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.     

Creating a reference to a complex emergency situation using time series methods: war in Guinea-Bissau 1998-1999

Impacts of complex emergencies or relief interventions have often been evaluated by absolute mortality compared to international standardized mortality rates. A better evaluation would be to compare with local baseline mortality of the affected populations. A projection of population-based survival data into time of emergency or intervention based on information from before the emergency may create a local baseline reference. We find a log-transformed Gaussian time series model where standard errors of the estimated rates are included in the variance to have the best forecasting capacity. However, if time-at-risk during the forecasted period is known then forecasting might be done using a Poisson time series model with overdispersion. Whatever, the standard error of the estimated rates must be included in the variance of the model either in an additive form in a Gaussian model or in a multiplicative form by overdispersion in a Poisson model. Data on which the forecasting is based must be modelled carefully concerning not only calendar-time trends but also periods with excessive frequency of events (epidemics) and seasonal variations to eliminate residual autocorrelation and to make a proper reference for comparison, reflecting changes over time during the emergency. Hence, when modelled properly it is possible to predict a reference to an emergency-affected population based on local conditions. We predicted childhood mortality during the war in Guinea-Bissau 1998-1999. We found an increased mortality in the first half-year of the war and a mortality corresponding to the expected one in the last half-year of the war.     

THE IMPLICATIONS OF CHOOSING "NO RACE" ON THE SALIENCE OF HISPANIC IDENTITY: How Racial and Ethnic Backgrounds Intersect among Hispanic Adolescents

Using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of youth from 7th to 12th grades, we examined how racial and ethnic identification overlap among Hispanic adolescents. We evaluated the relative proximity between race and ethnic identifiers among Hispanics. Empirical analyses suggest that the racial identification of other students at school has a significant impact on the odds of choosing particular racial identifiers. Both Hispanic and non-Hispanic schoolmates' racial identification is related to the racial identification of Hispanic adolescents. We also find evidence that both ethnicity and race are distinct stratifiers among Hispanics. Overall, our findings support the notion that Hispanic may be a more meaningful "racial" identity than black, white, or other, but we also find that racial identification and ethnic background are still important and meaningful dividers among Hispanic youth.     

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Social identities and political cleavages: the role of political context

Summary. Using a novel method, the paper investigates the influence of social group identities on attitudes and on voting in a variety of political contexts. Examining the major regions of Britain, Canada and the USA, we find considerable national and regional diversity in the nature of social cleavages. For example, social class and race had widely different effects across societies, but within societies their effects on attitudes and on voting were very similar. However, despite that, age and religion had a similar effect on attitudes across societies; the effects on voting varied considerably. The significant within-country differences underline the importance of using region, rather than country, as the unit of analysis. More importantly, these results highlight the role of political context, especially competing cleavages and the structure of party competition, in the establishment of politically relevant social cleavages.     

How Welfare Policies Affect Adolescents' School Outcomes: A Synthesis of Evidence From Experimental Studies

Using data from 8 random assignment studies and employing meta‐analytic techniques, this article provides systematic evidence that welfare and work policies targeted at low‐income parents have small adverse effects on some school outcomes among adolescents ages 12 to 18 years at follow‐up. These adverse effects were observed mostly for school performance outcomes and occurred in programs that required mothers to work or participate in employment‐related activities and those that encouraged mothers to work voluntarily. The most pronounced negative effects on school outcomes occurred for the group of adolescents who had a younger sibling, possibly because of the increased home and sibling care responsibilities they assumed as their mothers increased their employment.     

Preparing Parents for Adoption: An Agency Experience

To prepare for the complexities of family formation, 78 prospective adoptive parents participated in Pre-Adopt, a psychosocial educational orientation program offered by one private nonprofit agency. The five-session curriculum included an overview of adoption policies and procedures, discussion of the child placement process, exploration of couples' adoption concerns and expectations about child characteristics, information about adoption laws and birth-parent/child searches, and examination of anticipatory fantasies about birth parents. Program evaluation yielded statistically significant and clinically meaningful findings about changes in emotional readiness to adopt, parenting knowledge, and satisfaction with group participation, adoption policies and agency practices. Practice implications are considered.