Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

机械设计技能培训功能的教学模块

文章根据专业学习和技能培训的关系,设计了本科教学的机械设计技能培训模块,为培养大学生的设计技能提供了一个实践平台。     

The government, the market, and the problem of catastrophic loss

This article addresses the comparative advantage of the government to the private property/casualty insurance industry for the provision of insurance coverage for catastrophic losses. That the government can play an important role as an insurer of societal losses has been a central public policy principle since at least the New Deal. In addition, our government typically automatically provides forms of specific relief following unusually severe or unexpected disasters, which itself can be viewed as a form of ex post insurance. This article argues that, for systemic reasons, the government is much less effective than the private property/casualty insurance market in providing coverage of losses generally, but especially of losses in contexts of catastrophes.     

The impact of Chilean migration on employment in Patagonia

This paper discusses the employment situation of Chilean migrant workers, their impact on labor markets in Patagonia, Argentina, and the government's past and projected responses to this phenomenon. In 1980, Chilean inhabitants of patagonia comprised 11% of the area's population. Chilean migration to patagonia was closely linked to economic activities that began to flourish in the 20th century, such as livestock raising, fruit and vegetable cultivation, and mining for coal and petroleum. No Chilean migrants work in a wide range of sectors. In Patagonia's southern provinces availability and ability to withstand rigorous climate conditions are the main factors which account for the prevalence of Chilean manpower. Chilean migrants do not in general displace local manpower. Legislation and the permeability of the border ensure that most workers enter the country as tourists. Clandestine migration is not an issue. Illegal migrants have provoked negative reactions for several reasons: 1) they comprise a marginal population without formal citizenship; 2) being employed as clandestine workers, they pay no social security, nor do their employers; 3) being illegal, they are obliged to accept lower wages and inferior working conditions which creates unfair competition within labor markets; and 4) as a result of these conditions, xenophobic and endophobic attitudes in relations with Argentine nationalists are reinforced. The government has attempted to solve these problems through various measures. Beginning in 1934, most foreigners entered Argentina with a tourist visa, becoming illegal when they stayed beyond authorized limits. Several measures over the years provided amnesty to illegal migrants. Currently, the law promotes immigration, monitors the admission of foreigners to the country and stipulates their rights and obligations. The law lists 115 articles on immigration promotion and on regulation of the movements of foreigners. Because of the present economic crisis in Argentina, authorities are investigating the effect of Chilean manpower on Argentine labor markets.     

Physician-nurse migration to the United States: regional and health status origins in relation to legislation and policy

This article examines the origins of physicians and nurses who were admitted as permanent immigrants to the US from 1962-1979. Data are mainly from the Immigration and Naturalization Service. Countries used in the developmental analysis are only those whose population was estimated at 1 million or more as of mid-1979, encompassing 99% of the physicians and 97% of the nurses. Life expectancy at birth is the criterion used to differentiate origin countries by developmental dimension of health status. During the study period, health workers constituted about 30% of immigrants admitted to the US; of these, nurses and physicians constituted 72-82% throughout the study period. The period 1962-1979 has 4 distinct phases, marked by important legislative and/or policy changes; 1) 1962-1965, when the McCarran-Walter Act prevailed; 2) ending in 1968, the 2nd phase covers the transition mandated under the 1965 Immigration Act, which encouraged physician immigration; 3) the 3rd phase, 1969-1976, covers the transition to the 1976 Immigration and Nationality Act amendments; and 4) the 4th stage is 1977-1979. Results show that 1) under the McCarran-Walter Act, North America became the dominant physician source; 2) from 1966-1968, Asia attained dominance as the physician source and became even more predominant after 1968; 3) North America produced relatively few physicians in the early 1970s; 4) Europe produced substantially fewer physicians in the 1970s than in the 1960s; 5) South America, Africa, and Oceania were the lowest contributors of physicians; 6) during the McCarran-Walter years, North America and Europe produced almost 90% of nurses admitted into the US; 7) the 1965 Immigration Act and its aftermath resulted in Asia becoming the dominant source of nurses; 8) prior to the 1965 Immigration Act, Canada generated 20% of the aggregate number of physicians; 9) the Philippines surpassed Canada during the transition and India led after the transition; and 10) Canada supplied 30% of the nurses up through the transition, with the Philippines in the lead 1969-1979. Low health status countries were a relatively minor nurse source. Health status at the origin was a far less significant determinant of physician immigration than that of nurses. English language high and low health status country groups produced substantially more physician and nurse immigrants that their corresponding non-English language counterparts. The US attracted more physicians and nurses from less developed countries than more developed countries after 1968.     

Training with o (observing) and T (treatment) teams in live supervision: reflections in the looking glass*

Working with a treatment and observing team at the same time, behind the oneway mirror, offers a variety of ways to: (a) generate multiple realities; (b) work with two different models of family therapy simultaneously; and (c) provide feedback on the teams' own roles, rules and group process. The process that 6 trainees and two supervisors used with T and O teams to examine their own coevolution as a therapeutic system using the Milan model of family therapy and Ericksonian hypnotherapy is described. The article concludes with a discussion of the advantages and pitfalls of this type of dual supervision.     

Update on medications for the treatment of anxiety

It is interesting to note that antidepressants are widely represented in the medications used to treat the anxiety disorders. This has led to speculation about the role of depression, particularly subclinical forms being manifested as anxiety disorders. The specificity of diagnostic categories suggests that, at least for the moment, medications have a very specific and circumscribed role in the treatment of anxiety. This suggests that the difficulties of many anxious patients are not effectively treated with medication or that medication has only a short-term role at best. The next column will review health problems associated with psychotropic treatments for anxiety and discuss strategies for creating a "wedge," ie, introducing adjunct learning experiences along the anxiety gradient in conjunction with pharmacotherapy.     

The employment contract: A test of the transaction cost theory

This paper tests some predictions derived from Williamson's transaction cost theory of the organization of work, which holds that the form of the employment relationship is determined largely by the idiosyncrasy of work—that is, the nature of skills and knowledge used in production. It examines the occurrence of theoretically relevant provisions in collective bargaining agreements in the United States and finds they are related to a contract-level proxy for idiosyncrasy (based on bargaining structure) as predicted by the theory. An analysis of an individual-level variable, the difficulty of finding a comparable job, provides some additional support. Finally, several alternative explanations of the results are considered, and it is argued that none are consistent with the evidence. The analysis thus finds strong, if necessarily provisional, support for the theory.     

Some quantitative concepts of value and utility from a utilitarian point of view

This paper clarifies and interprets some basic quantitative concepts of value, utility and utility function from a utilitarian point of view. First, I discuss the question as to whether value is objective or subjective. I hold that value is subjective and statistical in nature (although from the various subjective values of a certain object a norm can usually be obtained). Second, I emphasize the distinction between use value and exchange value in relation to utility. Third, I propose a law of diminishing incremental interest, which refers to the incremental (marginal) utility of money. Fourth, I identify the utility of money with the von Neumann-Morgenstern utility. Fifth, I question the necessity of the usual normalization of utility functions and the restricted linear transformation (and the consequent concept of strategic equivalence). Sixth, I discuss in detail the terminal values and utilities of a utility function from a philosophical rather than mathematical point of view, particularly the boundedness of a utility function and the magnitudes of V ₀ and U ₀. Finally, I conclude that, in order to be able to have interpersonal comparisons of utility, utility should have the same dimension as value rather than no dimension, and the normalization problem should be reconsidered in the light of terminal values and utilities.