The problems of eligibility and endogenous confounders when assessing the mortality impact of a nationwide disease-prevention programme: the case of insecticide-treated nets in Togo

Evaluation of the mortality impact of nationwide disease-prevention efforts is complicated by potential endogeneity: programme recipients may have unobserved characteristics that simultaneously make them both more likely to become recipients and more likely to survive as a result of other health practices. This population-based study assesses the mortality impact of a nationwide programme that distributed insecticide-treated nets (ITNs) to mothers of children aged 9-59 months in Togo. By comparing mortality rates before and after the programme according to households' eligibility status, we demonstrate that a one-time programme that restricts eligibility to households with a surviving child excludes some households with a high risk of child mortality. We then apply simultaneous estimation models to untangle the mortality impact of ITNs from the effects of unobserved confounders and show that among eligible households, living in a household with ITNs significantly reduces mortality for children aged 20-59 months, even after controlling for endogeneity.     

“The Luggage that isn’t Theirs is Too Heavy…”: Understandings of Orphan Disadvantage in Lesotho

In Southern Africa, high adult HIV prevalence has fueled concern about the welfare of children losing parents to the epidemic. A growing body of evidence indicates that parental, particularly maternal, death is negatively associated with child outcomes. However, a better understanding of the mechanisms is needed. In addition, the way orphan disadvantage and the mechanisms giving rise to it are understood on the ground is essential for the successful translation of research into policies and programs. This study employs data from 89 in-depth interviews with caregivers and key informants in Lesotho, a setting where approximately one-quarter of adults is infected with HIV, to elaborate understandings of orphan disadvantage. Our analysis focuses on two questions: (i) Do local actors perceive orphans to be disadvantaged compared to non-orphans, and if so, in what ways; and (ii) How do they explain orphans’ differential disadvantage? Analyses suggest that orphans were widely perceived to be disadvantaged; respondents described this disadvantage in material as well as affective domains. Thematic analyses reveal five broad categories of explanation: poverty, love and kin connection, caregiver character, perceptions of orphans, and community norms related to orphan care. These results underscore the need for research and policy to address (i) multiple types of disadvantage, including deficits in kindness and attention; and (ii) the social embeddedness of disadvantage, recognizing that poverty, kinship, and community interact with individual attributes to shape caregiving relationships and child experiences. The findings suggest limited success for programs and policies that do not address the emotional needs of children, or that focus on child or caregiver support to the exclusion of community outreach.     

Testing for order among K populations: theory and examples

Testing for stochastic order among K populations is a common and important problem in statistical practice. It arises in the analysis of both planned experiments and observational studies. The authors develop a new nonparametric test for order among K populations that can accommodate any stochastic ordering. The test is based on a maximally selected chi‐bar‐square statistic. The authors find its limiting distribution and use simulations to derive critical values. Three important examples are used to illustrate the applicability of the general method. The authors find that the new tests outperform the existing methods in many practical cases. The Canadian Journal of Statistics 38: 97–115; 2010 © 2009 Statistical Society of Canada     

A robust posterior preference multi-response optimization approach in multistage processes

Nowadays, many manufacturing and service systems provide products and services to their customers in several consecutive stages of operations, in each of which one or more quality characteristics of interest are monitored. In these environments, the final quality in the last stage not only depends on the quality of the task performed in that stage but also is dependent on the quality of the products and services in intermediate stages as well as the design parameters in each stage. In this paper, a novel methodology based on the posterior preference approach is proposed to robustly optimize these multistage processes. In this methodology, a multi-response surface optimization problem is solved in order to find preferred solutions among different non dominated solutions (NDSs) according to decision maker's preference. In addition, as the intermediate response variables (quality characteristics) may act as covariates in the next stages, a robust multi-response estimation method is applied to extract the relationships between the outputs and inputs of each stage. NDSs are generated by the ?-constraint method. The robust preferred solutions are selected considering some newly defined conformance criteria. The applicability of the proposed approach is illustrated by a numerical example at the end.     

Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

The struggle of Batak Simalungun for their identity in Church organization in Simalungun,Medan, Indonesia

ABSTRACT

This research aims to find out the struggle of Batak Simalungun for their identity in church organization in Simalungun. This research uses a qualitative research approach, This qualitative research also uses an ethnographic approach. The qualitative research has at least five approaches and therefore can choose one of the five approaches. The results show about three demands of the Simalungun Batak movement over a special identity of Simalungun also include the church organization environment, where the entire Batak Church led by RMG touches on the original structures of Batak society and culture.     

Family Instability and Early Initiation of Sexual Activity in Western Kenya

Epidemiological, economic, and social forces have produced high levels of volatility in family and household structure for young people growing up in sub-Saharan Africa in recent decades. However, scholarship on the family to date has not examined the influence of this family instability on young people’s well-being. The current study employs unique life history calendar data from Western Kenya to investigate the relationship between instability in caregiving and early initiation of sexual activity. It draws on a body of work on parental union instability in the United States, and examines new dimensions of family change. Analyses reveal a positive association between transitions in primary caregiver and the likelihood of early sexual debut that is rapidly manifested following caregiver change and persists for a short period. The association is strongest at early ages, and there is a cumulative effect of multiple caregiver changes. The results highlight the importance of studying family stability in sub-Saharan Africa, as distinct from family structure, and for attention to dimensions such as age and recency.     

The competitive response of Blue Cross to the health maintenance organization

The health maintenance organization (HMO) is an alternative to the traditional fee-for-service health care system in the United States. Other studies have shown that the HMO reduces hospital utilization and offers greater benefit packages than fee-for-service. This paper tests whether the presence of HMO's provides effective competitive pressure on Blue Cross, the largest insurer of hospital costs. The cross sectional regression analysis supports the hypotheses that Blue Cross has reduced hospital utilization and increased benefit packages in response to HMO competition. Consequently, competitive forces are shown to be operative in at least one area of health care.     

The social work services in screening process of compulsory treatment interventions in addicts in Iran: A content analysis study

Compulsory treatment has had a detrimental impact on drug abuse treatment policies and programs in Iran. Physicians are currently required to conduct initial treatment screening. Social workers are a part of the treatment team but have no authority to initiate a compulsory drug treatment plan. For this reason, the present article investigates social work service participation in the process of compulsory drug treatment. The study methodology is content analysis. Nine social workers participated in seven focus group discussions. Overall, 110 codes were extracted from the sessions and were categorized into five main themes: interview and initial assessment; referral; investigation of ineligibility criteria; report to judicial authority; and follow‐up and advocacy. The results of this research suggest amending executive bylaws based on a social work approach to the screening process for compulsory drug treatment.