HIV seroprevalence and risk behaviors among clients attending tuberculosis clinics in Miami-Dade County,Florida, 1989–1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigrants from nations with high endemic rates of tuberculosis (TB). We analyzed data from an unlinked (blinded) serosurvey of clients attending four Miami TB clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecutive TB patients at four TB treatment clinics over eight years. Overall HIV seroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infection rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispanics and 14.2% for Hispanics. U.S.-born clients had significantly higher HIV rates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with significant trends observed for men and women; and for blacks, whites and Hispanics. Seroprevalence was 15.7% for clients identifying heterosexual contact as their only risk. Highly significant increases in seroprevalence above this heterosexual-contact-only `baseline', were found for clients disclosing the following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant elevations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosexual-contact-only clients was markedly higher than that of the general population. These findings underscore the need to obtain routine HIV serology on all TB patients.     

Utilizing a Family Decision-Making Lens to Examine Adults’ End-of-Life Planning Actions

Guided by Rettig’s family decision-making theory, the study investigated the effect of an adult child’s decision environment, an adult child’s decision-making perceptions, and a parent’s end-of-life (EOL) planning actions before death on an integrated measure of medical and financial EOL planning actions. Data came from Wave 3 of the public use data of the Wisconsin Longitudinal Study. Results indicated that household net worth, parent’s completion of a living will before death, and adult children’s avoidance of death ideation explained the greatest proportion of variance in adult children’s EOL planning actions. Results also indicated that women, those married, and those with higher education did more EOL planning. Practitioners can use this information to close accessibility gaps due to net worth differences, advocate for a more unified approach to EOL planning, and shift the focus of discussions of death from the death itself to a life well lived.     

The Political Construction of Elder Care Markets: Comparing Denmark,Finland and Italy

In Europe over the last two decades, marketization has become an important policy option in elder care. Comparative studies predominantly adopt an institutional perspective and analyze the politics and policies of marketization. This analysis takes a step back and examines the fundamental ideas underpinning the policies of marketization, using the ‘What's the problem?’ approach by Carol Bacchi. The central question is how the market was discursively framed as the solution to the perceived problems of three different systems of elder care, and how such processes are similar or different across the three countries. The analysis includes two extreme types of elder care systems, the Nordic public systems in Denmark and Finland, and the Southern European family‐based model in Italy. Empirically, the analysis offers interesting insights into processes of constructing and legitimating markets at the level of discourse; this occurs by defining specific problem representations, underlying assumptions and silences. In all three countries, marketization is presented as a solution which builds on rather than challenges dominant ideas of care. Conceptually, in addition to its institutions, it is crucial to understand the ideas behind the marketization of elder care. Ideas emerge as a key leverage for making policies and practices of marketization acceptable and which decision makers and other influential political/societal actors use in policy and public debates. The importance of ideas is further underlined by the fact that they do not necessarily relate to the institutions of elder care systems in a linear way.     

Missing in Action: Strategic Human Resource Management in German Nonprofits

Human resource (HR) management is important for human service nonprofits because they rely on the quality of their employees for the provision of their services. Using a typology of nonprofit HR architecture developed by Ridder and McCandless (Nonprofit Volunt Sect Q 29(1):124–141, 2010), we attempt to unpack the black box between performance and HR practices. To this end, we conducted semi-structured interviews with HR managers and young employees to investigate their perceptions of HR practices in their nonprofit organizations. Based on the findings, we extend the research on HR management in nonprofit organizations and caution that success or failure of implementing HR practices may be directly influenced by the external environment.     

What Makes Inheritance Fair in Stepfamilies? Examining Perceptions and Complexities

This article examines the complexity of fairness in the inheritance process within the context of divorce, remarriage, and stepchildren. Interpersonal social justice theory and qualitative vignette methods were used to explore family members' perceptions of fair inheritance outcomes and processes for financial assets and personal possessions. Findings identify decision rules for determining fair outcomes, including treating biological and stepchildren equally and differently. Who participates, what structures are relied upon, the role of information, and ethical interpersonal treatment were identified as key factors when determining fair processes. Understanding fairness provides a sound basis for helping stepfamily members navigate unavoidable inheritance decisions.     

The Significance of Affirmative Action for theSouls of White Folk: Further Implications of a Helping Model

We develop further our model of affirmative action as help (Pratkanis & Turner, 1996b; Turner & Pratkanis, 1994) by looking at the impact of aid on the donor. White Americans often take one of three approaches toaffirmative action. First, they can reject affirmative action because of their own personal frustrations. Second, they can engage in selective aid that maintains the basic patterns of social dominance. Both of these approaches can damage the psychological functioning of Whites. Third, White Americans can proactively seek to remove discriminatory barriers in a process we call democratic altruism, thereby opening the possibility of learning from diverse others and growth as a person. We conclude by discussing tactics for promoting democratic altruism.     

A female lay perspective on the establishment of long-term sickness absence

In Sweden women account for about 60% of the long-term cases of sickness absence. The aim of this study was to describe women's explanations as to how long-term sickness absence arises and becomes permanent, with reference to their personal experience. Semi-structured interviews were performed with 82 middle-aged women who have personal experience of long-term sickness absence. Long-term sickness absence can be said to arise in three distinguishable "spaces": the work space, the medico-legal space and the mental space. In the beginning, the women were positive about sick-leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick-leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital and the social insurance office transformed seemingly trivial sick-leaves into long-term and irreversible sickness absences     

Economic Security and Financial Management Issues Facing Same-Sex Couples

Same-sex couples experience economic rights and responsibilities in a context that differs from that of married couples. Financial management and economic security issues facing same-sex couples have received little attention to date. These issues are examined in this article within changing legal and social conditions. Family professionals should be knowledgeable about the context and scope of these important issues facing same-sex couples to be able to educate their constituent groups appropriately, deal with clients in therapy, and inform and influence policy makers.