Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.     

Using Bayesian Aldrich‐McKelvey Scaling to Study Citizens' Ideological Preferences and Perceptions

Aldrich‐McKelvey scaling is a powerful method that corrects for differential‐item functioning (DIF) in estimating the positions of political stimuli (e.g., parties and candidates) and survey respondents along a latent policy dimension from issue scale data. DIF arises when respondents interpret issue scales (e.g., the standard liberal‐conservative scale) differently and distort their placements of the stimuli and themselves. We develop a Bayesian implementation of the classical maximum likelihood Aldrich‐McKelvey scaling method that overcomes some important shortcomings in the classical procedure. We then apply this method to study citizens' ideological preferences and perceptions using data from the 2004–2012 American National Election Studies and the 2010 Cooperative Congressional Election Study. Our findings indicate that DIF biases self‐placements on the liberal‐conservative scale in a way that understates the extent of polarization in the contemporary American electorate and that citizens have remarkably accurate perceptions of the ideological positions of senators and Senate candidates.     

A multidimensional scaling analysis of the Hare PCL-R: Unfolding the structure of psychopathy

Abstract

Recent studies examining the Psychopathy Checklist – Revised (PCL-R) have argued for a range of factorial solutions to describe and explain the dimensions of psychopathy. This study details an empirical analysis of North American PCL-R data for 4630 male offenders, using multidimensional scaling (MDS) as a non-linear alternative to factor analysis. The emergent structure of Hare's psychopathy psychometric can be interpreted in more than one way and at different levels of specificity. The multidimensional scalograms reveal a set of facets consistent with the two- and four-factor solutions that emerge from the same data. Equally the structure of the PCL-R can be interpreted through personality theory as a set of core traits and behavioural manifestations, consistent with an evolutionary basis for psychopathic tendencies. These analyses provide support for a multidimensional structure within the PCL-R, and suggest that psychopathy can be viewed as an extreme variant of multiple dimensions of personality.     

Prevalence and correlates of psychopathic traits in the household population of Great Britain

There are no previous surveys of psychopathy and psychopathic traits in representative general population samples using standardized instruments. This study aimed to measure prevalence and correlates of psychopathic traits, based on a two-phase survey using the Psychopathy Checklist: Screening Version (PCL: SV) in 638 individuals, 16–74 years, in households in England, Wales and Scotland. The weighted prevalence of psychopathy was 0.6% (95% CI: 0.2–1.6) at a cut score of 13, similar to the noncriminal/nonpsychiatric sample described in the manual of the PCL: SV. Psychopathy scores correlated with: younger age, male gender; suicide attempts, violent behavior, imprisonment and homelessness; drug dependence; histrionic, borderline and adult antisocial personality disorders; panic and obsessive–compulsive disorders. This survey demonstrated that, as measured by the PCL: SV, psychopathy is rare, affecting less than 1% of the household population, although it is prevalent among prisoners, homeless persons, and psychiatric admissions. There is a half-normal distribution of psychopathic traits in the general population, with the majority having no traits, a significant proportion with non-zero values, and a severe subgroup of persons with multiple associated social and behavioral problems. This distribution has implications for research into the etiology of psychopathy and its implications for society.