The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

ProblemAlthough perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.AimTo compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).MethodsWomen attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an ‘at-risk’ flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the ‘at-risk’ flag for PIPA than for Usual-Care. Each model’s performance was evaluated using the midwife’s agreement with the ‘at-risk’ flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.FindingsBoth models performed well at identifying ‘at-risk’ women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying ‘at-risk’ women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.DiscussionOverall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as ‘at-risk’ and ‘not at-risk’ of perinatal psychosocial morbidity.     

The Development of a Screening Tool for the Adult Children of Alcoholics Traits (STACAT)

In order to develop a valid tool for screening the traits of adult children of alcoholics (ACOA), this study focused on finding common characteristics among ACOA and developing a tool based on those characteristics. An item pool was generated targeting three distinct characteristics discussed in the alcohol literature related to ACOA, and the items were reviewed by a panel of experts. Using data from the sample, a confirmatory factor analysis, t -test and correlation analysis were conducted to gather various validity evidences for the screening tool. Cronbach's coefficient alpha test was used to check the internal consistency of the tool. The evidence of the reliability and validity for the ACOA traits screening tool provide the social work practice with an empirically validated method of measuring these traits in the children of alcoholics.     

跨文化管理中文化整合的探讨

文化冲突是跨文化管理的核心问题,文化整合是解决文化冲突的有效途径,本文从文化整合的目标、文化整合的原则、文化整合的方法详细探讨了如何进行有效的文化整合。     

民事诉讼目的略论

民事诉讼目的理论是民事诉讼法学最重要的基本理论之 ，数代学人对此进行的深入、持久而有效的研究形成了几种颇具代表性的学说。本文试图通过对现有学说的分析和评价，探索民事诉讼目的理论的规律性认识，并结合民事诉讼的本质特征和我国的现实国情，着眼于实践性和政策性，构筑更有建设性的、多元化、多层次的我国民事诉讼目的理论。     

Evaluating the Probative Value of Child Custody Evaluations

Abstract

The ultimate purpose of a child custody evaluation is to assist children and their families to restructure their family lives after divorce. A competent forensic work product is defined, in part, by the eval-uator'S use of current state of the art forensic methods and procedures applied to child custody evaluations (Gould, 1998). In this paper, a detailed structure for reviewing the reliability and relevance of a child custody advisory report is provided in order to help these professionals produce a work product of greater weight and sufficiency to the court and a work product that is increasingly useful to the families we seek to help.     

Composite screener for androgen deficiency related to the aging males’ symptoms scale

Objective.?Methodological characteristics of the Aging Males’ Symptoms (AMS) scale point towards a high standard measurement and comparison of health-related quality of life (HRQoL) over time or intervention. However, the scale was neither developed nor standardized as a screening instrument for androgen deficiency.

Methods.?Data of the Austrian ANDROX study suggested to develop a composite screener for androgen deficiency based on AMS, age, and BMI, to determine sensitivity and specificity to detect low total testosterone (TT) levels. The findings were compared with those of an independent sample of urological patients with suspicion of androgen deficiency (AD) from Germany (n = 803).

Results.?A graphical solution for a composite-screening tool was proposed, with three levels of suspicion for AD: positive screening result (high suspicion), equivocal result, and negative screening result (no suspicion, AD unlikely). The percentage of TT values < 4 ng/ml were 18.7%, 40.7% and 58.8% in the three categories: negative, equivocal and positive, respectively. The findings were confirmed in the independent German sample. In both instances, neither sensitivity nor specificity was very high, i.e., between about 50% and 75%.

Conclusion.?The results of the development and initial validation of the new screener are promising. Further information, and experience from the practice, is needed to confirm or refute the hypothesis that this screener is a useful tool for medical practice.     

我国行政听证制度产生及存在的原因初探

作为我国行政程序核心内容之一的行政听证制度,是从国外引入的.但它能在我国宪法中找到依据,并有符合我国国情的理论基础.同其他国家相比,我国行政听证制度有其独特的产生及存在的原因.它既是行政程序价值--公正、效率的内在要求,又是我国民主法治建设的必然结果.     

意大利式辩诉交易制度评介

意大利刑事诉讼法规定了“依当事人要求适用刑罚”的特殊程序.该程序具有与普通法的辩诉交易类似之处.法官可以根据当事人提出的请求适用减轻的刑罚.但是,它又具有自己的特点.在该程序的适用过程中,可以不需要控辩双方达成一致,甚至可以只根据被告人单方请求适用;法官在适用该程序中具有更大的主动性,他通过对有关情况的审查,作出最后判决;当事人只能对刑罚适用提出自己的请求,不能对定罪问题进行讨论;刑罚的减轻有明确的法定幅度,等等.这些特点,充分反映了意大利刑事诉讼中当事人主义与职权主义融合的特色.这也是其追求诉讼效率,节省司法资源的必然结果.     

On a bayesian approach for the shiftpoint problem

Using a direct resampling process, a Bayesian approach is developed for the analysis of the shiftpoint problem. In many problems it is straight forward to isolate the marginal posterior distribution of the shift-point parameter and the conditional distribution of some of the parameters given the shift point and the other remaining parameters. When this is possible, a direct sampling approach is easily implemented whereby standard random number generators can be used to generate samples from the joint posterior distribution of aii the parameters in the model. This technique is illustrated with examples involving one shift for Poisson processes and regression models.     

Rapid Assessment for Psychopathology in a College Health Clinic: Utility of College Student Specific Questions

Abstract

Objective: The purpose of this study was to determine the utility and unique benefits of employing the College Health Questionnaire (CHQ) in a college health care setting. The CHQ is a newly designed measure to assess psychosocial issues commonly problematic among college students. Participants: One hundred nine patients participated in the study during their medical appointments. Methods: Participants completed the study questionnaires (CHQ and Patient Health Questionnaire) in the waiting room. Their provider had the opportunity to use the responses in treatment decision making. Results: A majority (66.1%) endorsed at least one CHQ item. Patients who indicated traditional mental health problems were more likely to be prescribed psychotropic medications, whereas patients who endorsed psychosocial issues commonly problematic among college students were more likely to be referred for behavioral treatment. Conclusions: Screening for behavioral problems in college primary care settings without the use of college-related questions would result in missing numerous important psychosocial problems.