The Personhood in Dementia Questionnaire (PDQ): Establishing an association between beliefs about personhood and health providers' approaches to person-centred care

Purpose of the studyInterest in person-centred dementia care has flourished in the last two decades. Despite growing interest in the development and implementation of person-centred approaches to dementia care, important empirical questions remain. For instance, although Kitwood (1997) emphasized that personhood, a status extended by others, is at the heart of person-centred care, to our knowledge, no one has demonstrated empirically that beliefs about patient status influence how care is provided. The purpose of this series of three studies was to operationalize Kitwood's definition of personhood in order to test this hypothesis.Design and methodsTo operationalize Kitwood's definition of personhood, we generated items to create the Personhood in Dementia Questionnaire (PDQ; Study 1). We then completed preliminary tests of the PDQ's convergent and discriminant validity (Study 2). Finally, we examined the PDQ's relationships with other constructs such as burnout and job satisfaction, and we used linear regression to test the hypothesis that health providers' beliefs about personhood influence intended approaches to dementia care (Study 3).ResultsIn Study 1, we generated a pool of 64 potential questionnaire items. In Study 2, a 20-item version of the PDQ demonstrated good internal consistency, resistance to socially desirable responding, and evidence of convergent and discriminant validity. In Study 3, PDQ scores accounted for a significant proportion of variance in health providers' intended approaches to dementia care, including pain management. PDQ scores were not related to job satisfaction or to most aspects of burnout.ImplicationsThese results provide the first direct empirical evidence of Kitwood's (1997) theory that beliefs about patient personhood have the potential to influence health providers' care decisions, including decisions about pain management.     

Strategic competitive information systems

A variety of strategic competitive information systems is described and evaluated in terms of three criteria which should be met by strategic information systems. The more sophisticated varieties—those that incorporate specific models into the system—generally meet the criteria better than do the ‘retrieval’ varieties of systems. Since systems of this kind are relatively expensive to develop, this suggests that the area of strategic competitive information may be one of great potential payoff for the integration of models into information systems.     

Tobacco,Marijuana, and Alcohol Use in University Students: A Cluster Analysis

Abstract

Objective: Segmentation of populations may facilitate development of targeted substance abuse prevention programs. The authors aimed to partition a national sample of university students according to profiles based on substance use. Participants: The authors used 2008–2009 data from the National College Health Assessment from the American College Health Association. The sample consisted of 111,245 individuals from 158 institutions. Methods: The sample was partitioned using cluster analysis according to current substance use behaviors. The association of cluster membership with individual and institutional characteristics was examined. Results: Cluster analysis yielded 6 distinct clusters. Three individual factors—gender, year in school, and fraternity/sorority membership—were the most strongly associated with cluster membership. Conclusions: In a large sample of university students, the authors were able to identify 6 distinct patterns of substance abuse. It may be valuable to target specific populations of college-aged substance users based on individual factors. However, comprehensive intervention will require a multifaceted approach.     

On the Skew-Normal-Cauchy Distribution

A fixed effects one-way layout model of analysis of variance is considered where the variances are taken to be possibly unequal. Conservative single-stage procedures based on Banerjee’s method for the solution of the Behrens-Fisher problem are proposed for the following multiple comparisons problems: 1) all pairwise comparisons with a control population mean, and 2) all pairwise comparisons and all linear contrasts among the means. Since these procedures are likely to be very conservative in practice, approximate procedures based on Welch’s method for the solution of the Behrens-Fisher problem are suggested as alternatives. Monte Carlo studies indicate that the latter are much less conservative and hence may be better in practice. Both these sets of procedures need only the tables of the Student’s t-distribution for their application and are very simple to use. Exact two-stage procedures are proposed for the following multiple comparisons problems: 1) all pairwise comparisons and all linear contrasts among the means, and 2) all linear combinations of the means.     

Multimarket pioneers: Does multimarket contact improve their performance?

First-mover advantages (FMA) and multimarket contact (MMC) have evolved independently in the strategic management literature. This is surprising because FMA erode as a result of competition which, in turn, is affected by MMC. This paper links these literatures through the concept of spheres of influence and analyses the effect of MMC on pioneers' profitability. We use the order of market entry to identify spheres of influence and to determine their distribution among multimarket firms. The distribution of spheres of influence allows us to distinguish between reciprocal MMC and non-reciprocal MMC and to study how each of them determines pioneers' profitability. We test our hypotheses in the mobile telecommunications industry. Our findings show that reciprocal MMC has a positive effect on pioneers’ results, but non-reciprocal MMC negatively affects them.     

Recycling the idea of race: socio-political agenda,transnational business culture,and diversity management in Brazil

ABSTRACT

This article intends to contribute to the line of studies that critically addresses diversity management, bringing the Brazilian experience into the discussion. It aims to demonstrate how large Brazilian companies and transnational corporations operating in the country have been recycling the idea of race in order to cope with the greatest politicisation of debates on the racial issue within the Brazilian public sphere since the late twentieth century. This phenomenon is related to changes in the political actions of the black movement in Brazil, which since the same period has been absorbing the new socio-political agenda existing within the global network of anti-racism advocacy. This is an agenda in which two purposes have a central importance: the battle against racial inequality and the demand for affirmative action policies. The data presented in this paper are part of broader research in which, by means of the biographical method and the ethnographic fieldwork, the social trajectories and career paths of two generations of Brazilian black executives were analysed.     

Bayesian methods for the cross-design synthesis of epidemiological and toxicological evidence

Summary.  Systematic review and synthesis (meta-analysis) methods are now increasingly used in many areas of health care research. We investigate the potential usefulness of these methods for combining human and animal data in human health risk assessment of exposure to environmental chemicals. Currently, risk assessments are often based on narrative review and expert judgment, but systematic review and formal synthesis methods offer a more transparent and rigorous approach. The method is illustrated by using the example of trihalomethane exposure and its possible association with low birth weight. A systematic literature review identified 13 relevant studies (five epidemiological and eight toxicological). Study-specific dose–response slope estimates were obtained for each of the studies and synthesized by using Bayesian meta-analysis models. Sensitivity analyses of the results obtained to the assumptions made suggest that some assumptions are critical. It is concluded that systematic review methods should be used in the synthesis of evidence for environmental standard setting, that meta-analysis will often be a valuable approach in these contexts and that sensitivity analyses are an important component of the approach whether or not formal synthesis methods (such as systematic review and meta-analysis) are used.     

Productivity growth,external shocks,and capital inflows in Chile: A general equilibrium analysis

This paper uses a computable general equilibrium model to analyze the growth path of the Chilean economy during 1977–1981. During that period a comprehensive package of reforms liberalized international trade and removed restrictive labor legislation. As a result of the reforms, there were large changes in relative prices and in the structure of production and demand, and the economy enjoyed unprecedented growth with declining inflation. But large macroeconomic imbalance become evident toward the end of the period and in 1982 Chile experienced an abrupt and severe recession. Taking the real exchange rate as an exogenous policy variable, and using the observed levels of employment growth and foreign capital inflows, this paper compares model-generated growth paths with those of the economy. First, the benchmark simulation path is used to estimate the magnitude and pattern of growth and productivity change during the 1971–1981 period. Next, counter-factual simulations are used to assess how Chile's economic performance would have differed if (a) external events had been different; and (b) foreign capital inflows had been different. The analysis suggests that the macroeconomic imbalances that led to the crisis in 1982 were exacerbated by the large capital inflows and real exchange rate appreciation that resulted from the use of the exchange rate as a stabilization device.