Ability, disability, and the oldest old

A measure of range of ability is used to profile the 85-years-old-and-older (oldest old) population, including the highly disabled institutional population. This new measure uses two new questions available in the 1990 Decennial Census concerning a self-care limitation and a mobility limitation as well as the usual question concerning a work limitation. In addition to examining the extent of disability among the oldest old, the article examines the extent of care potentially available in the household as well as the economic characteristics of this age group. It is also profiled in terms of relevant personal characteristics, including age, gender, marital status, race, ethnicity, rural residence, education, and employment. A key question addressed is the need for help or care among the oldest old and how various long-term care proposals would meet such needs. A careful analysis of this unique and growing population is necessary to both allay fears of the cost of care or help as well as to dispel stereotypes of this age group as frail and dependent, and in need of institutional care.     

Unjust Freedom: The Ethics of Client Self-Determination in Runaway Youth Shelters

Client self-determination has been called the most confounding and professionally debilitating concept of all the intellectual principles under-girding social work (Rothman, 1989). Identifying the appropriate parameters of client self-determination is a particularly acute problem for social workers employed by runaway and homeless youth shelters where minors are making adult decisions free from parental guidance. We examine the ethical dimensions of practice with minor clients in runaway shelters by arguing that a conflict exists between the liberty-based principle of self-determination and the justice-based notion of client competency. We analyze the conflict by using minimal distributive justice as the organizing principle of social work practice. We conclude that client self-determination in runaway shelters should be restricted and that presuming client competence violates the basic value tenets of the profession.     

Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

On the shrinkage of local linear curve estimators

Local linear curve estimators are typically constructed using a compactly supported kernel, which minimizes edge effects and (in the case of the Epanechnikov kernel) optimizes asymptotic performance in a mean square sense. The use of compactly supported kernels can produce numerical problems, however. A common remedy is ridging, which may be viewed as shrinkage of the local linear estimator towards the origin. In this paper we propose a general form of shrinkage, and suggest that, in practice, shrinkage be towards a proper curve estimator. For the latter we propose a local linear estimator based on an infinitely supported kernel. This approach is resistant against selection of too large a shrinkage parameter, which can impair performance when shrinkage is towards the origin. It also removes problems of numerical instability resulting from using a compactly supported kernel, and enjoys very good mean squared error properties.     

Scenarios,uncertainty and conditional forecasts of the world population

This study is concerned with the methods available for the forecasting of future trends in the world's population. Particular attention is given to the problem of the uncertainties that these forecasts include. "The purpose of this paper is to show how subjective and data-based probabilistic assessments of error can be combined, to give a user a realistic assessment of the uncertainty of demographic forecasts, and to apply these concepts to forecasts of the world population. Moreover, we shall show how conditional forecasts can provide a simple conceptual framework in which to view scenarios. They can be particularly useful in the evaluation of proposed policies. Indeed, the so-called environmental impact assessments...that are now mandatory in many countries for major construction projects typically contain elements of conditional forecasting." The concepts discussed are illustrated by comparing a scenario of future global population growth prepared at the Institute of Applied Systems Analysis with a UN population projection.     

Nevada gaming: revenues and taxes (1945-95)

In 1931, Nevada legalized casino gambling, an act which allowed its gaming industry to develop. Because many jurisdictions outside Nevada are now embracing legalized gambling as a path to a brighter economic future and because this proliferation presents Nevada with new challenges and opportunities, it is a good time to review the Nevada experience. Here, the focus is on gaming revenues and gaming tax collections during the 1945–95 period. We find that the growth rate of Nevada's gaming industry has slowed over time, with the relative importance of gaming in the Nevada economy peaking in the late 1970's. The Nevada economy has since been gradually diversifying, something which will increasingly pressure Nevadans to look for government revenue sources other than gaming if current levels of government services are to be maintained.     

"How much do you spend gambling?" ambiguities in survey questionnaire items

The validity of a survey's findings is dependent upon the clarity and lack of ambiguity contained in each individual item yet minimal attention has been directed to this issue in most prevalence studies. Researchers have shown a tendency to accept the uncritical assumption that respondents interpret seemingly simple and straightforward items such as 'how much do you spend gambling?' in a consistent manner. No attempt is made to confirm the uniformity of responses by clarifying the mathematical formulae used by respondents to derive their answers. The purpose of this paper was to examine the consistency shown by a sample of 181 medical undergraduate subjects in estimating the level of gambling expenditure in a series of five case vignettes describing various scenarios of wins and losses during a session of gambling. Results revealed a wide variation in calculated figures depending upon whether or not subjects interpreted the item to mean net expenditure or turnover. Only two thirds or less of subjects calculated the figure to be the difference between the initial amount risked and the residual at the conclusion of the session. It is suggested that more attention be paid in prevalence and clinical studies to providing subjects with clear instructions on how to calculate expenditure estimates.     

Excessively pronated feet: a health hazard to developing children

There is a serious misconception on the part of the public as well as amongst a great number of professionals to equate the problem of flatfoot with excessively pronated feet in growing children. This is a matter of grave concern since flatness of the arch of the foot can be a normal or abnormal finding in foot posture, whereas the excessively pronated foot is flattened as part of a pathological structural malposition. This inherent biomechanical defect is commonly present in the great majority of human children and is the basic reason for most postural pathology of the lower extremity.Excessive pronation of the feet in children should in no way be interpreted as a normal condition to be automatically outgrown. As a matter of fact, Whitman, the famous Orthopaedic Surgeon, noted in 1917 in his text Orthopaedic Surgery that pronation of the feet commonly seen in children is more likely to worsen than improve over the years. This paper presents the probable cause of the condition, treatment and prevention of the problem and recommendations for the future.The deforming foot posture known as excessive pronation is familiar to Podiatric Medicine and to Medicine generally. Yet, in spite of this familiarity, only an insignificant number of the millions of children in our country receive the simple available help required to minimize the problem.The Podiatric profession has within its grasp the wherewithal to correct this situation, through education and counseling of parents, through cooperation with pediatricians and other professionals and by utilizing technological advances in children's footgear and orthotics. It is the intention of this paper to provide an overview of the literature and history associated with the problem of excessive pronation in children, as well as to suggest some simple techniques for improving this situation.Dr. Tax is an international renowned consultant to many Podiatric Hospital amon which is the Veterans Administration in New Jersey, New York College of Podiatric Medicine, Ohio College of Podiatric Medicine. He has written and lectured extensively on the subject of children and problems with their feet.