'Til death do us part: intimacy and sexuality in the marriages of Alzheimer's patients.

1. Alzheimer's disease (AD) is likely to have a significant effect on sexual behavior, but both patient and partner will still have sexual feelings and needs. 2. Research has shown that a high proportion of men with AD develop erection problems, but causes of their erection difficulties are not understood. 3. Research has shown that inappropriate sexual behavior in AD patients is uncommon, although it can be very troubling to the family and health-care provider if it occurs. 4. More professionals need to be trained to discuss sexual issues openly and sensitively with AD patients and partners and to offer useful clinical suggestions.     

Defining and measuring patient satisfaction with medical care

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

The marketing approach to purchasing

The determination of supply and demand is a complex problem to which both sides of the equation must contribute. Although marketing departments have organized themselves to provide such a contribution to data, purchasing has done little to promote its contribution to demand forecasting. Until it does the equation will remain not merely complex but insoluble.A continuous inter-change between marketing and purchasing, supplier and customer, is essential for improving the accuracy of longer range forecasting and for logistical co-ordination of investment planning. The corporate plans of manufacturing organizations, at least, should reflect these considerations.     

Educating Women: Gender Inequalities among Canadian University Graduates*

Dans le présent article, les auteurs proposent une analyse comparative des revenus et du chomage dliommes et de femmes diplômés universitaires entre 1978 et 1988. Les résultats montrent que le sexe continue d'exercer une influence importante sur ces données; le rapport global hommes-femmes est en effet passé de 84% a 91%. Seule une petite partie de l'écart des revenus peut s'expliquer par des différences entre les hommes et les femmes au regard du recrutement sur le marché du travail. Les auteurs considèrent ces résultats révélateurs de la ségrégation entre les hommes et les femmes, et que celle-ci mène à des différences dans les cheminements de carrière. De plus, pour l'avenir, ils prévoient que, tandis que l'écart des revenus continuera probablement de diminuer, les formes d'inégalité entre les diplômés seront peut-ôtre de plus en plus marquées, surtout que l'écart des revenus est en déclin parmi les cohortes récentes. This paper compares male versus female income and unemployment for three cohorts of university graduates between 1978 and 1988. Results show that gender became a weaker predictor of these outcomes, with the female-male earning ratio growing from 84% to 91% over this period. Nonetheless, a notable wage gap remained in later cohorts, and for one cohort income disparities widened with time in the labour market. Moreover, only a relatively small portion of the earnings gap could be attributed to male-female differences in market endowments. The authors interpret these results as illustrating gender segregation within occupations that result in disparate earning trajectories. Also, it is suggested that while the wage gap will likely continue to shrink, future patterns of inequality among graduates may become increasingly uneven, especially since real wages are declining among recent cohorts.     

Fractal analysis of surface roughness by using spatial data

We develop fractal methodology for data taking the form of surfaces. An advantage of fractal analysis is that it partitions roughness characteristics of a surface into a scale-free component (fractal dimension) and properties that depend purely on scale. Particular emphasis is given to anisotropy where we show that, for many surfaces, the fractal dimension of line transects across a surface must either be constant in every direction or be constant in each direction except one. This virtual direction invariance of fractal dimension provides another canonical feature of fractal analysis, complementing its scale invariance properties and enhancing its attractiveness as a method for summarizing properties of roughness. The dependence of roughness on direction may be explained in terms of scale rather than dimension and can vary with orientation. Scale may be described by a smooth periodic function and may be estimated nonparametrically. Our results and techniques are applied to analyse data on the surfaces of soil and plastic food wrapping. For the soil data, interest centres on the effect of surface roughness on retention of rain-water, and data are recorded as a series of digital images over time. Our analysis captures the way in which both the fractal dimension and the scale change with rainfall, or equivalently with time. The food wrapping data are on a much finer scale than the soil data and are particularly anisotropic. The analysis allows us to determine the manufacturing process which produces the smoothest wrapping, with least tendency for micro-organisms to adhere.     

Tradition and transformation: Pakistani-heritage young people explore the influences upon their educational progress

This article explores the perspectives of Pakistani-heritage Muslim young people on their educational progress, against a background where Muslim students are monitored for their vulnerability to radicalisation. The literature offers competing explanations for the persistent inequalities in attainment among different minority-ethnic groups, but the voices of pupils themselves are seldom heard. In this study, young people offer their own explanations of distinctive aspects within the local attainment data, which run counter to national trends. The principal sources of data are extended discussions with 36 Pakistani-heritage young people, and a survey conducted by some of the young people among 165 of their peers. Analysed through a Bourdieuian lens, the findings indicate that these Muslim young people are motivated by a strong sense of habitus and religious identity that transcends the divisions of social class. Further, they are actively engaged in habitus transformation, which drives their educational aspirations but involves personal cost, dilemmas and constraints.     

Toward a dimensional model of risk and protective factors influencing children's early cognitive,social, and emotional development during the COVID-19 pandemic

Variation in infants’ home environment is implicated in their cognitive and psycho-social development. The pandemic has intensified variations in home environments through exacerbating socioeconomic inequalities, and increasing psychological stressors for some families. This study investigates the effects of parental (predominantly maternal) mental health, enriching activities and screen use on 280 24- to 52-month-olds’ executive functions, internalising and externalising problems, and pro-social behaviour; with socioeconomic status and social support as contextual factors. Our results indicate that aspects of the home environment are differentially associated with children’s cognitive and psycho-social development. Parents who experienced sustained mental distress during the pandemic tended to report higher child externalising and internalising problems, and executive function difficulties at follow-up. Children who spent more time engaged in enriching activities with their parents showed stronger executive functions and social competence six months later. Screen use levels during the first year of the pandemic were not associated with outcomes. To mitigate the risk of persistent negative effects for this ‘pandemic generation’ of infants, our study highlights the importance of supporting parents’ mental health. As our results demonstrate the impact of social support on mental health, investing in support services and interventions promoting building support networks are likely to be beneficial.     

Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.