Improving Primary Care for Persons with Disabilities: the nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.     

School Racial Composition Effects on Avoidance,Separatism, and Integrationist Attitudes of Adolescents*

Support for integration versus separatism and approach versus avoldance reactions among junior and senior high school students was examined in integrated and segregated schools. Two surveys of a panel of black and white students in selected Milwaukee public schools were conducted in the spring of 1974 and the spring of 1975. The approach-avoidance and integration-separatism dimensions emerged from a factor analysis of racial attitude items. Black students in all-black schools scored more on the avoidance end of the approach-avoidance dimension while the black students in the integrated schools scored more on the approach end. The black students in the all-black schools, however, tended to score on the integration end of the integration-separatism dimension while the black students in the integrated schools tended to score on the separatism end. The attitudes of the students in the all-black schools changed towards those in the integrated school during the year between interviews. Reasons for the changes are suggested and partially tested with additional analysis. White students in essentially all-white schools scored on the avoidance and separatism end of the two dimensions. White students in mixed Latin schools were more acceptant of the minority students than the white students in the mixed black schools.     

Characteristics of the maximal independent set ZDD

Zero-suppressed binary decision diagrams (ZDDs) are important data structures that are used in a number of combinatorial optimization settings. This paper explores a ZDD characterization for the maximal independent sets of a graph; a necessary and sufficient condition for when nodes in the ZDD can be merged is provided, and vertex orderings of the graph are studied to determine which orderings produce smaller ZDDs. A bound on the width of the maximal independent set ZDD is obtained, relating it to the Fibonacci numbers. Finally, computational results are reported.     

Posttraumatic Stress Disorder and Suicidal Ideation Among Sexually Abused Adolescent Girls: The Mediating Role of Shame

ABSTRACT

Sexual abuse is associated with a host of negative repercussions in adolescence. Yet the possible mechanisms linking sexual abuse and negative outcomes are understudied. The purpose of this study was to investigate the relationships among self-blame, shame, coping strategies, posttraumatic stress disorder, depressive symptoms, and suicidal ideation. The sample included 147 sexually abused adolescent girls between 14 and 18 years of age. A total of 66% of girls reached clinical score for posttraumatic stress disorder, and 53% reached clinical score for depressive symptoms. Close to half (46%) reported suicidal thoughts in the past 3 months. Shame was found to partially mediate the relationship between self-blame and posttraumatic stress disorder. Shame and depressive symptoms were also found to partially mediate the relationship between self-blame and suicidal ideation. Results suggest that shame is a crucial target in interventions designed for sexually abused adolescent girls.     

Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: rates and covariates in clinical and nonclinical samples

Self-destructive and delinquent behaviors were assessed in three samples of adolescent females. The first sample (N=140) were substantiated victims of sexual abuse recruited from clinical settings. They were contrasted to a second sample (N=430) of secondary school students, and a third sample from the same school setting (N=94), that reported that they had been sexually abused. Few differences were found between the two groups of sexually abused girls, and both groups reported significantly more at-risk behaviors than nonabused girls. Family adversity was a consistent predictor of both self-destructive and delinquent behaviors. However, violence during the abuse, lower quality mother-daughter relationships, and depression were also related to self-destructive behaviors, while family economic problems and self-blame for the abuse were the only correlates of delinquent behavior.     

Question wording and the house vote choice : some experimental evidence

Since 1978, the vote reported for House incumbents in the American National Election Studies (NES) has been significantly higher than the actual incumbents' vote in the districts surveyed; in NES surveys before 1978, the reported vote was much closer to the actual vote. The prime suspect for the source of this bias is the new question format introduced in 1978 and used in all subsequent studies. We document the problem and review the results of several question-wording experiments that confirm the superior accuracy of a format that does not mention the candidates' names over the ballot format currently in use. We also find evidence that a modified version of the ballot format may reduce the pro-incumbent bias, so that improvement may be possible without a major interruption of the post-1978 NES times series.     

Predictors of maternal support: the point of view of adolescent victims of sexual abuse and their mothers

Maternal support received by sexual abuse victims is considered a key factor in coping with the aftermath of abuse. The present study looked at four groups of potential predictors of maternal support: mothers' psychosocial characteristics, abuse characteristics, victim's characteristics, and disclosure characteristics. A total of 120 adolescents aged 12 to 17 years and their mothers, who were recruited from Child Protective Services, completed questionnaires and semi-structured interviews. Multiple regression analyses performed separately on mother and child data sets revealed five significant predictors of maternal support in each analysis, four of which were common to both. The discussion underscores the importance of taking into account both the mother's and the victim's perceptions regarding psychological adjustment and family environment.     

The impact of the family on diabetes adjustment: A developmental perspective

This study investigated how pubertal development may influence the relation between aspects of the family environment and diabetes adjustment. Subjects were 49 youngsters with newly diagnosed insulin-dependent diabetes mellitus (IDDM) and their parents. Pearson correlations between aspects of the family environment and diabetes adjustment revealed many significant findings for the total sample and separately by pubertal development. Tests of differences between these correlations revealed support for our hypotheses in expected directions. These results suggest the adoption of a developmental perspective when considering how family life is related to a youngster's diabetes adjustment.     

Modeling unemployment duration in a dependent competing risks framework: Identification and estimation

Three Mixed Proportional Hazard models for estimation of unemployment duration when attrition is present are considered. The virtue of these models is that they take account of dependence between failure times in a multivariate failure time distribution context. However, identification in dependent competing risks models is not straightforward. We show that these models, independently derived, are special cases of a general frailty model. It is also demonstrated that the three models are identified by means of identification of the general model. An empirical example illustrates the approach to model dependent failure times.