Patient-Centered Approach to Building Problem Solving Skills Among Older Primary Care Patients: Problems Identified and Resolved

This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified 568 problems, 59% of which were resolved. Most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. Using PST in primary care may facilitate patients in addressing key health and wellness issues.     

Heart ed 101

Cardiovascular disease is the leading cause of death for men and women in the United States. Risk factors and health behaviors combine over time to contribute to the disease process. College communities provide a unique environment for health promotion, risk reduction, and primary intervention. Heart health should be an integral part of college health.     

How does POSSLQ measure up? Historical estimates of cohabitation

We use March Current Population Survey (CPS) data from 1977 to 1997 to produce a new historical series of indirect cohabitation prevalence estimates. We compare our new estimates with those produced by the traditional method and evaluate the new estimates. We then compare the indirect estimates with the new direct estimates to investigate whether biases exist in the indirect estimates. Our findings indicate that the traditional indirect method of estimating cohabitation prevalence underestimates cohabitors in different subpopulations, especially among those with children. We also find that the new indirect measure produces relatively unbiased estimates of cohabitors' characteristics.     

Self-care: Why do parents leave their children unsupervised?

We used a preferences-and-constraints model to develop four hypotheses to explain why parents may choose self-care (an unsupervised arrangement) as the primary child care arrangement for their children over supervised alternatives and tested them in a multivariate framework using 1995 data from the Survey of Income and Program Participation. We found that the choice of self-care over supervised care alternatives is linked to the availability of parents' time to care for children, the child's level of responsibility and maturity, and the neighborhood context. However, we found no evidence that parents' ability to pay for child care is related to the choice of self-care. The results also suggest that parents use different decision-making processes, depending on their children's ages.     

Census adjustment and the distribution of federal spending

In 1989, programs that use population counts to determine the distribution of their funds transferred $236 per capita to state and local governments. If the 1990 census were adjusted to reflect undercounting, about 40% of state and local governments would receive increased grants averaging $56 per miscounted person; other jurisdictions would lose an almost equal amount of grant money. The surprisingly small reallocations arise because 1) total funds allocated by population are essentially fixed; 2) allocations depend on other factors in addition to population; and 3) programs vary as to whether they allocate funds in direct or inverse proportion to population.     

Logistic retainment interval dose exploration design for Phase I clinical trials of cytotoxic agents

Phase I studies of a cytotoxic agent often aim to identify the dose that provides an investigator specified target dose-limiting toxicity (DLT) probability. In practice, an initial cohort receives a dose with a putative low DLT probability, and subsequent dosing follows by consecutively deciding whether to retain the current dose, escalate to the adjacent higher dose, or de-escalate to the adjacent lower dose. This article proposes a Phase I design derived using a Bayesian decision-theoretic approach to this sequential decision-making process. The design consecutively chooses the action that minimizes posterior expected loss where the loss reflects the distance on the log-odds scale between the target and the DLT probability of the dose that would be given to the next cohort under the corresponding action. A logistic model is assumed for the log odds of a DLT at the current dose with a weakly informative t-distribution prior centered at the target. The key design parameters are the pre-specified odds ratios for the DLT probabilities at the adjacent higher and lower doses. Dosing rules may be pre-tabulated, as these only depend on the outcomes at the current dose, which greatly facilitates implementation. The recommended default version of the proposed design improves dose selection relative to many established designs across a variety of scenarios.     

Piketty comes to South Africa

One of the most valuable features of Capital and Ideology is its concern to take history seriously and consider how the emergence of different political and economic regimes relate to discourses about fairness and justice across time. This paper pushes this agenda further by acknowledging that the experience of a few developed nations should not be taken as the template for the generalized study of inequality dynamics across time and space. In this paper, we interrogate Piketty's analysis and policy proposals against specificities that are central to understanding the production and reproduction of inequalities within South Africa. We reflect on the South African case, the structure of inequality and its changes since 1994. We review a battery of policy interventions that have been implemented to address inequality in the last 25 years. We emphasize that the long shadow cast by centuries of colonialism and various forms of apartheid strongly affirm Piketty's emphasis on understanding history. But this is both affirmation and critique given the foundational, imbedded impact that this specific legacy has had on post‐apartheid society and its policies. Piketty is aware that the levels of inequality in South Africa are so high that this is “unknown territory.” We map out some of this territory to reveal how these extreme initial wealth and racial inequities inform the reproduction of inequalities in all dimensions and undermine well intentioned policies. We claim that understanding extractive histories, imbedded wealth inequalities, and complex social and political institutions allows us to understand and confront some of the reasons why even in light of progressive policies, many of which are in line with the proposals from Piketty, government interventions have thus far failed to reduce inequality.