EDITH WHARTON'S SICK ROLE

In this article, we conduct a textual analysis of Edith Wharton's 1911 novel, Ethan Frome . We offer three readings. The first presents Wharton's account of illness through a framework developed foru decades later by Talcott Parsons. Wharton's sick role was less medico-centric than Parsons; it emphasized the importance of class, gender and community in defining and legitimizing the sick role. Our second reading explores the socially constructed nature of roles in illness. The sick role as portrayed by Wharton is not the social fact later conceived by Parsons, but a social construct with no determinate reference beyond that which the local community is willing to grant it. Our third reading examines the social context, particularly the power relations, within which this story of illness has been constructed.     

The analysis of incomplete data using stochastic covariates

In the development of many diseases there are often associated random variables which continuously reflect the progress of a subject towards the final expression of the disease (failure). At any given time these processes, which we call stochastic covariates, may provide information about the current hazard and the remaining time to failure. Likewise, in situations when the specific times of key prior events are not known, such as the time of onset of an occult tumour or the time of infection with HIV-1, it may be possible to identify a stochastic covariate which reveals, indirectly, when the event of interest occurred. The analysis of carcinogenicity trials which involve occult tumours is usually based on the time of death or sacrifice and an indicator of tumour presence for each animal in the experiment. However, the size of an occult tumour observed at the endpoint represents data concerning tumour development which may convey additional information concerning both the tumour incidence rate and the rate of death to which tumour-bearing animals are subject. We develop a stochastic model for tumour growth and suggest different ways in which the effect of this growth on the hazard of failure might be modelled. Using a combined model for tumour growth and additive competing risks of death, we show that if this tumour size information is used, assumptions concerning tumour lethality, the context of observation or multiple sacrifice times are no longer necessary in order to estimate the tumour incidence rate. Parametric estimation based on the method of maximum likelihood is outlined and is applied to simulated data from the combined model. The results of this limited study confirm that use of the stochastic covariate tumour size results in more precise estimation of the incidence rate for occult tumours.     

Training with o (observing) and T (treatment) teams in live supervision: reflections in the looking glass*

Working with a treatment and observing team at the same time, behind the oneway mirror, offers a variety of ways to: (a) generate multiple realities; (b) work with two different models of family therapy simultaneously; and (c) provide feedback on the teams' own roles, rules and group process. The process that 6 trainees and two supervisors used with T and O teams to examine their own coevolution as a therapeutic system using the Milan model of family therapy and Ericksonian hypnotherapy is described. The article concludes with a discussion of the advantages and pitfalls of this type of dual supervision.     

Severely Traumatized Siblings: A Treatment Strategy

Siblings who have suffered severe trauma and disrupted attachment relate to one another in ways that interfere with individual development, the chance to benefit from connections with adults, the establishment of healthy sibling relationships, and the working through of traumatic experiences. The authors use case examples to illustrate four distinct sibling patterns: absent, adult lockout, half and half, and trauma shield. The authors highlight the importance of recognizing these types and then varying the therapist's treatment stance to pursue five goals. These include suspending problematic sibling relationships to create room for bonding with caring adults, transferring attachment behaviors and impulses to a receptive adult, resuming healthy individual development, forming more adaptive sibling connections, and expressing shared traumatic content.     

Health education evaluation and beliefs and practices in rural Tamil Nadu

This paper reports the findings of 2 studies in North Arcot District of Tamil Nadu, one of which was an evaluation of health education programs. A wide range of information is made available on the local Tamil names for allopathic diseases, their etiology, beliefs related to preventive and curative practices, significance and medical consequences of recourse to doctors and practitioners of indigenous systems of medicine. The attitude survey covers a variety of topics about which not much is known -- immunization, sanitation, environment, antenatal care and allopathic medicine. The data suggest that allopathic treatment is preferred for most diseases, although traditional or spiritual methods continue to be used for certain diseases, many of which are believed to be the cause of infant and child mortality.     

Mutual Transformation in Psychotherapy

A growing body of psychoanalytic literature recognizes that dynamic therapy can be transformative for therapists as well as for patients. Relational concepts such as co-construction and mutual regulation highlight interactive processes that facilitate bidirectional change. This paper summarizes the theoretical rationale for mutual transformation, presents a detailed case study illustrating how transformation evolves, and concludes with a brief commentary written by the patient.     

Viewing the child as a participant within context

This paper explores tensions between the social nature of learning and the current emphasis upon individual support. The paper contrasts the focus upon context in discussions with parents and practitioners, with the focus upon the individual within formal and informal written documents. The analysis is partly situated within the first author’s experiences as a parent researcher, drawing additionally upon ethnographic research carried out with families involved in early intervention, including an evaluation of over 150 pages of documentation provided by a parent. It identifies the need for assessment and evaluation to focus upon and record the broad range of context that influences learning.     

Methods to assess measurement error in questionnaires of sedentary behavior

Sedentary behavior has already been associated with mortality, cardiovascular disease, and cancer. Questionnaires are an affordable tool for measuring sedentary behavior in large epidemiological studies. Here, we introduce and evaluate two statistical methods for quantifying measurement error in questionnaires. Accurate estimates are needed for assessing questionnaire quality. The two methods would be applied to validation studies that measure a sedentary behavior by both questionnaire and accelerometer on multiple days. The first method fits a reduced model by assuming the accelerometer is without error, while the second method fits a more complete model that allows both measures to have error. Because accelerometers tend to be highly accurate, we show that ignoring the accelerometer's measurement error, can result in more accurate estimates of measurement error in some scenarios. In this article, we derive asymptotic approximations for the mean-squared error of the estimated parameters from both methods, evaluate their dependence on study design and behavior characteristics, and offer an R package so investigators can make an informed choice between the two methods. We demonstrate the difference between the two methods in a recent validation study comparing previous day recalls to an accelerometer-based ActivPal.     

Assessing lesbian and gay prospective foster and adoptive families: a focus on the home study process

Foster care and adoption by gay men and lesbians is not a new phenomenon. Children and youth have always been placed by states and public agencies in homes with gay and lesbian parents. Some gay men and lesbians have fostered or adopted children independently from private agencies or have made private adoption arrangements with individual birthmothers, while others have fostered or adopted through the public system. Drawing on research literature, practice wisdom from 31 years of child welfare experiences, and case examples, this article offers child welfare professionals guidelines for competent assessment with prospective foster or adoptive parents who identify as lesbian or gay.