A longitudinal study of depressiveness in children in public care

Rajhvajn Bulat L. A longitudinal study of depressiveness in children in public care Int J Soc Welfare 2010: 19: 412–423 © 2009 The Author, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. The aim of this article is to analyse the challenges involved when making longitudinal observations of depressiveness in children raised in public care. The first measurement comprised 375 children from children's homes and foster families; however, most of the results are based on an analysis of the 139 children who participated in both parts of the research. We used the Child Depression Inventory and the anxiety/depression subscales of Youth Self Report and Child Behaviour Checklist as measures of depressiveness. The comparison of results from the first and second measurements showed that depressiveness in children in public care decreased over time. Children who grew up in children homes were, in the first measurement, more depressed than those living in foster families, but after five years that difference had disappeared. Furthermore, decrease in depressiveness is predominantly associated with less frequent delinquent, aggressive or hyperactive behaviour, less withdrawal and better control over uncomfortable emotions.     

Palliative care patients' experiences of healthcare treatment

Kennett C, Payne M. Palliative care patients' experiences of healthcare treatment Int J Soc Welfare 2010: 19: 262–271 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article reports on a thematic analysis of the opinions of 34 palliative care patients about medical and healthcare treatment expressed in comments, narratives and discussions during a series of facilitated group discussions undertaken as part of training events for medical students. Palliative care patients often have long healthcare careers, which enables them to compare different professionals and services, thus offering a more powerful and complex analysis of patient experience than that obtainable from analysis of complaints or satisfaction surveys, and permits some understanding to be obtained of the attitudes that condition evaluations of services. The patients balanced negative views with positive experiences. They appreciated open, listening, equal and friendly relationships with professionals in which careful explanation fostered their confidence in the overall service. They criticised inflexible services that did not consider their broad needs, and in which relationships with professionals were characterised by busy‐ness and professional distance.     

Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit

Saario S, Raitakari S. Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit Int J Soc Welfare 2010: 19: 321–329 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. Mental health NGOs in Western Europe are increasingly managed by contractual audit procedures. This article concerns how contractual audit and its emphasis on effectiveness of care impact on the practices of long‐term mental health rehabilitation. To demonstrate this, a case study of a Finnish NGO that provides supported housing is presented. The study looks at how service purchasing practices, as stated in the contract between the municipality and the NGO, are reflected in the meetings among practitioners. Documentary and meeting data were utilised together with Mitchell Dean's notion of technologies of agency. It was found that practitioners actively sought to show the effectiveness of their everyday work in terms of contractual audit by demonstrating both the economic and progressive aspects of care. Thus, professional competency in mental health rehabilitation appears to entail both the skills of care interventions and the ability to perform these interventions as efficient and financially accountable activities.     

Using a mixture model for multiple imputation in the presence of outliers: the 'Healthy for life' project

Summary.  We consider the problem of obtaining population-based inference in the presence of missing data and outliers in the context of estimating the prevalence of obesity and body mass index measures from the 'Healthy for life' study. Identifying multiple outliers in a multivariate setting is problematic because of problems such as masking, in which groups of outliers inflate the covariance matrix in a fashion that prevents their identification when included, and swamping, in which outliers skew covariances in a fashion that makes non-outlying observations appear to be outliers. We develop a latent class model that assumes that each observation belongs to one of K unobserved latent classes, with each latent class having a distinct covariance matrix. We consider the latent class covariance matrix with the largest determinant to form an 'outlier class'. By separating the covariance matrix for the outliers from the covariance matrices for the remainder of the data, we avoid the problems of masking and swamping. As did Ghosh-Dastidar and Schafer, we use a multiple-imputation approach, which allows us simultaneously to conduct inference after removing cases that appear to be outliers and to promulgate uncertainty in the outlier status through the model inference. We extend the work of Ghosh-Dastidar and Schafer by embedding the outlier class in a larger mixture model, consider penalized likelihood and posterior predictive distributions to assess model choice and model fit, and develop the model in a fashion to account for the complex sample design. We also consider the repeated sampling properties of the multiple imputation removal of outliers.     

The EPA Health Risk Assessment of Methylcyclopentadienyl Manganese Tricarbonyl (MMT)

This paper describes the U.S. Environmental Protection Agency's assessment of potential health risks associated with the possible widespread use of a manganese (Mn)-based fuel additive, methylcyclopentadienyl manganese tricarbonyl (MMT). This assessment was significant in several respects and may be instructive in identifying certain methodological issues of general relevance to risk assessment. A major feature of the inhalation health risk assessment was the derivation of Mn inhalation reference concentration (RfC) estimates using various statistical approaches, including benchmark dose and Bayesian analyses. The exposure assessment component used data from the Particle Total Exposure Assessment Methodology (PTEAM) study and other sources to estimate personal exposure levels of particulate Mn attributable to the permitted use of MMT in leaded gasoline in Riverside, CA, at the time of the PTEAM study; on this basis it was then possible to predict a distribution of possible future exposure levels associated with the use of MMT in all unleaded gasoline. Qualitative as well as quantitative aspects of the risk characterization are summarized, along with inherent uncertainties due to data limitations.     

Three-part model for fractional response variables with application to Chinese household health insurance coverage

A survey on health insurance was conducted in July and August of 2011 in three major cities in China. In this study, we analyze the household coverage rate, which is an important index of the quality of health insurance. The coverage rate is restricted to the unit interval [0, 1], and it may differ from other rate data in that the “two corners” are nonzero. That is, there are nonzero probabilities of zero and full coverage. Such data may also be encountered in economics, finance, medicine, and many other areas. The existing approaches may not be able to properly accommodate such data. In this study, we develop a three-part model that properly describes fractional response variables with non-ignorable zeros and ones. We investigate estimation and inference under two proportional constraints on the regression parameters. Such constraints may lead to more lucid interpretations and fewer unknown parameters and hence more accurate estimation. A simulation study is conducted to compare the performance of constrained and unconstrained models and show that estimation under constraint can be more efficient. The analysis of household health insurance coverage data suggests that household size, income, expense, and presence of chronic disease are associated with insurance coverage.     

News

U. S. National Income Series Revised—Congress Votes No on Censuses of Business and Manufactures—Britain Revises Living Cost Index-U. S. and U. K. Surveys Uncover Lacks in Statistical Training-Forthcoming Statistical Conferences     

健康在多大程度上引致贫困脆弱性——基于CHNS农村数据的经验分析

贫困脆弱性的产生,很大程度上归因于居民健康水平的下降.在阐述健康引致贫困理论机制的基础上,基于CHNS在2000-2009年间追踪调查数据,对贫困脆弱性和健康效用指数HUI进行测度,估计并分析健康对贫困脆弱性的影响与内在机制.研究发现:居民健康水平的恶化会使其面临更高的贫困脆弱性,居民健康水平每下降10％,贫困脆弱性大约会上升6％;健康影响贫困脆弱性的作用机制中,物质资本和社会资本渠道被证明是相对有效的,而人力资本渠道尽管体现出微弱效应,但尚未在统计上得到显著性验证.因此,制订前瞻性的反贫政策应着眼于建立健康风险防范机制,包括提高农村医疗保障水平和重大疾病救助力度,并增加农村公共服务的投入,以促进其均衡化发展.     

Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

A case–control study relating railroad worker mortality to diesel exhaust exposure using a threshold regression model

A case–control study of lung cancer mortality in U.S. railroad workers in jobs with and without diesel exhaust exposure is reanalyzed using a new threshold regression methodology. The study included 1256 workers who died of lung cancer and 2385 controls who died primarily of circulatory system diseases. Diesel exhaust exposure was assessed using railroad job history from the US Railroad Retirement Board and an industrial hygiene survey. Smoking habits were available from next-of-kin and potential asbestos exposure was assessed by job history review. The new analysis reassesses lung cancer mortality and examines circulatory system disease mortality. Jobs with regular exposure to diesel exhaust had a survival pattern characterized by an initial delay in mortality, followed by a rapid deterioration of health prior to death. The pattern is seen in subjects dying of lung cancer, circulatory system diseases, and other causes. The unique pattern is illustrated using a new type of Kaplan–Meier survival plot in which the time scale represents a measure of disease progression rather than calendar time. The disease progression scale accounts for a healthy-worker effect when describing the effects of cumulative exposures on mortality.