The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

Considering lesbian identity from a social-psychological perspective: two different models of "being a lesbian"

One long-standing project within lesbian studies has been to develop a satisfactory working definition of "lesbian." This article proposes two new models of a definition using principles of social psychology. Each model (a) utilizes the premise that gender lacks a categorical essence and (b) separates behavioral adherence to cultural stereotypes of femininity and masculinity from one's gender self-categorization. From these premises, I generate and critique two internally coherent models of lesbian identity that are inclusive (to different degrees) of various gender identities. For each model, the potential inclusion of trans men, trans women, genderqueers, and lesbian-identified cisgender men is evaluated. The explanatory power of these models is twofold. One, the models can serve as theoretical perspectives for scholars who study the intersection of gender and sexual identity. Two, the models can also characterize the everyday experience of people who have tacit working definitions of lesbian identity.     

Statistical approaches for conducting network meta-analysis in drug development

We introduce health technology assessment and evidence synthesis briefly, and then concentrate on the statistical approaches used for conducting network meta-analysis (NMA) in the development and approval of new health technologies. NMA is an extension of standard meta-analysis where indirect as well as direct information is combined and can be seen as similar to the analysis of incomplete-block designs. We illustrate it with an example involving three treatments, using fixed-effects and random-effects models, and using frequentist and Bayesian approaches. As most statisticians in the pharmaceutical industry are familiar with SAS? software for analyzing clinical trials, we provide example code for each of the methods we illustrate. One issue that has been overlooked in the literature is the choice of constraints applied to random effects, and we show how this affects the estimates and standard errors and propose a symmetric set of constraints that is equivalent to most current practice. Finally, we discuss the role of statisticians in planning and carrying out NMAs and the strategy for dealing with important issues such as heterogeneity.     

A Two-Question Method for Assessing Gender Categories in the Social and Medical Sciences

Three studies (N = 990) assessed the statistical reliability of two methods of determining gender identity that can capture transgender spectrum identities (i.e., current gender identities different from birth-assigned gender categories). Study 1 evaluated a single question with four response options (female, male, transgender, other) on university students. The missing data rate was higher than the valid response rates for transgender and other options using this method. Study 2 evaluated a method of asking two separate questions (i.e., one for current identity and another for birth-assigned category), with response options specific to each. Results showed no missing data and two times the transgender spectrum response rate compared to Study 1. Study 3 showed that the two-question method also worked in community samples, producing near-zero missing data. The two-question method also identified cisgender identities (same birth-assigned and current gender identity), making it a dynamic and desirable measurement tool for the social and medical sciences.     

The role of coping and problem drinking in men's abuse of female partners: test of a path model

This article examines the relationship of coping and problem drinking to men's abusive behavior towards female partners. While previous research has demonstrated a consistent association between problem drinking and male abuse of intimate partners, virtually no studies have assessed the role of coping in relation to men's violence. Furthermore, multivariate studies have not examined how these factors operate together to increase risk for abusive behavior. An ethnically diverse sample of 147 men in a court-mandated program for domestic violence offenders completed questionnaires at the first session. Path modeling was conducted to test the extent to which coping and problem drinking predicted both physical and psychological abuse. In addition, the relationships of problem drinking and physical abuse to injury of the men's female partners were examined. Results indicated that both the use of avoidance and problem-solving coping to deal with relationship problems were related indirectly to abusive behavior through problem drinking. Greater use of avoidance coping strategies was more likely among problem drinkers. By contrast, men who used higher levels of problem-solving coping were less likely to be problem drinkers. Avoidance, but not problem-solving coping also was directly and positively related to physical and psychological abuse. Men identified as problem drinkers were more likely to use both physical and psychological abuse. Finally, greater use of physical violence was strongly related to higher levels of injury among female partners, and served to mediate the relationship between problem drinking and injury. Results are discussed in terms of their contribution to the identification of risk and protective factors for men's violent behavior toward intimate female partners and implications for developing intervention strategies.     

Targeting the role of the endosome in the pathophysiology of Alzheimer's disease: a strategy for treatment

Membrane-bound endosomal vesicles play an integral role in multiple cellular events, including protein processing and turnover, and often critically regulate the cell-surface availability of receptors and other plasma membrane proteins in many different cell types. Neurons are no exception, being dependent on endosomal function for housekeeping and synaptic events. Growing evidence suggests a link between neuronal endosomal function and Alzheimer's disease (AD) pathophysiology. Endosomal abnormalities invariably occur within neurons in AD brains, and endocytic compartments are one likely site for the production of the pathogenic beta-amyloid peptide (Abeta), which accumulates within the brain during the disease and is generated by proteolytic processing of the amyloid precursor protein (APP). The enzymes and events involved in APP processing are appealing targets for therapeutic agents aimed at slowing or reversing the pathogenesis of AD. The neuronal endosome may well prove to be the intracellular site of action for inhibitors of beta-amyloidogenic APP processing. We present here the view that knowledge of the endosomal system in the disease can guide drug discovery of AD therapeutic agents.     

The susceptible circle: A taxonomy of followers associated with destructive leadership

While leadership scholars increasingly acknowledge the influence of followers in the leadership process, less attention has been paid to their role in the destructive leadership process. Specifically, the current debate lacks a broad-based understanding of different susceptible follower types that synthesizes related research across academic domains. Expanding on Padilla, Hogan, and Kaiser's (2007) toxic triangle model of destructive leadership, we integrate research and theory across various academic literatures to derive a cohesive taxonomy of vulnerable followers that we call the susceptible circle. We describe the core characteristics of each follower type, drawing on Barbuto's (2000) theory of follower compliance to highlight the psychological processes that motivate each follower to comply with destructive leaders. We then conclude by discussing theoretical and practical implications, as well as avenues for future research.     

Themes from older men's lay definitions of successful aging as indicators of primary and secondary control beliefs over time: The Manitoba Follow-up Study

Constructs of control have theoretically been equated to successful aging in the psychology literature. Hence, we used themes from lay definitions of successful aging to quantify the prevalence of primary and secondary control beliefs over time. In doing so we hoped to shed new light upon the virtually uncharted area of older men's primary and secondary control beliefs over time. Using successful aging narratives spanning a 10-year timeframe from the Manitoba Follow-up Study cohort, we mapped themes from older men's lay definitions of successful aging onto Rothbaum, Weisz, and Snyder's (1982) constructs of primary and secondary control. We then examined the prevalence of the constructs of control over 10 years and found that some men emphasized primary control, some emphasized secondary control, and others emphasized both, prospectively. Counter to what had previously been theorized, many older men continued to emphasize primary control as important well into late life. As expected, secondary control became more important with age. Furthermore, among those men who endorsed both primary and secondary control, significantly more men switched emphasis from primary to secondary control beliefs as they aged. This finding supported Rothbaum et al.'s (1982) surmise that individuals could switch from one type of control to another, presumably as life circumstances dictated. Knowing which types of control beliefs older men emphasize as they age has theoretical and practical implications. Theoretically, it sheds new light on the under-researched area of control beliefs in older men. Practically, it is informative for anyone interested in enhancing older men's perceptions of control in very late life, particularly in the face of otherwise uncontrollable age-related decline and imminent demise.     

Art therapy. Enhancing psychosocial nursing

1. The creative process can be a means of reconciling conflicts and increasing awareness. 2. Art provides a permanent representation of clients' internal states and reflects the changes seen in the therapeutic progression. 3. Many psychological states lend themselves to a much greater extent to graphic representation, as opposed to verbalization. 4. Art holds the potential for enhancing the quality of therapy for clients by increasing expression and facilitating insight.