Psychosocial Predictors of Self-Esteem in a Multiethnic Sample of Women Over 50 at Risk for HIV

Self-esteem is linked to high-risk behaviors in other populations but has not been examined in women aged 50 and older. This study explored how self-esteem is related to variables that can influence high-risk sexual behaviors in women over 50. A multiethnic community-based sample of 572 women aged 50 and older completed an anonymous questionnaire on sexual behaviors, sociodemographic characteristics, and psychosocial measures relevant to midlife and older women. Regression analysis showed sensation-seeking, HIV stigma, sexual assertiveness, and self-silencing predicted self-esteem in women over 50 (F = 43.632, p < .001). Factors such as relational context, interpersonal power, and silencing can affect self-esteem and may be contributing to HIV risk in this group.     

Embedding effects: Stimulus representation and response mode

Thecontingent valuation (CV) methodology assigns prices to environmental amenities by asking people how much they would be willing to pay in order to preserve or acquire those amenities. If this measurement procedure is valid, then responses should be sensitive to relevant changes in the amenities being judged and insensitive to irrelevant changes. One apparent demonstration of inappropriate insensitivity is theembedding effect: the observation that people are apparently willing to pay the same amount of money for a good as for a minor subset of that good. This study examined the possibility that the source of this effect lies with each of two (potentially treatable) methodological problems: 1) subjects have difficulty using quantitative (dollar) response modes to express their values; and 2) subjects have difficulty absorbing the essential details of the CV scenarios describing those goods. The study found that 1) subjects showed considerable embedding both with a simple paired-comparison response mode and with a more demanding one requiring direct dollar estimates; 2) embedding was much reduced with the simpler response mode; 3) subjects' preferences with the two response modes were usually inconsistent; 4) when asked to describe the CV scenario that they had just heard, subjects often reported key task details inaccurately; and 5) there was less embedding when tasks were reinterpreted in terms of the questions subjects reported having answered (as opposed to what had actually been asked). These results are discussed in terms of the match between the questions that investigators would like to ask and the ones that subjects are capable of answering.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia

Cambodia aims to expand social health protection to move toward Universal Health Coverage. We developed a modeling tool to facilitate the simple, interactive estimation of cost and coverage for three policy alternatives, enabling decision-makers to simultaneously adjust for scenario options currently under consideration. Assuming the adoption of all scenario options, the projected cost of expanding social health protection to all is US$42 million, to vulnerable individuals is US$32.1 million, and to uncovered 1st–3rd wealth quintile people is US$30.4 million. These policy alternatives are projected to increase population coverage to 100%, 89.1%, and 92.5% by 2025, respectively. The results have multiple policy implications. First, given the similar costs and coverage estimates for the targeted approaches, and other considerations, expansion to the 1st–3rd wealth quintiles is recommended. Second, the model quantifies the potential impacts for policy changes relating to each scenario option. The inclusion of dependents under the contributory schemes significantly shifts costs; reversing the policy of non-payment for priority public health services increases public health facility revenue; and, alignment of reimbursement rates leverages demand-side financing which can increase value for money. Finally, the cost estimates provide a basis for economic planning. Revenue raising options include increasing the contribution ceiling for the private employees’ scheme and the progressive adoption of strategic purchasing.     

Achieving permanency for LGBTQ youth

This article brings together two significant efforts in the child welfare field: achieving permanence for youth in out-of-home care and meeting the needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. During the past several years, a national movement has taken place to assure all children and youth have a permanent family connection before leaving the child welfare system; however, LGBTQ youth are not routinely included in the permanency discussions. At the same time, efforts in addressing the needs of LGBTQ youth have increased, but permanency is rarely mentioned as a need. This article offers models of permanence and practices to facilitate permanence with LGBTQ youth and their families. It also offers a youth-driven, individualized process, using youth development principles to achieve relational, physical, and legal permanence. Reunification efforts are discussed, including services, supports, and education required for youth to return to their family of origin. For those who cannot return home, other family resources are explored. The article also discusses cultural issues as they affect permanence for LGBTQ youth, and, finally, addresses the need for ongoing support services to sustain and support permanency.     

A Comparison of Reorder Point and Material Requirements Planning Inventory Control Logic*

This paper reports the results of simulation experiments that compared the inventory efficiency (i.e., the customer service level provided by a given level of inventory) for two different inventory policies. One of these policies uses time-phased information on future demands like that found in material requirements planning (MRP) systems, while the other (the reorder point or ROP policy) relies on forecasts implicitly based on average past demands. After establishing that the MRP policies dominate for reasonable conditions, the uncertainty of the forecasts was manipulated until the policy preference was reversed. It requires a very perverse relationship between the forecast and actual demand before ROP beats MRP on inventory efficiency.     

Tour Scheduling and Task Assignment of a Heterogeneous Work Force: A Heuristic Approach

The dual problem of work tour scheduling and task assignment involving workers who differ in their times of availability and task qualifications is examined in this paper. The problem is presented in the context of a fast food restaurant, but applies equally well to a diverse set of service operations. Developing a week-long labor schedule is a nontrivial problem, in terms of complexity and importance, which a manager spends as much as a full workday solving. The primary scheduling objective (the manager's concern) is the minimization of overstaffing in the face of significant hourly and daily fluctuations in minimum staffing requirements. The secondary objective (the workers’ concern) is the minimization of the sum of the squared differences between the number of work hours scheduled and the number targeted for each employee. Contributing to scheduling complexity are constraints on the structure of work tours, including minimum and maximum shift lengths and a maximum number of workdays. A goal programming formulation of a representative problem is shown to be too large, for all practical purposes, to be solved optimally. Existing heuristic procedures related to this research possess inherent limitations which render them inadequate for our purposes. Subsequently, we propose and demonstrate a computerized heuristic procedure capable of producing a labor schedule requiring at most minor refinement by a manager.