Handgun sales, beer sales, and youth homicide, California, 1972-1993.

Whether regulating access to firearms and alcohol will reduce violent injuries is an important policy question. Empirical answers are difficult to obtain because only observational data are available. The present study estimated the association of firearm sales and alcohol sales with subsequent homicides, after adjusting statistically for potential confounders (e.g., unemployment rates) using California data from 1972 through 1993. Handgun sales and beer sales were lagged one year and used to explain variation in the homicides of Californians (e.g., 1990 sales were used to explain 1991 homicides). Differences across population groups were investigated, with a focus on 15- to 34-year-olds, the highest risk age group. Even when taking potential confounders in the base population into account, beer sales and handgun sales generally are associated positively one year later with homicide, particularly among young men. Reducing beer sales may reduce homicides. And, although they represent a small fraction of existing firearms, regulating the number of handguns sold may reduce the number of homicides.

Using a faculty evaluation triad to achieve evidence-based teaching.

Aneffective and comprehensive faculty evaluation system provides both formative and summative data for ongoing faculty development. It also provides data for annual faculty evaluation and tenure and promotion decision making. To achieve an effective system, a triad of faculty evaluation data sources--student ratings, teaching portfolio, and peer evaluation--were developed. Concurrently, a system of faculty mentorship was implemented, as well as an administrative structure to effectively use data to assist in merit pay and promotion decisions. Using a comprehensive, evidenced-based system to document, analyze, and improve teaching effectiveness is essential to assuring excellence in teaching and learning.

Measuring consumer experiences with primary care.

OBJECTIVE: To assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) for evaluating the attainment of the key characteristics of primary care services for children and youth. DESIGN: Community-based telephone survey. SETTING: Specific political subdivision in Washington, DC. PARTICIPANTS: Four hundred fifty parents/guardians of offspring 18 years of age or less. MEASURES: Reliability, validity and principal component analysis of 5 scales representing key aspects of the 4 cardinal domains of primary care included in the PCAT-CE. In addition, 2 subdomains (first contact use and extent of affiliation with a primary care source) were included as indices to describe overall patterns of use and affiliation with the particular source of care. RESULTS: Most scales had adequate internal consistency, test-retest reliability, and construct validity. The principal components factor analysis yielded 5 separate factors. These corresponded to the subdomains of first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; and comprehensiveness (both services available and indicated services received). CONCLUSIONS: Psychometric assessment supported the integrity and general adequacy of the PCAT-CE for assessing the characteristics and quality of primary care for children and youth. Testing of revised versions in a variety of different settings is underway. A major component of this testing is to explore the possibility of reducing the number of items while retaining sufficient detail about each component of primary care to make judgements about people's experiences with that care.

Measuring consensus about scientific research norms.

In this paper, we empirically explore some manifestations of norms for the conduct of science. We focus on scientific research ethics and report survey results from 606 scientists who received funding in 1993 and 1994 from the Division of Molecular and Cellular Biology of the Biology Directorate of the National Science Foundation. We also report results for 91 administrators charged with overseeing research integrity at the scientists' research institutions. Both groups of respondents were presented with a set of scenarios, designed by fractional factorial methods, describing different kinds of scientific conduct that in the eyes of some would likely be unethical. Respondents then were asked to evaluate each of these scenarios for how unethical the behavior might be and what kinds of sanctions might be appropriate. We use the responses to consider the nature of consensus around norms related to the practice of science and in particular, similarities and differences between scientists and science administrators. Implications for policy are also discussed.

Young guns: an empirical study of persons who use a firearm in a suicide or a homicide.

OBJECTIVES: The purpose of this investigation was to identify population groups at highest risk of using a firearm in a fatal incident. SETTING: Los Angeles County (California, USA). METHODS: Data were gathered from vital statistics reports and law enforcement records on the characteristics of suicide victims (n = 4799) and homicide suspects (n = 5369) from 1990 through 1994. Logistic regression was used to identify characteristics of the actor/perpetrator that were associated with firearm use. RESULTS: Persons less than 21 years old and males were more likely to use a firearm to kill themselves or someone else. Even when their other demographic attributes and characteristics of the incident itself were taken into consideration, persons under the age of 18 were substantially more likely than those 21 or more years old to use a firearm in the commission of a homicide (adjusted odds ratio = 2.59). Asians were less likely than white people to use a firearm in the commission of a suicide, whereas black people, Hispanics, and Asians were more likely than whites to use a firearm in the commission of a homicide. CONCLUSIONS: The US enacts and enforces some policies differentially by age. These data support the idea that such an approach may be warranted when addressing fatalities associated with the use of a firearm. Of particular interest, given minimum age requirements for firearm purchases, is the source of the weapons themselves.

News media coverage and the epidemiology of homicide.

OBJECTIVES: This study assessed how newspaper coverage of homicides corresponds to the epidemiology of homicide. METHODS: Stories in the Los Angeles Times about homicide (n = 2782) were compared with the homicides that occurred in Los Angeles County from 1990 through 1994 (n = 9442). The generalized linear model assessed how victim, incident, and suspect characteristics related to coverage. RESULTS: Even when multiple variables were taken into account, some homicides (those with female, child, or elderly victims; those in which the suspect was a stranger to the victim; those in wealthier neighborhoods) received more coverage and others (those with Black or Hispanic victims or victims with less than a high school education; those committed with nonfirearm weapons; those in which the suspect was an intimate of the victim) received less coverage than expected. CONCLUSIONS: Some homicides are more newsworthy than others. Potential implications of not providing the public with representative data are discussed.

Prediction of the healthcare needs of persons with HIV/AIDS from preliminary health assessment information.

The authors present evidence on the utility of standard health assessment information (i.e. health status, behavioural, and sociodemographic characteristics) collected by nurses for predicting the psychosocial and physiological healthcare needs of persons with HIV/AIDS in four clinical settings. A cross-sectional descriptive design using 386 patients tested the predictive accuracy of 10 predictors against 8 criterion variables. Multiple correlation and regression analyses produced employment status and income level as statistically significant predictors of several types of psychosocial needs. Only one equation with employment, medical diagnosis, and income predicting Health Behaviours/Social Support was clinically significant.

Health care needs of persons with HIV/AIDS in various settings.

This study describes the psychosocial and physiological health care needs of persons with HIV/AIDS in hospital, outpatient, home care, and long-term care settings. A cross-sectional descriptive design with 386 patients selected from the four settings was used to test between-setting differences on Healthcare Needs Scales. Univariate analyses of variance of scale and subscale scores and Kruskal-Wallis analyses of variance by ranks on item scores were computed. There was neither a relationship between psychosocial and physiological health care needs nor a distinctive pattern of needs across settings by HIV classification. The patients' needs varied between settings on health behaviors/social support, health management, and elimination/physical/sensory functions but were quite similar in psychosocial/financial support and neurological/digestive functions. These results question assumptions about the relationships among stage of HIV infection, level and type of health care need, and type of setting and suggest that health system resources and nursing care focus on both the psychosocial and physiological needs of persons with HIV/AIDS using individualized protocols.

Use of primary caretakers as proxies to measure the health care needs of patients with AIDS.

This study evaluated the validity of patient-proxy responses to the Healthcare Needs Scale for Patients with HIV/AIDS. This scale measures environmental and psychosocial support, financial resources, health behaviors, social support, and health management. A sample of 35 patients with HIV/AIDS and their primary caretakers was selected from a hospital inpatient AIDS unit in Baltimore, Maryland, between 1990 and 1992. The significance of discrepancies between the patient and caretaker responses was tested with Wilcoxon's matched pairs/signed ranks test. None of the 19 scale items exhibited a significant Z statistic. It was concluded that the primary caretakers of PWAs can serve as informed proxies and provide accurate information on the patients' healthcare needs.

Healthcare needs scales for patients with HIV/AIDS: construct validation.

The authors report on the quantitative analysis phase in the development of the Healthcare Needs Scales for Patients with HIV/AIDS (Berk, Poe, & Bagis-Smith, 1992). The scales were administered to a cross-sectional sample of 386 patients from hospital, outpatient HIV clinic, homecare, and long-term care settings. The authors collected construct validity evidence based on a factor analysis and comprehensive item, subscale, and scale analyses, concurrent validity evidence of primary caretakers serving as proxies for hospital patients, and internal consistency reliability evidence. The results produced an instrument for diagnosing the psychosocial and physiological needs of the target population.

Murder Board: some postmortem thoughts on instrument construction.

The Murder Board provides a mechanism by which educational and psychosocial instruments developed for use in nursing research can be systematically reviewed to identify errors or flaws in construction. The information for this review is based on a small field-test of the tool administered to a sample of respondents representative of the population for whom the instrument was designed. Only eyewitness evidence obtained from this sample can reveal certain types of errors that would not be detected at any other stage of development. The board can use this evidence to comprehensively review each item and the instrument's structure and format to recommend appropriate revisions. This process should produce a draft version of an instrument that is free of structural flaws.

Healthcare needs scale for patients with HIV/AIDS: content validation.

The authors of this study adapted Peters' (1987) community health specifications of patients' nursing requirements so they could be applied to patients with HIV/AIDS in hospital, dedicated outpatient HIV clinic, home care, and long-term care settings. The authors then collected validity evidence on the revised specifications, developed a sample of 62 multiple-choice items, and obtained content-related validity evidence via a judgmental review panel. The results produced: (a) a set of specifications for the environmental, psychosocial, physiological, and health behaviors domains; and (b) a 44-item scale of patient characteristics related to four levels of healthcare needs.

Importance of expert judgment in content-related validity evidence.

The unified conceptualization of validity with regard to content-related evidence has been expressed succinctly by the authors of the Standards for Educational and Psychological Testing (AERA et al., 1985): Content-related evidence of validity is a central concern during [instrument] development, whether such development occurs in a research setting, in a publishing house, or in the context of professional practice. Expert professional judgment should play an integral part in developing the definition of what is to be measured, such as describing the universe of content, generating or selecting the content sample, and specifying the item format and scoring system. Thus, inferences about content are linked to [instrument] construction as well as to establishing evidence of validity after [an instrument] has been developed and chosen for use. (p. 11) This article has demonstrated the process of collecting content-related validity evidence in terms of the specific requirements of the Standards. Five standards were identified and interpreted according to the initial stages of instrument construction: domain specification, item development, and item, subscale, and scale content validation. The role of expert judgment during these stages and the variety of evidence that can be gathered were described. For most instruments, the review process would necessitate two meetings of 1 to 2 hours each to review the domain specifications and another two meetings to determine the match between the items and the specifications. The importance of these 8 hours or whatever additional time is needed to obtain the validity evidence was emphasized. Finally, an application of the Standards was provided to illustrate step-by-step how the judgmental review process can be planned and executed.

Test of motor and neurological functions in high-risk infants: preliminary findings.

A 24-item Test of Motor and Neurological Functions (TMNF) was developed to measure automatic and equilibrium reactions, muscle tone, primitive reflexes, and qualitative movement findings in infants up to 12 months of age. A preliminary study was conducted with data gathered on 31 high-risk and 25 full-term infants ranging in age from 0 to 12 months. The psychometric quality of the test was investigated in terms of construct validity and interobserver reliability. It was determined that the most effective subtests were the automatic/equilibrium reactions and muscle tone subtests for the 7 to 12-month age group. The high-risk infant sample revealed significantly more qualitative findings at all age levels when compared to the full-term infants, particularly after 6 months of age. It was also found that the TMNF could be administered with a high degree of objectivity. These findings must be regarded as "tentative" until longitudinal cross-validation studies and research on decision-making reliability have been conducted.

The value of WISC-R profile analysis for the differential diagnosis of learning disabled children.

Examined the research on WISC-R profile analysis germane to the differential diagnosis of learning disabled children in relation to several methodological problems that concern score use and interpretation. The evidence based on Bannatyne's (1974) recategorization of the subtests indicates a Spatial greater than Conceptual greater than Sequencing pattern of performance for learning disabled children. The application of this evidence of group characteristics to the individual child is problematic. The trend is not consistent. In addition, the interpretation of the individual profile is complicated by the unreliability of a few of the subtests, the unreliability of subtest difference scores, the unreliability of Bannatyne category difference scores, and the invalidity of the difference scores for discriminating between learning disabled and other children. It was recommended that clinicians not use the WISC-R profile to diagnose specific learning disabilities. Instead, the analysis may have greater utility in the prevention and remediation of learning problems, especially at the preschool level.

Verbal-performance IG discrepancy score: a comment on reliability, abnormality, and validity.

Analyzed the reliability abnormality, and validity of Verbal-Performance discrepancy scores on the WISC-R in relation to clinical decision-making about learning disabilities. From the standpoint of screening and differential diagnosis, the information of greatest value seems to be the magnitude of the discrepancy that is both reliable and valid for learning-disabled children. Inasmuch as definitive evidence on validity is not available at present, it is recommended that discrepancy scores not be used as the primary diagnostic tool. Information on the abnormality of the scores was judged less useful in this context.

The delivery of continuing education: teleconferencing, an alternative mode.

An experimental offering of the Medical Library Association's continuing education course CE 46, Library Management/Budgeting, was made available to sixteen health sciences librarians via the University of Wisconsin-Education Telephone Network. Features of the hardware of the teleconference network, a few applications relating to medicine and library science, and administrative considerations are examined. The paper also describes how the experimental course was conducted, course participants, design, problems encountered, and evaluation data obtained from participants. A comparison between the teleconferencing mode of delivery and the traditional face-to-face format is stressed. Recommendations call for continued consideration of teleconferencing as a method of delivering continuing education courses and suggest the possibility of MLA providing its own teleconferencing network.