Has the Portuguese NHS Achieved its Objectives of Equity and Efficiency?

The Portuguese healthcare system has been in a state of continuous change since the political revolution of 1974, which brought about a constitutional commitment to a universal and comprehensive national health service. Despite much legislative activity, only partial implementation of these laws has taken place and the current system requires further changes if it is to attain its stated objectives of increasing equity and efficiency. This article analyses and assesses the state of the healthcare system in Portugal based on a review of the literature and interviews with key policymakers and academics and evaluates it against the criteria of equity and efficiency.     

Autonomy,Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.     

Differing Domains of Actual Sibling Conflict Discussions and Associations with Conflict Styles and Relationship Quality

Four types of sibling conflict were identified in actual adolescent sibling discussions: equality and fairness, invasion of the personal domain, intrinsic harm, and relationships. Older [M = 14.97, standard deviation (SD) = 1.69 years] and younger siblings (M = 12.20, SD = 1.90 years) from 144 dyads discussed conflicts during a semi‐structured conflict task. Trained observers coded the topics discussed, and separate observers rated their conflict styles, whereas siblings rated their relationship quality. The proportion of conflicts of each domain differed by dyadic gender composition. Equality and fairness conflicts (and invasion of the personal domain conflicts for sister–sister pairs) were discussed the most frequently whereas intrinsic harm conflicts were associated with destructive conflict styles. Siblings' discussions of conflicts involving intrinsic harm were associated with older siblings' reports of negative relationship quality. The associations between these conflict topics and negative relationship quality were mediated by the siblings discussing the conflicts in destructive ways.     

Values in Middle Childhood: Social and Genetic Contributions

Theories of value development often identify adolescence as the period for value formation, and cultural and familial factors as the sources for value priorities. However, recent research suggests that value priorities can be observed as early as in middle childhood, and several studies, including one on preadolescents, have suggested a genetic contribution to individual differences in values. In the current study, 174 pairs of monozygotic and dizygotic seven‐year‐old Israeli twins completed the Picture‐based Value Survey for Children (PBVS–C). We replicated basic patterns of relations between value priorities and variables of socialization—gender, religiosity, and socioeconomic status—that have been found in studies with adults. Most important, values of Self‐transcendence, Self‐enhancement, and Conservation, were found to be significantly affected by genetic factors (29 percent, 47 percent, and 31 percent, respectively), as well as non‐shared environment (71 percent, 53 percent, and 69 percent, respectively). Openness to change values, in contrast, were found to be unaffected by genetic factors at this age and were influenced by shared (19 percent) and non‐shared (81 percent) environment. These findings support the recent view that values are formed at earlier ages than had been assumed previously, and they further our understanding of the genetic and environmental factors involved in value formation at young ages.     

Reciprocal Relations across Time between Basic Values and Value‐expressive Behaviors: A Longitudinal Study among Children

The current study examines the reciprocal relations between children's values and value‐expressive behavior over a sixth‐month period. Three hundred and ten sixth‐grade students in Italy completed value and value‐expressive behavior questionnaires three times in three‐month intervals during the scholastic year. We assessed Schwartz's (1992) higher‐order values of conservation, openness to change, self‐enhancement, and self‐transcendence, as well as their respective expressive behaviors. Reciprocal relations over time between values and behaviors were examined using a cross‐lagged longitudinal design. Results showed that values and behaviors had reciprocal longitudinal effects on one another, after the stability of the variables was taken into account (i.e., values predicted change in behaviors, but also behaviors predicted change in values). Our findings also revealed that: (1) values were more stable over time than behaviors and (2) the longitudinal effect of values on behaviors tended to be stronger than the longitudinal effect of behaviors on values. Findings are discussed in light of the recent developmental literature on value change.     

Individual Differences in Children's Understanding of the School

Following previous research (Buchanan-Barrow and Barrett, 1996) which investigated the developmental trends in children's understanding of the school, this paper reports a study which explored wider influences on children's thinking in an examination of individual differences within those broad trends. First, the role of socio-economic class, gender and birth-order were examined for possible relationship to the children's understanding. Second, the attitudes of children, parents and teachers towards their school were investigated in order to assess possible links with the children's thinking. Children, aged 5-11, from two primary schools, were interviewed, with separate questionnaires being completed by their parents and teachers. Although the findings suggested developmental trends associated with age, there were also clear indications of other patterns associated with all the social categories examined in this study. Furthermore, there was evidence of context-effects, with links between the children's attitudes and their understanding of the school and also between parental and children's attitudes. Given the extent and significance of the factors which emerged, children's social understanding would appear to be complex and liable to vary according to their social group memberships.     

Making Sense of Inequalities: How Do Clinical Commissioning Groups in England Understand their New Role?

This research explored how newly forming clinical commissioning groups (CCGs) were beginning to think about their new ‘duty’ to tackle health inequalities (HIs), as outlined in UK health policy. The concept of ‘sensemaking’ (Weick 1995) was used to illustrate the influences on CCGs’ interpretations of the policy. Three CCGs in the North of England were recruited, and qualitative methods, including interviews, observations and document analysis, were used to collect data, over a period from January 2012 to December 2012. The tangibility of central policy objectives is important in providing clear guidance and direction to organizations trying to tackle large scale policy agendas such as HIs. At a local level, both individual and collective organizational histories and wider relationships were influential on the way CCGs understood the problem of HIs and how they decided to try to tackle the issue locally. The research highlights what influences local level relationships and what factors need to be considered when trying to interpret and implement national policy at a local level.     

The Influence of Minority Stress,Gender, and Legalization of Civil Unions on Parenting Desire and Intention in Lesbian Women and Gay Men: Implications for Social Policy and Clinical Practice

Although the rate of lesbian and gay (LG) parents is increasing, lesbian and gay adults are less likely than heterosexual adults to be parents, as desire and intention to become a parent tend to be lower. This study aims at assessing 290 childless LG individuals (120 lesbian women and 170 gay men) to explore the influence of minority stress, gender differences, and legalization of civil unions in Italy on parenting desire and intention. The results indicated that the minority stressors associated with parenting dimensions included prejudice events, outness, and internalized homophobia for lesbian women, but only felt stigma among gay men. Support from family or significant others buffered the effects of minority stressors on parenting dimensions. Thus, the minority stress processes partly explain the intention and desire to become parents in LG childless individuals. Furthermore, lesbian women showed higher levels of parenting desire and intention than gay men and the levels of these parenting dimensions increased after the law on civil unions was enacted. The findings have important implications for both social policies and clinical practice.