Quality adjusted survival analysis: A neglected application of the quality of well-being scale

Abstract

Background In survival analysis, those who are alive are statistically coded as 1.0 while those who are dead are coded as 0.0. Since everyone who remains alive is given the same score, a person confined to bed with an irreversible coma is alive and is counted the same as someone who is active and asymtomatic. The Quality of Well-being (QWB) scale defines levels of wellness on the continuum between death and optimum function and integrates morbidity and mortality into the same number. This paper demonstrates the effect of including mortality in QWB estimates for male adults with HIV infection.

Method This study involves follow-up of a cohort of 386 male adults participating in the San Diego HIV Neurobehavioral Research Center (HNRC). Patients were evaluated using the QWB at enrollment and at six month intervals. All patients were classified into three stages of HIV disease according to the Center for Disease Control (CDC) classification: CDC IV (symptomatic HIV disease), CDC II or III (asymptomatic infection) and uninfected male controls.

Results QWB scores were calculated with and without mortality included for men in each CDC class who completed a one year (N = 148) or two year follow-up (N = 60). At each evaluation, there were significant differences among CDC classes and inclusion of deaths increased the variance accounted for by CDC class at each evaluation.

Conclusions HIV infection has significant impacts upon both morbidity and mortality. Survival analysis captures only the mortality dimension, while quality adjusted survival analysis using the QWB includes both dimensions. We propose quality adjusted survival analysis as a more sensitive method for assessing outcome in HIV disease and other health conditions.     

Structural Equation Modeling of Spatial Presence: The Influence of Cognitive Processes and Traits

This article examines the formation process of spatial presence, which is conceived as a two-step process involving the construction of a mental model of the mediated environment, followed by the emergence of spatial presence. During both stages, cognitive processes and user traits are in effect. We present data derived from a pooled set of data of three studies using the same virtual environment. Structural equation modeling is used to confirm the proposed theoretical model. The results show that attention and the trait of visual spatial imagery are positive predictors of the mental model of the mediated environment. In the second step, the formation of spatial presence is governed by involvement, the suspension of disbelief, and the domain-specific interest, together with the mental model.     

Rights and Restrictions: Temporary Agricultural Migrants and Trade Unions’ Activism in Canada and Spain

In the last two decades, temporary worker programs have experienced an unprecedented expansion as instruments of what is defined as the migration management approach. Various migrant rights activists have voiced concerns about the treatment of temporary migrants in these programs and taken initiative to advance their rights. For some migrant rights advocates, it is the temporary nature of migration that is primarily responsible for the rights deficit. Yet, other migrant rights activists accept the temporariness of labour migration while trying to ensure that migrants receive legal protections for their work rights and that these protections are enforced. Trade unions are among the actors who try to protect and advance temporary migrants’ labour rights, but their role in supporting or challenging the principles of temporary migration governance has been neglected in the scholarly literature. The article addresses this gap by highlighting the divergent position of Canadian and Spanish Unions on temporariness of this type of migration. As the article argues, the difference is related to the following four factors: (1) the degree to which the unions in question are institutionally embedded in immigration policy-making, (2) the social environment (that is, discourses on temporariness advanced by other unions and grassroots organizations), (3) the degree of protectionism unions express vis-à-vis new immigrant flows and (4) whether regulated temporary migration is contrasted with permanent or unauthorized migration.     

Developing Dyadic Evaluation for Supervision: An Exploratory Factor Analysis

This study addresses the need for empirically validated tools to support the training, supervision, and the discovery of best practices in Marital and Family Therapy (MFT). This project represents a first step in developing the Dyadic Supervision Evaluation (DSE), an assessment tool that is grounded in developmental and systemic theory and is psychometrically strong. An Exploratory Factor Analysis (EFA) approach was applied to data from 88 trainee-supervisor dyads across four time periods during the first year of clinical training, resulting in 20 factors, including 9 factors for trainees and 11 factors for supervisors with internal reliabilities ranging from α’s = .82–.98. Discussion addresses the utility of the DSE in documenting the developmental and dyadic progression of supervision during the first year of MFT training.     

Maternal anxiety and depression and development of prematurely born infants in the first year of life

The purpose of this study was: (a) to assess and to compare anxiety and depression symptoms in mothers of preterm neonates during hospitalization in the Neonatal Intensive Care Unit, after discharge, and at the end of the infants' first year of life; and (b) to assess the child's development at 12 months of chronological corrected age (CCA). Thirty-six mothers, with no psychiatric antecedents assessed with the SCID-NP, were evaluated by STAI and BDI. The infants were assessed with Bayley-II Scales. There was a significant decrease in clinical symptoms of state-anxiety in mothers (p = .008), comparing the period during hospitalization and after discharge of the infants. Clinical symptoms of anxiety and depression were observed in 20% of the mothers at the end of the infants' first year of age. The majority of the infants exhibited normal development on Bayley-II at 12 months CCA; however, 25% of the infants displayed cognitive problems and 40% motor problems. The mothers' anxiety and depression symptoms decreased at the end of the first year of life of the pre-term infants and the children showed predominately normal development at this phase.