A Rapid Review of Sexual Wellbeing Definitions and Measures: Should We Now Include Sexual Wellbeing Freedom?

An increasing number of studies refer to sexual wellbeing and/or seek to measure it, and the term appears across various policy documents, including sexual health frameworks in the UK. We conducted a rapid review to determine how sexual wellbeing has been defined, qualitatively explored and quantitatively measured. Eligible studies selected for inclusion from OVID Medline, PsychInfo, PubMed, Embase, CINAHL were: in English language, published after 2007, were peer-reviewed full articles, focused on sexual wellbeing (or proxies for, e.g. satisfaction, function), and quantitatively or qualitatively assessed sexual wellbeing. We included studies with participants aged 16–65. Given study heterogeneity, our synthesis and findings are reported using a narrative approach. We identified 162 papers, of which 10 offered a definition of sexual wellbeing. Drawing upon a socio-ecological model, we categorised the 59 dimensions we identified from studies under three main domains: cognitive-affect (31 dimensions); inter-personal (22 dimensions); and socio-cultural (6 dimensions). Only 11 papers were categorised under the socio-cultural domain, commonly focusing on gender inequalities or stigma. We discuss the importance of conceptualising sexual wellbeing as individually experienced but socially and structurally influenced, including assessing sexual wellbeing freedom: a person’s freedom to achieve sexual wellbeing, or their real opportunities and liberties.     

Exploring the ethics of treatments for depression: The ethics of care perspective

This article explores the ethics of current treatments for depression through the lenses of social work values and ethics. As a vehicle for analysis, the approach associated with ethics of care will be utilized. Particular attention is paid to ethical dilemmas in the treatment of depression under the auspices of managed care companies. A case example is presented to help social workers understand these dilemmas in the context of practice. Adopting an ethics of care perspective would mandate that social workers become more politically active, and work toward integrating direct and indirect practice approaches in treating people who suffer from depression and similar problems.     

Middle‐Class Political Activism and Middle‐Class Advantage in Relation to Public Services: A Realist Synthesis of the Evidence Base

Since the late 1960s social policy scholarship has been concerned with the distribution of the resources or benefits across social gradients. This article presents a review of the literature on one mechanism by which inequity might be produced – activism by middle‐class service‐users enabling them to capture a disproportionate share of resources. The review used the methodology of realist synthesis to bring together evidence from the UK, the USA and Scandinavian countries over the past 30 years. The aim was to construct a ‘middle‐theory’ to understand how and in which contexts collective and individual activity by middle‐class service‐users might produce inequitable resource allocation or rationing decisions that disproportionately benefit middle‐class service‐users. The article identifies four causal theories which nuance the view that it is the ‘sharp elbows’ of the middle‐classes which confer advantage on this group. It shows how advantage accrues via the interplay between service‐users, providers and the broader policy and social context.     

One-sided commitment in dynamic insurance contracts: Evidence from private health insurance in Germany

This paper studies long-term private health insurance (PHI) in Germany. It describes the main actuarial principles of premium calculation and relates these to existing theory. In the German PHI policyholders do not commit to renewing their insurance contracts, but insurers commit to offering renewal at a premium rate that does not reflect revealed future information about the insured risk. We show that empirical results are consistent with theoretical predictions from one-sided commitment models: front-loading in premiums generates a lock-in of consumers, and more front-loading is generally associated with lower rates of lapse. Due to a lack of consumer commitment, dynamic information revelation about risk type implies that high-risk policyholders are more likely to retain their PHI contracts than are low-risk types.     

Regional cultures and health outcomes: Implications for performance measurement,public health and policy

The U.S. Medicare program now ties payment to health care providers based on their patients’ outcomes. This change comes as compilations of data on geographic variations in health outcomes and quality of care indicate patterns that appear to be deeply ingrained. This study explores whether cultural characteristics correlate with health outcomes such that quality indicators may be measuring something other than quality of care, and whether regional subcultures have a significant impact on public health. It concludes that two cultural dimensions, social capital and traditional/rational-secularism, which explain a sufficient proportion of outcome variations to cast doubt as to whether outcome measures capture provider quality. Correlations are explored between American regional subcultures identified by Joel Lieske and the variation in health outcomes. In a multidimensional analysis of Lieske's typology, results indicate that certain U.S. subpopulations have cultural advantages or disadvantages relating to health.     

Increasing walking in college students using a pedometer intervention: differences according to body mass index

Objective: The researchers assessed the effectiveness of a pedometer intervention and differences in walking behaviors according to body mass index (BMI). Participants: Two hundred ninety college students completed the intervention from January to February 2005. Methods: Participants wore pedometers 5 days per week for 12 weeks and completed questionnaires assessing demographic information. The authors calculated daily step averages for weeks 1, 6, and 12. They then classified students as underweight (UW), normal weight (NW), or overweight/obese, by BMI. The authors analyzed data using repeated-measures analysis of variance. Results: The average number of daily steps increased from week 1 to week 6 (p < .001) and week 12 (p = .002). UW participants reported the fewest steps at each time point, but the difference was significant only when compared with NW participants (p = .03). Conclusions: These results support the effectiveness of a pedometer intervention to increase walking in college students. Health benefits other than weight management should be emphasized to maximize the effects for all students.     

Gender differences in cardiovascular disease prevention

Risk factors are generally shared between men and women with the major differences being hormonal. Nine modifiable risk factors account for over 90% of the risk of a coronary event in men and women--smoking, hypertension, hyperlipidaemia, diabetes, abdominal obesity, lack of exercise, alcohol excess, reduced intake of fruit and vegetables, and psychosocial issues. Approximately half the decline in deaths from coronary heart disease (CHD), between 1980 and 2000, can be attributed to a reduction in the major risk factors and the other half to the use of evidence-based management. As educational efforts to increase awareness of cardiovascular disease (not cancer) to be the leading cause of death and disability in women are also associated with preventative action, it is important that health-care professionals educate themselves about CHD in women and communicate with women themselves, so that women can come forward for advice and evaluation.     

An examination of the strategic and operational impact of global sourcing on UK small firms

This paper presents three in-depth case studies of UK small manufacturers from the electronics manufacturing industry with global supply chains. There is no overlap in products, suppliers or customers and over time, each has developed a distinct and different strategy for managing an extended supply chain. The outcomes and experiences though are not markedly different. The operational challenges they encounter around quality and delivery, as well as the strategic dimensions of information asymmetry and capability fit are discussed. The study identifies the financial risks the firms are exposed to, the constraints to innovation and the wider strategic implications for long-term business performance.     

Keeping Australia's Older Workers in the Labour Force. A Policy Perspective

As in other western industrialised countries the structural ageing of the Australian population has significant labour market implications. Government has responded with a range of policies to persuade older workers to abandon early retirement and/or remain in the workforce past traditional retirement ages. But whether this generation of workers will be prepared to change their retirement plans in response to policy encouragement, and whether current policy measures will translate into significant numbers of older workers extending their labour force participation is uncertain. Using the Australian Survey of Retirement Attitudes and Motivations (ASRAM) a recently completed, nationally representative survey of Australian workers aged 40 – 59 years we find that while the Government message about working longer is getting through, older workers are relatively unresponsive to current policy measures. Other policies, especially policies outside the financial realm, are needed to maximise the number of older Australians in the labour force.     

Taiwan's path to national health insurance (1950–1995)

This study explores the evolution of statutory health insurance in the Republic of China on Taiwan from its inception in 1950 through to the inauguration of the National Health Insurance Programme in 1995. The main focus of the study is the timings of the adoption of the different statutory health insurance schemes targeted to the various segments of the population. It is argued that Taiwan's adoption of Labour Insurance for workers in 1950 could be best explained by the country's specific historical circumstance. The then-ruling Nationalist government was keen to build up Taiwan as a showcase for the whole of China. The inauguration of the National Health Insurance Programme in 1995 was predominantly subjected to the Nationalist government's adjustment to its changing political position.