Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

Testing a stochastic foraging model in an operant simulation: Agreement with qualitative but not quantitative predictions

An operant simulation of foraging through baited and empty patches was studied with 4 pigeons. On a three-key panel, side keys were designated as patches, and successive opportunities to complete 16 fixed-ratio 10 schedules on side keys were defined as encounters with feeders. In a random half of the patches in any session, some of the fixed-ratio 10 schedules yielded reinforcement (baited feeders) and the other schedules yielded nonreinforcement (empty feeders). In the other half of the patches, all feeders were empty. Pigeons could travel between patches at any time by completing a fixed-ratio schedule on the center key. An optimal foraging model was tested in Experiments 1 and 2 by varying center-key travel time and number of baited feeders in baited patches. The ordinal predictions that number of feeders visited in empty patches would increase with travel time and decrease as number of baited feeders increased were supported, but pigeons visited far more feeders in empty patches than the optimal number predicted by the model to maximize energy/time. In Experiment 3, evidence was found to suggest that the number of empty feeders encountered before the first baited feeder in baited patches is an important factor controlling leaving empty patches.     

The many null distributions of person fit indices

This paper deals with the situation of an investigator who has collected the scores ofn persons to a set ofk dichotomous items, and wants to investigate whether the answers of all respondents are compatible with the one parameter logistic test model of Rasch. Contrary to the standard analysis of the Rasch model, where all persons are kept in the analysis and badly fittingitems may be removed, this paper studies the alternative model in which a small minority ofpersons has an answer strategy not described by the Rasch model. Such persons are called anomalous or aberrant. From the response vectors consisting ofk symbols each equal to 0 or 1, it is desired to classify each respondent as either anomalous or as conforming to the model. As this model is probabilistic, such a classification will possibly involve false positives and false negatives. Both for the Rasch model and for other item response models, the literature contains several proposals for a person fit index, which expresses for each individual the plausibility that his/her behavior follows the model. The present paper argues that such indices can only provide a satisfactory solution to the classification problem if their statistical distribution is known under the null hypothesis that all persons answer according to the model. This distribution, however, turns out to be rather different for different values of the person's latent trait value. This value will be called ability parameter, although our results are equally valid for Rasch scales measuring other attributes.As the true ability parameter is unknown, one can only use its estimate in order to obtain an estimated person fit value and an estimated null hypothesis distribution. The paper describes three specifications for the latter: assuming that the true ability equals its estimate, integrating across the ability distribution assumed for the population, and conditioning on the total score, which is in the Rasch model the sufficient statistic for the ability parameter.Classification rules for aberrance will be worked out for each of the three specifications. Depending on test length, item parameters and desired accuracy, they are based on the exact distribution, its Monte Carlo estimate and a new and promising approximation based on the moments of the person fit statistic. Results for the likelihood person fit statistic are given in detail, the methods could also be applied to other fit statistics. A comparison of the three specifications results in the recommendation to condition on the total score, as this avoids some problems of interpretation that affect the other two specifications.The authors express their gratitude to the reviewers and to many colleagues for comments on an earlier version.     

Modeling item responses when different subjects employ different solution strategies

A model is presented for item responses when different subjects employ different strategies, but only responses, not choice of strategy, can be observed. Using substantive theory to differentiate the likelihoods of response vectors under a fixed set of strategies, we model response probabilities in terms of item parameters for each strategy, proportions of subjects employing each strategy, and distributions of subject proficiency within strategies. The probabilities that an individual subject employed the various strategies can then be obtained, along with a conditional estimate of proficiency under each. A conceptual example discusses response strategies for spatial rotation tasks, and a numerican example resolves a population of subjects into subpopulations of valid responders and random guessers.The first author's work was supported by Contract No. N00014-85-K-0683, project designation NR 150-539, from the Cognitive Science Program, Cognitive and Neural Sciences Division, Office of Naval Research. We are grateful to Murray Aitkin, Isaac Bejar, Neil Dorans, Frederiksen, and Marklyn Wingersky for their comments and suggestions, and to Alison Gooding, Maxine Kingston, Donna Lembeck, Joling Liang, and Kentaro Yamamoto for their assistance with Example 2.     

Effectiveness of School-Based Mental Health Services for Children: A 10-Year Research Review

A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search. Of the 5,046 references initially identified, 228 were program evaluations. Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures. Only 16 studies met these criteria. Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation. The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model. Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions.     

Positive and negative self-related goals and subjective well-being: A prospective study

To examine whether having self-related personal goals, or rather whether positive or negative appraisal of them, is associated with subjective well-being, 311 students were asked to complete the Personal Project Analysis (PPA) and revised Beck Depression Inventory, first at the beginning of their studies, and then 2 years later. After 3 years they were asked about the use of mental health services. Two groups of students were identified: (1) those with positive self-projects and (2) those with negative self-projects. The results showed that both positive and negative self-related projects showed stability across a 2-year period, but only negative ones were prospectively predicted by earlier depressive symptomatology. Although neither positive nor negative projects predicted depressive symptomatology, both predicted the use of mental health services.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

The use of the occupational stress indicator (OSI) in factory workers in China

The purpose of the study was to investigate occupational stress among Chinese factory workers (N=342), from three cities of South East China, using the shortened version of the Occupational Stress Indicator (OSI)-2. The results showed that the reliabilities and predictive validity of the OSI-2 subscales and other subscales used for the study were reasonably high. Quite a high percentage of workers perceived high work pressure. The main sources of stress were intrinsic to the job; and the coping strategies that were most frequently used to tackle stress were “control” methods. In addition, “satisfaction on environmental condition” seemed to be a common predictor for job satisfaction, and mental and physical well-being. The logical relationships between job satisfaction, mental well-being and physical well-being in Chinese workers have provided support to the findings obtained in Western countries.     

分时距认知特点的研究

本研究探讨了分时距估计的认知特点,检验了SS模型、PT模型和CS模型的预测效度,结果表明：分时距估计主要是在信息提取阶段采用分段推算策略对时间信息进行重建的过程,变化／分割和注意分配对分时距估计有显著影响;SS模型的预测效度最低,PT、CS模型的预测效度较高。