Are old-age security and the utility of children in rural India really unimportant?

Abstract Extract In their recent paper in this journal M. and Carol Vlassoff are to be commended for helping to remedy the dearth of empirical studies on the old-age security motive for children (and particularly sons) in rural areas of developing countries.(1) However, while the questionnaire which they applied to 357 ever-married men in a rural village in Maharashtra state in India is potentially useful, several of the conclusions they derive from it are unwarranted and, if left unquestioned, would undoubtedly have the effect of setting back the serious investigation of the effects of this motive rather than furthering it. The invalid or at least questionable inferences are taken up one at a time in the order of their appearance:     

MARITAL PARADIGMS: COMPATIBILITY, TREATMENT, AND OUTCOME IN MARITAL THERAPY

Marital paradigms comprise the guiding images that serve as reference models for a couple's relationship. Such individualized images can be understood as variations on a small set of basic themes. An understanding of clients' marital paradigms can help foeus treatment on the most appropriategoals usingapproaches and techniques that are most effective for a particular couple. An unselected group of 103 couples seen in systems-oriented marital therapy were reviewed, to identify outcome and treatment issues as a function of marital paradigm. Based on outcome criteria that took marital paradigm into account, 92% of 38 cases where both partners identified with the same basic paradigm were judged to be treatment successes, while only 60% of the cases where the partners identified with different paradigms could be considered successful outcomes. Clinical approaches based on experience with marital therapy conducted within a paradigmatic framework are presented.     

Meta-Analysis as a Research Synthesis Methodology: Cause for Concern

ABSTRACT

The use of meta-analysis is growing in popularity. It is based on the fundamental notion of the effect size, and a critical assumption is that effect sizes based on different measures are directly comparable. In this article it is argued that the direct comparability of effect sizes across measures implies the invariance of the effect sizes across these measures. A model of standardized mean difference (SMD) effect size invariance is developed, based on multifacet generalizability theory, which shows that SMD effect size invariance requires certain validity invariance conditions to hold. One implication of these findings is that the direct comparability of SMD effect sizes based on different measurement procedures is an empirical matter requiring testing prior to conducting a meta-analysis. Findings are also discussed suggesting that violations of one of these conditions—universe score validity invariance—can bring about substantial differences across SMD effect sizes as a function of measurement procedure. These findings suggest the need for a more refined use of meta-analysis since meta-analytic results may be adversely impacted by the lack of direct comparability of effect sizes based on different measures.     

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.     

Eighteen Months Old in Dublin

SUMMARY: The data reported and discussed in this article are taken from the Dublin Child Development Study, a longitudinal study which started in 1985 with interviews of 200 women expecting their first child. Using information gathered in the first 18 months of the children's lives, an attempt is made to describe the sample of children as they arrive at the age of 18 months. The findings on the children's development are placed in the context of the study's information on their parents and in the wider social context in which the families lived, in Dublin in the late 1980s.     

Homosexuality: Protestant, Catholic, and Jewish issues; a fishbone tale

Homosexuality is compared to a fishbone caught in the church's throat that the church can neither eject nor swallow entirely. Authors in all denominations are questioning traditional church stances influenced by the model of clinical pastoral education. Most major denominations have made policy statements on homosexuality. Four such stances discussed here highlight some of the common issues denominations face in their reexamination of the subject. Homosexuals struggling for full acceptance in the church must confront the classical understanding of the human being and human sexual differentiation as these concepts have traditionally influenced the churches.     

“It's hard work,believe me!”: Active efforts to optimise housing by people who live with mental illness and access housing assistance

Secure and appropriate housing is critical for the well‐being of people living with mental illness (consumers). Yet it is often difficult to achieve. Housing assistance is available, but is often difficult for consumers to access and negotiate. While the need for support is well‐recognised, little is known about the active part consumers play in finding and keeping appropriate accommodation. This paper addresses the research question: How do consumers who use housing assistance actively manage their housing situations? In‐depth interviews were conducted with 18 consumers who had used housing assistance within the past five years. These were analysed using constant comparative analysis, based on a grounded theory approach. Participants engaged in a range of activities to address six major concerns: working toward my home; following the rules to keep what I have; managing and improving my accommodation; working with housing services; living within my current situation; and finding and using supports. All participants described times when their mental health negatively affected their ability to do these activities. The findings highlight the need for housing services and mental health services to collaborate to develop policies and protocols that place reasonable demands on consumers and support their abilities to actively manage their housing situations.