“You’re a ‘high-risk’ customer”: A qualitative study of women’s experiences of receiving information from health professionals regarding health problems or complications in pregnancy

BackgroundExperiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women’s perspectives on communicating with their healthcare providers about their concerns.AimThis study explored women’s experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy.MethodsThis was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data.FindingsWomen had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach.ConclusionTo improve women’s experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women’s need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.     

Effects of Outcome and Probabilistic Ambiguity on Managerial Choices

Information ambiguity is prevalent in organizations and likely influences management decisions. This study examines, given imprecise probabilities and outcomes, how managers make choices when they are provided with single-figure benchmarks. Seventy-nine MBA students completed two experiments. We found that, in a decision framed as a decision under certainty involving an ambiguous outcome, the majority of the subjects were ambiguity prone in the loss condition and switched to ambiguity aversion in the gain condition. However, in the presence of probabilistic ambiguity in a decision under risk, this expected switching pattern was shown only when the difference in riskiness between the two choice options (in the loss condition) was perceived to be relatively small. In a companion study, we used a written protocol approach to identify factors that affect decision makers' investment choices when faced with ambiguous outcomes. Protocols frequently mentioned that the ambiguous outcome option was risky, even in the case which was framed as a decision under certainty in the problem statement. In a decision under risk with ambiguous outcomes, the combination of probabilistic risk and outcome ambiguity was seen as even more risky.     

Explaining inconsistencies between patients and collaterals: validity in outcome studies of coercive alcoholism treatment

This study aims to assess the consistency of replies to questionnaires mailed to patients and two kinds of collaterals, i.e., social workers and significant others, at a public treatment center with socially unstable and compulsory committed patients. It compares the quantity and kind of discrepancies between replies by patients and collaterals on outcome data concerning social situation and drinking habits. It aims to measure the amount of systematic bias among factors that may explain inconsistencies between reports, especially the factors compulsory commitment, worse outcome, frequency of contact and type of collateral. The responders generally agreed. Variables in which there was less agreement were explored in logistic regressions using ten explanatory variables. Significant relations did not exceed those expected by chance. Discrepancies were not systematic in size and kind. On a six-rank ordinal scale of alcohol use or abuse, however, patients tended to underestimate the extent of their abuse. Inconsistencies here concerned the degree but not the presence of abuse. No difference in consistency due to type of collateral was found. In conclusion, the consistency of the questionnaires was high and independent of the social situation of the patient, of compulsory commitment and of other background or treatment factors, as well as of treatment outcome and type of collateral.     

Multivariate regression analysis of panel data with binary outcomes applied to unemployment data

Summary  In panel studies binary outcome measures together with time stationary and time varying explanatory variables are collected over time on the same individual. Therefore, a regression analysis for this type of data must allow for the correlation among the outcomes of an individual. The multivariate probit model of Ashford and Sowden (1970) was the first regression model for multivariate binary responses. However, a likelihood analysis of the multivariate probit model with general correlation structure for higher dimensions is intractable due to the maximization over high dimensional integrals thus severely restricting ist applicability so far. Czado (1996) developed a Markov Chain Monte Carlo (MCMC) algorithm to overcome this difficulty. In this paper we present an application of this algorithm to unemployment data from the Panel Study of Income Dynamics involving 11 waves of the panel study. In addition we adapt Bayesian model checking techniques based on the posterior predictive distribution (see for example Gelman et al. (1996)) for the multivariate probit model. These help to identify mean and correlation specification which fit the data well. C. Czado was supported by research grant OGP0089858 of the Natural Sciences and Engineering Research Council of Canada.     

Diagnostic checks for discrete data regression models using posterior predictive simulations

Model checking with discrete data regressions can be difficult because the usual methods such as residual plots have complicated reference distributions that depend on the parameters in the model. Posterior predictive checks have been proposed as a Bayesian way to average the results of goodness-of-fit tests in the presence of uncertainty in estimation of the parameters. We try this approach using a variety of discrepancy variables for generalized linear models fitted to a historical data set on behavioural learning. We then discuss the general applicability of our findings in the context of a recent applied example on which we have worked. We find that the following discrepancy variables work well, in the sense of being easy to interpret and sensitive to important model failures: structured displays of the entire data set, general discrepancy variables based on plots of binned or smoothed residuals versus predictors and specific discrepancy variables created on the basis of the particular concerns arising in an application. Plots of binned residuals are especially easy to use because their predictive distributions under the model are sufficiently simple that model checks can often be made implicitly. The following discrepancy variables did not work well: scatterplots of latent residuals defined from an underlying continuous model and quantile–quantile plots of these residuals.     

Group work in the mental health field: researching outcome

This paper reviews outcome studies from groups facilitated for persons living with serious mental illness. Although the research base is limited (groups posing considerable methodological challenges), available studies show that, in general, group work is as effective as individual work, if not more so. This paper describes findings from studies of short-term, long-term and self-help groups dealing with mood disorders, schizophrenia, eating disorders and borderline personality disorders over the last 10 years. The concept of ‘time-effective’ group work is discussed as are the potentially harmful effects of group participation. The paper concludes by arguing that group work is an effective and less expensive treatment option that would benefit from further research to establish an evidence base, both for current practice and for the expansion of group work practice in the future.     

Alternative posterior consistency results in nonparametric binary regression using Gaussian process priors

We establish consistency of posterior distribution when a Gaussian process prior is used as a prior distribution for the unknown binary regression function. Specifically, we take the work of Ghosal and Roy [2006. Posterior consistency of Gaussian process prior for nonparametric binary regression. Ann. Statist. 34, 2413–2429] as our starting point, and then weaken their assumptions on the smoothness of the Gaussian process kernel while retaining a stronger yet applicable condition about design points. Furthermore, we extend their results to multi-dimensional covariates under a weaker smoothness condition on the Gaussian process. Finally, we study the extent to which posterior consistency can be achieved under a general model where, when additional hyperparameters in the covariance function of a Gaussian process are involved.     

琐事颠覆男权：论《琐事》中的女权主义意识

苏珊.格拉斯佩尔的《琐事》是耐人寻味的,明妮.赖特(Minnie Wright)因受到长期的心灵窒息而杀害其丈夫这一事实出发,揭示了隐藏在其背后却贯穿全剧的三个二元对立关系:男性与女性的对立关系,男女价值观的对立,自由与压迫的对立。进而指出该体系中的对立关系是可以相互转化的,甚至一方可以反抗另一方。剧中的两位女性(黑尔太太和彼得斯太太)正是通过关注男人们所不齿的“琐事”与女主角无声的言说颠覆了男性的权威。     

民事诉讼举证责任的分配

举证责任的分配是举证责任的核心问题。举证责任包括行为责任和结果责任两方面的含义。“谁主张,谁举证”的一般分配原则,不能合理、有效地解决结果责任的分配。结果责任的分配所要解决的问题是,当诉讼即将终结时若案件事实仍然真伪不明,由谁承担不利的诉讼后果。我国现行的司法解释,完善了举证责任分配的有关规则,但结果责任的分配,尚需确立明确的标准和分配的规则。民事诉讼证据立法需要从实体法和程序法进一步完善,公平、科学地解决举证责任的分配。     

调整二元结构 推进城乡经济一体化

“三农”问题的症结在于中国传统的城乡二元结构以及不合理的制度安排,要改变中国传统的城乡二元结构以及不合理的制度安排,需要进行一系列制度改革的共同努力,才能逐步实现城乡一体化。实现城乡一体化要在市场化的基础上,站在统筹城乡发展的高度调整二元结构、推进城乡经济同步发展。