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.     

Seriousness checks are useful to improve data validity in online research

Nonserious answering behavior increases noise and reduces experimental power; it is therefore one of the most important threats to the validity of online research. A simple way to address the problem is to ask respondents about the seriousness of their participation and to exclude self-declared nonserious participants from analysis. To validate this approach, a survey was conducted in the week prior to the German 2009 federal election to the Bundestag. Serious participants answered a number of attitudinal and behavioral questions in a more consistent and predictively valid manner than did nonserious participants. We therefore recommend routinely employing seriousness checks in online surveys to improve data validity.     

General and Specific Question Sequence Effects in Satisfaction Surveys: Integrating Directional and Correlational Effects

Researchers investigate relationships between well-being variables and the antecedents to well-being by examining statistical results from survey data. A common measurement approach in survey designs is to include measures of more specific aspects (i.e., facets) and more global assessments of well-being in the same survey. Research shows, however, that the sequence of specific and general measures within the survey affects the magnitude of relationships between specific and general measures. In the current study, we extend such general-specific sequence research by offering an alternative explanation for the occurrence of such sequence effects. Specifically, we propose that having the specific measure before the more general one can shift the mean-level of the specific measure toward the extremes, thereby yielding restricted variance and, ultimately, attenuated correlations between the two measures. We test our proposal on two separate samples examining job-related well-being. Our findings show that the general-specific measure relationship is stronger and the mean-level of satisfaction is lower when the general measure is read first. Our findings suggest important theoretical implications for the study and measurement of well-being. Most importantly, our study suggests that placing general measures before specific measures could avoid sequence-related bias.     

Übertragung und Übertragungsneurose

The authors investigate Freud's concepts of transference, transference neurosis and their mutual relationship. They discuss the current criticism made on the concept of transference neurosis and raise the question, why patients accept the analyst's interpretations? They suggest understanding transference neurosis as conscious manifestations of transference referring to the analyst which are the outcome of successive interpretations of the type "just-like" followed, changed, and removed again by "just-like-it-was"-interpretations. They conclude that the patient does accept these interpretations not for reasons that are rational, but for reasons pertaining the transference situation.     

The Growing Use of Firearms by Suicidal Older Women, 1979–1992: A Research Note

Suicide among older women (65 +) has received very little attention despite increasing numbers of suicides in this population. An examination of national mortality data from the National Center for Health Statistics for the years 1979 through 1992 shows an increasing trend in rates of suicide among older women and a declining trend among women under 65. Over the 14-year period, firearms replaced poisoning as the most prevalent method of suicide by women 65 and over. The results seem consistent with the assertion that the availability, familiarity, and cultural acceptability of firearms may play a role in the choice of suicide method among older women. Although violent death and the use of firearms are generally associated with males in our society, the trends reported here indicate that greater attention to firearm suicides among older women is warranted.     

Jacob's Blessing and the Curse of Oedipus: Sibling Rivalry and its Resolution

The present paper examines the effects of paternal relationship with sons on the sons' relationship with each other. The Biblical stories initially abound with conflict between the sons because they vie for the father's blessing and favor. The Greek stories initially show little sign of sibling rivalry because the sons band together against a threatening father. With time, paternal blessing (as exemplified by Jacob's blessing) overcomes sibling rivalry. The Greek families become more pathological with time, as the diminution of the paternal threat allows on accentuating of sibling conflict (as exemplified by the curse of Oedipus).