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Biomedical subjects

A Vinokur

Publications and source records attributed to A Vinokur.

9 recordsLinked to original sources
PubMed1988

Do consensus conferences work? A process evaluation of the NIH Consensus Development Program.

The purpose of this evaluation study is to identify problems and suggest modifications in the NIH Consensus Development Program. The current program consists of three-day conferences in which experts assess medical technologies for issues of efficacy, safety, conditions of use, and other related topics (e.g., costs and social impact). Eight consensus conferences held between 1980 and 1982 were studied in depth using a variety of methods; five of the conferences were investigated concurrently. In addition, archival material was examined for all but one of the 33 conferences held up to that time, and four planning meetings for future conferences were observed. The delay in publishing our findings provided an opportunity to examine the changes introduced by NIH; it also allowed us to avoid the criticism of numerous prior evaluations for finding fault with programs that are still developing. NIH adopted many of the recommendations in our evaluation report and has investigated others. Based on our evaluation and more recent evidence, however, we conclude that the major problem that was uncovered--selection bias, particularly with respect to the choice of questions and panelists--remains a significant threat to the credibility of the consensus process. More specifically, the results indicate that controversial issues cannot be properly addressed within the present conference format, although that was one of its major purposes. Recommendations for improving the consensus process are presented, as are their implications for a larger set of consensus activities that are currently being conducted.

Consensus Statements as Topic↗
PubMed1987

Determinants of perceived social support: interpersonal transactions, personal outlook, and transient affective states.

During the last decade, the study of social support has relied heavily on recipients' reports of perceived support. However, such reports of support may reflect not only actual supportive interpersonal transactions but also the recipients' own personal and perceptual dispositions and comparatively transient mood states. This study examines these factors' independent effects on perceived support. Interpersonal transactions of social support were assessed in a longitudinal panel design using reports from 486 adult male respondents and their significant others (mostly wives). Using structural modeling techniques (LISREL VI), an unfolding series of statistical analyses were performed. The results provide strong support for a model in which recipients' perception of support is determined significantly and strongly by actual interpersonal transactions as reported by significant others, moderately by the recipients' negative outlook bias, and weakly by their anxiety and depression as indicators of their poor mental health. The implications of the results for future research are discussed.

Adult↗
PubMed1986

Cognitive and affective components of life events: their relations and effects on well-being.

A model of how five key facets of life events are related to one another and influence mental health and functioning was examined. The facets are the experience of control over, anticipation of, pleasantness from, stress generated by, and adjustment to life events. Multivariate analyses of data from 420 adult male respondents yielded results that were largely consistent with the hypothesized model. The results suggested that control over and anticipation of life events influenced the perceived stress produced by the events and the ability to adjust to them. In turn, it appeared that such stress and adjustment influenced mental health and functioning. The effects of control and anticipation on mental health and functioning were indirect only. Contrary to our hypothesis, control seemed to heighten perceived stress; but control, as well as anticipation, appeared to increase the ability to adjust. Whereas previous studies found no effect of desirable events on well-being, this study found that pleasant events had a beneficial effect. The discussion examines the implications of the findings for future research.

Adaptation, Psychological↗
PubMed1985

Group decision making by experts: field study of panels evaluating medical technologies.

Decision-making processes and their outcomes were investigated in six consensus development conferences at the National Institutes of Health in which panels of experts evaluated new medical technologies. One hundred seventy-seven self-administered questionnaires were obtained from participants in these conferences. Questionnaire data were analyzed along with data derived from content analyses of the six consensus statements (CS) produced by the conferences. Results of these analyses provide considerable support for the hypotheses that the quality of the outcome (i.e., the CS) is determined by the existence of an interaction process, a decision procedure, and a chairperson, which facilitate the exchange of relevant information. Strong disagreements among the panelists appear to inhibit such exchange and harm the quality of the CS. Personal satisfaction appears to be more strongly related to the quality of the process and of the information disseminated than to the quality of the outcome. A clear relation was found between the panelists' status and expertise, their participation in the process, and their contribution to the CS. The pattern of these findings is quite similar to that obtained in laboratory studies. The role of preconference organizational factors, such as the selection of conference questions, panel, and speakers, and the characteristics of the technology are discussed.

Decision Making↗
PubMed1977

Twin relationships and depression.

The authors investigated closeness and other variables measuring depression in 22 identical and 13 fraternal twin pairs. Each twin rated him/herself on a two-part questionnaire; part 1 included questions on demographic characteristics and the twin relationship, and part 2, the Zung Self-Rating Depression Scale, measured depressive symptoms. There was a high degree of agreement across all variables for the total sample, and degrees of depression were comparable to that in the general population. Closeness was found to be inversely correlated with depression. The authors suggest that future studies include other groups (siblings, spouses, etc.) and follow-up data.

Adolescent↗
PubMed1977

A psychosocial comparison of drunken drivers and alcoholics.

A self-administered questionnaire was used to compare selected demographic, drinking and psychosocial variables of 306 convicted drunken drivers with those of 289 alcoholics and 269 controls. The drunken-driver group fell between the other groups on many parameters but resembled the control group on as many others.

Adaptation, Psychological↗
PubMed1975

Desirable versus undesirable life events: their relationship to stress and mental distress.

The research of Holmes, Rahe, and their associates disclosing that life events and stress are related to the onset of physical illness is extended to the psychological domain in the present study. Using a modified version of their life events checklist, it is shown that an accumulation of life events is correlated with self-reported tension and distress, with emotional disturbances manifested by depression, paranoid thinking, suicidal proclivity, and anxiety, as well as with behavioral indications of stress such as drinking and traffic accidents. Most importantly, it is shown that these relationships do not hold for desirable life events but primarily for undesirable events. Thus, the authors suggest that the quality of the events in terms of their desirability is the crucial determinant of stress and the above-mentioned relationships rather than simply the life change produced by the events, as suggested in earlier studies. Methodological and theoretical implications for future research are discussed, emphasizing the importance of studying additional stress-relevant dimensions such as anticipation of the events and control over their outcome.

Affective Symptoms↗
PubMed1975

Role of life events in accident causation.

The concept of stress as causative in human illness has been documented in studies relating significant illnesses to major life changes (i.e., marriage, parenthood, divorce, employment changes, etc.). Although some studies have related accidents to stress, the various types of stress involved were either poorly-defined or narrowly delineated by the specific interests or professional training of the investigators. Our current study represents an attempt to investigate traffic accidents as a function of multi-dimensional stresses which result from life changes experienced by the driver. In addition we have attempted to assess the subject's feelings and responses to these life changes as well as his general adjustment to the total environment. Our ultimate goal is to develop a questionnaire to identify drivers who are highly susceptible to traffic accidents. This questionnaire will be designed to be self-administered and easily scored. It is intended to provide help in traffic safety countermeasure programs that will focus on cause rather than effect. Only by developing a comprehensive stress-accident model will comprehensive and workable accident prevention programs be developed to replace the current patchwork of existing programs.

Accident Proneness↗