute to two individual-level outcomes that inform the issue of career longevity: the concepts of burnout and intent to stay in the career. The findings of a national survey of hospitalists reveal that job burnout and intent to remain in the career are more meaningfully associated with favorable social relations involving colleagues, co-workers, and patients than with negative experiences related to the economically induced pressures of the job, such as reduced autonomy and the use of financial incentives. In addition, career longevity is enhanced by the extent to which individual physicians pursue intrinsic and extrinsic rewards through their choices to become hospitalists. These findings demonstrate that sociologists should pay greater attention to the career trajectories of contemporary doctors in order to understand larger scale professional stratification within medicine. They also offer empirical support for redirecting our focus towards the relational dynamics that shape these trajectories.     

Bridging gaps between mind, body, & spirit. Healing the whole person.

Fifty percent of visits of primary care providers are for psychiatric problems making it desirable to screen for mental, addictive, or behavioral disorders at the level of primary care. Psychiatric/mental health nurses prepared at the master's level to practice in the blended clinical specialist/nurse practitioner role are well placed to treat or collaborate in the treatment of people who present with symptoms of physical or psychological problems. The role of the clinical specialist/nurse practitioner is evolving in response to changes in health demographics, epidemiology, scientific and technological advances, and changes in managed care. Advanced practice nursing education must continue to anticipate and meet on-going changes and challenges.     

The new breed

Structural changes within the health system--particularly in the organization and financing of services--have made new and different opportunities available to physicians interested in management. What types of physicians are currently going into management? How do they compare to others who have been in management for a longer period of time and to the "traditional" portrait of the physician executive? The author profiles the emerging, contemporary physician executive and explores the implications for the viability of the field of medical management as a whole.     

A hierarchical eigenmodel for pooled covariance estimation

Summary.  Although the covariance matrices corresponding to different populations are unlikely to be exactly equal they can still exhibit a high degree of similarity. For example, some pairs of variables may be positively correlated across most groups, whereas the correlation between other pairs may be consistently negative. In such cases much of the similarity across covariance matrices can be described by similarities in their principal axes, which are the axes that are defined by the eigenvectors of the covariance matrices. Estimating the degree of across-population eigenvector heterogeneity can be helpful for a variety of estimation tasks. For example, eigenvector matrices can be pooled to form a central set of principal axes and, to the extent that the axes are similar, covariance estimates for populations having small sample sizes can be stabilized by shrinking their principal axes towards the across-population centre. To this end, the paper develops a hierarchical model and estimation procedure for pooling principal axes across several populations. The model for the across-group heterogeneity is based on a matrix-valued antipodally symmetric Bingham distribution that can flexibly describe notions of 'centre' and 'spread' for a population of orthogonal matrices.     

Career Outcomes Data From Social Media: Examining Quality in Current Practices

Social media websites contain information that can be used to assess career outcomes. Yet, questions remain about the quality of this data source. This study examined social media data collected from a large sample of recent college graduates (N = 3,094), considering how well those data represented the broader population of graduates and to what extent social media data matched survey responses on 5 employment variables. Results indicated that indiscriminately using social media data can lead to biased inferences about career outcomes. Specifically, social media data matched survey data in just 67% to 76% of comparisons. Despite these limitations, findings also revealed strategies to improve agreement between data sources, leading to more trustworthy inferences about career outcomes from social media. Results indicate a need to heighten practitioner awareness of data quality issues related to career outcomes data sources. A framework for examining data quality is offered, with suggested directions for future research.     

Problem and Pathological Gambling in Schizophrenia: Exploring Links with Substance Use and Impulsivity

High rates of both problem and pathological gambling (PPG) and substance-use disorders (SUDs) have been reported in schizophrenia, and yet PPG frequently goes undetected in clinical practice and unexamined in research. Here, we aimed to examine the relationship between PPG and SUDs in a large sample of patients across several factors related to both gambling and substance use, including poly-substance use. Additionally, delay discounting is a form of impulsivity known to positively associate with both PPG and SUDs and thought to underlie mechanisms of addiction in both contexts. We aimed to investigate the relationship between PPG and delay discounting in schizophrenia. 337 individuals with schizophrenia completed structured face-to-face interviews regarding gambling behaviors, substance use, and delay discounting. PPG in schizophrenia was associated with substance use, in particular with poly-substance use, and with delay discounting among males. Factors related to substance use were strongly linked with gambling in this sample, but not always with PPG more than recreational gambling. Our findings overall support the notions that multiple forms of gambling in schizophrenia are clinically relevant, that gambling may share common substrates with substance use, and that delay discounting represents a potential mechanism of this association in males.