Unmet Needs for Assistance with ADLs and IADLs: A Measure of Healthy Life Expectancy

Measures of healthy life expectancy have beendeveloped over the last thirty years to evaluate thequality of life of an increasing life expectancy.These measures are usually accounting for prevalencerates of either disability or physical dependence inperforming everyday activities. Although they allowfor a better assessment of quality of life, they arenot reflecting the fact that a disabled person mightbe receiving adequate or inadequate assistance forthese activities. In a context of population aging,where our health care system will have to deal moreand more with chronic disease instead of acutedisease, it is imperative to develop a measure thatwill account for the adequacy of the assistanceprovided to the disabled elderly population. Usingdata from the 1986 Health and Activity LimitationSurvey, we are introducing a measure of healthy lifeexpectancy which will fill this gap. We present theconstruction of this measure of population health anddiscuss its usefulness in assessing policies at amacro level.     

Puerto Rican drug users experiences of physical and sexual abuse: comparisons based on sexual identities

This study integrates the results of quantitative and qualitative methods to elucidate the association between sexual identity and physical and sexual abuse among Puerto Rican drug users. A structured questionnaire was administered to 800 subjects in New York and 399 in Puerto Rico. A total of 93 subjects (7.9%) self-identified as homosexual or bisexual. Gay males were significantly more likely than heterosexual males to report first occurrence of physical abuse by a family member in childhood. Both gay and bisexual males were more likely than their heterosexual counterparts to report first experiencing unwanted sex in childhood and intimate partner physical abuse later in life. Lesbians were more likely than female heterosexuals to report unwanted sex in childhood. Qualitative data were collected through in-depth life histories with 21 subjects and suggest that gay and lesbian subjects perceive antihomosexual prejudice on the part of family members as one cause of childhood physical and sexual abuse.     

Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups according to level of self-mutilating behavior and then compared on symptom self-reports; 62.1% of the adolescents engaged in at least one self-mutilating behavior. A graded relation was observed between level of self-mutilating behavior and rate, and total number of clinical disorders. At nine month follow-up, one in four teenagers still reported a moderate or high level of self-harm. The need for systematic assessment and intervention of self-mutilating behaviors is discussed.     

Work and mental health: the experience of the Quebec workforce between 1987 and 1998

This study examines the distribution of psychological distress in twelve occupational groups over the decade 1987-1998 in the Quebec workforce. Cross-sectional data from the three phases of the Quebec Health and Social Survey are used with n = 9,450 in 1987, n = 10,947 in 1992 and n = 10,960 in 1998, totalling 31,357 workers aged 15 and over. Occupations are classified according to the Canadian Socio-economic Classification of Occupations. Prevalence estimates for occupational groups are computed and logistic regression analyses are conducted controlling for gender, age and marital status. The results show that the prevalence of workers with psychological distress increased sharply between 1987 and 1992 and declined back in 1998 but still increased compared to 1987. However, only non-qualified white collars, semi-qualified blue collars and male non-qualified blue collars show a significant increment in psychological distress over time. Analysis of the differentials in the prevalence of psychological distress gives greater odds of distress for supervisors, semi-qualified white and blue collar workers compared to upper managers. The odds for occupations are stable over time, gender, age and marital status. The odds of female workers significantly decreased in the three phases. It appears that the restructuring of the work environment and the perturbations in the larger society promoted an increase of psychological distress within definite segments of the workforce. The specific contribution of occupation is limited but supervisors and occupations requiring lower qualifications are more at risk regarding mental health at work.     

Magic Transformation and Tragic Transformation—Splitting of Ego and Superego in Severely Traumatized Patients

Our fairy tales and myths, our dreams and fantasies, live from the wishes that we could magically change ourselves and the world we live in. In almost every hour of our psychotherapeutic or psychoanalytic work we meet this hope for magical transformation that our patients set in various objects in the outside: in drugs, or our presence, or in the symbiotic union with others, in money, in gambling, television, success, food and especially also in sexual gratification or religious ritual. Such magical transformation is contrasted by what George Eliot called tragic transformation. The term refers to a process of profound inner change brought about by suffering, i.e., trauma, through massive inner conflict, through insight and through action or active work, in behalf of somebody else, or in the service of a great cause. In the case described in detail, the magical transformation occurs with the establishment of several versions of double reality and double identity, as a way of dealing with extreme traumatization (killing of the mother by the father, the probable participation of the latter in the Holocaust, severe physical abuse). In the psychoanalysis, particular attention was being paid to conflicts within the superego. The gradual shift during therapy as a form of tragic transformation is being described.     

Is the SOGS an Accurate Measure of Pathological Gambling Among Children, Adolescents and Adults?

The South Oaks Gambling Screen (SOGS) is widely used to assess the prevalence of pathological gambling. For a variety of reasons, this instrument may not provide an accurate rate of the prevalence of pathological gambling. In this paper, one source of error in data provided by the SOGS is investigated. It is argued that individuals may not fully understand the meaning of some items, and that clarification of the meaning of misunderstood items may in some cases lead to a changed score on the scale. The present study evaluates respondents' understanding of the SOGS items. The results from three studies are reported, each using a different sample: grade school children, adolescents and adults. It was hypothesised that (1) participants would not understand some items of the SOGS, (2) problem gamblers and probable pathological gamblers would be more inclined to interpret items incorrectly than would non-problem gamblers and, (3) consistent with the first two hypotheses, clarification of items would decrease the number of participants identified as problem gamblers or probable pathological gamblers. The data obtained supported hypotheses 1 and 3. Furthermore, hypothesis 2 was supported for grade school children, but not for adolescents or adults. These results are consistent with recent literature on endorsement and acquiescence phenomena, and have implications for prevalence studies of probable pathological gambling.     

Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance

Traditional insurance contracts do not offer protection against the replacement value of a vehicle. A replacement cost endorsement gives the opportunity to get a new vehicle in the case of a total theft or in the case of total destruction of the car in a road accident. This type of protection was introduced in Canada in the late 1980's. It is also offered in France and many insurers in the United States are going to move in that direction. We propose tests that separate moral hazard from adverse selection in the analysis of the effect of this additional protection on car theft. We show that holders of car insurance policies with a replacement cost endorsement have a higher probability of theft near the end of this additional protection (usually 24 months following the acquisition of a new car). Our tests indicate that this result is a form of ex post moral hazard or opportunistic insurance fraud.     

Methods for measuring school performance through cohort analysis

In order to evaluate the main educational characteristics of a grade cohort—which are the proportion of those who get a degree, the average time spent in school and finally the mean educational attainment of the cohort—we present a school system in which repeat enrolments are well identified. In this discrete model, we present, for each grade, three transition coefficients: the proportion of those passing to the next grade, the proportion of those repeating the grade and the proportion of those leaving the school system. Afterwards, we set up a system of equations leading to the distribution of the entrants in the cohort according to the levels of their educational attainment, a system of equations for which a simple solution will depend on two assumptions.