Dementia Problem Behavior and the Production of Informal Caregiving Services

Informal caregivers of individuals with Alzheimer's disease spend a considerable amount of time providing care. In this paper, we use Grossman's health production and Becker's time allocation models to develop a model of informal care provision to elderly dementia patients. In our model, time inputs produce caregiving services, which provides utility to the caregiver, but reduces leisure. We assume that time is less productive of services on the margin as the disease progresses. In this framework, an increase in patients' disease severity does not necessarily increase informal caregiver time input. The cost of formal care establishes a reservation price for informal caregiving. When the costs of informal caregiving rise above this reservation level, the patient is institutionalized. We test empirically the effect of deterioration in the patients' condition, proxied by both disease severity and dementia problem behavior, on informal caregiving time. We find that dementia-related problem behaviors and functional limitations significantly increase inputs of informal caregiving time. Patients' problem behavior exerts a modifying effect on functional limitations, and patients' comorbidities have no effect on informal caregiving time.     

Efe fathers: one among many? A comparison of forager children's involvement with fathers and other males

The study reported describes Efe (pygmy) forager one-, two-, and three-year-olds' involvement with males. The Efe of northeastern Zaïre were chosen because their social organization allows us to examine hypotheses based on studies in Western, technologically complex societies about the distinctive role fathers play in the lives of their young children. Behavioral observations of Efe children's day-to-day activities with fathers, men and boys were recorded using a focal subject sampling technique (Altmann, 1974). Two behavioral measures were created to capture the extent to which males were involved with children: Social engagement describes males' involvement with children and social attention describes eavesdropping by children on males' everyday activities. Eight one-year-olds, 7 two-year-olds and 8 three-year-olds were each observed for six, one-hour observation sessions that were distributed evenly over the daylight hours. Data were analyzed using the traditional measure of involvement (e.g., adult males) and using a newly developed measure of the involvement of the average individual (e.g., average adult mate). Comparisons at each of the ages showed that fathers were consistently like other men in the extent to which children participated in social activities with them and watched their activities. Only fathers' level of social engagement declined significantly as children grew older. Boys' role relative to other males became increasingly distinctive as children aged. The findings suggest that Efe fathers may not be unique in the same sense assumed by Western study ideals, and raise questions about the special status given to fathers in Western theory and data. The patterning of mate involvement with children is discussed in terms of Efe community life, and in terms of Efe children's developing understanding of their relationship with fathers and other males.     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

世纪辉煌的地域文化背景呈示——"浙江潮"文学现象研究之一

"浙江潮"文学现象对中国20世纪文学的发展极具观照意义,而就其"生成"原因看,则显然是这个地域积淀深厚的历史文化传统所致,对此作深入探讨,必将有助于文学历史经验的总结。     

Can we remember differently? A case study of the new culture of memory in voluntary organisations

This article analyses the positive contribution that Slovenian voluntary, non–governmental organisations, users' organisations and community–based services in the field of mental health have made to the 'new culture of memory' of helpers and users. The conceptual differences between Slovenian psychiatric (institutional) treatment and voluntary community care are presented through the case study of Clare, a young woman who was diagnosed as a chronic schizophrenic. This example shows the importance of community care in voluntary organisations for the reduction of disability associated with mental disorders. The development of the new culture of memory in voluntary organisations and community–based services is not only the 'narrative turn' within social welfare, but also symbolises the 'implicit turn' in the relationship between the helper and the user. The real challenge of the new culture of memory in the process of help to disabled people (in respect of individuals working through traumatic memories) is that the helper can bear and support the user on a daily basis. During the process of their relationship, the deep implicit relational memories of both become activated and influence the change within the user as well as the helper.     

Child‐Care Usage and Mother‐Infant “Quality Time”

Mothers' time‐use patterns were compared in families in which infants spent more than 30 hours per week in child care (In‐Care group; n= 143) versus 0 hours per week (At‐Home group; n= 183) from birth to 6 months of age. In‐Care group mothers spent about 12 fewer hours per week interacting with their infants, for about 32% less time; fathers of these infants were more involved in caregiving. The groups did not differ in the quality of mother‐infant interaction. In the In‐Care group, quantity of interaction was related to greater separation anxiety and concerns about effects of maternal employment. Time‐use data were not related to child outcomes at 15 months of age. Results suggest that the effect of extensive time spent apart on the quantity and quality of mother‐infant interaction may be smaller than anticipated.     

The Boston Area Diary Study and the Moral Citizenship of Care

This paper describes the theoretical foundations, empirical findings, and practical and philosophical implications of the Boston Area Diary Study (BADS), a study of the caring behavior of 44 participants over one calendar year. In particular, the paper presents an identification theory of care and discusses how it shaped the conceptualization, collection, and analysis of the data in a year-long diary study of daily voluntary assistance. The findings from the BADS (1) theoretically confirm the identification theory of care; (2) methodologically capture how individuals perceive and carry out caring behavior as a unity; and (3rpar; empirically document the existence of a moral citizenship in America that is substantially more vigorous than is implied by the usual indicators of civic and political citizenship.     

谈发展中的高校社区医疗保健

就高校医疗保健机构如何适应社会主义市场经济、如何适应国家的卫生体制 3项改革、适应高等教育发展等问题 ,探讨了高校医疗保健的现状及高校社区医疗保健的任务。从社区卫生诊断角度出发 ,研究了高校社区具有的特点 ,提出了健全高校社区医疗保健机构的对策 ,把高校的医疗机构演变成社会化的公益的社区卫生服务机构作为奋斗目标     

中国各地区医疗卫生服务的生产效率分析

医疗卫生是与国民密切相关的一个问题，所以医疗卫生服务的生产效率如何倍受人们的关注。运用DEA模型可以对中国各地区的医疗卫生服务生产效率进行研究，分析不同地区效率高低的原因。结果显示，虽然总体上中国的医疗卫生服务的生产效率处于一个较低水平，但地区之间还是存在着很大的区别，并且地区间即便都是高效率或者低效率的地区，其投入和产出水平也不尽相同。