Individual vs. household determinants of the demand for medical care: A study of rural families

This article investigates, from a household perspective, the demand for medical care. Earlier (economic) studies have typically focused on individual utilization patterns; however, the data set employed here allows for an investigation of the role of other family members on individual demand. The theoretical results suggest that the labor force status (via the wage rate) of one family member may, in addition to influencing that person's rate of medical care use, effect the utilization of other household members. Separate physician visit demand equations are estimated for husbands, wives, and the household unit. The empirical results indicate that the wife's (full) cost of receiving medical care is a significant determinant of utilization by both the husband and other family members. Overall, the findings suggest that demand studies should take the presence of other household members and family structure into consideration when analyzing the determinants of individual medical care utilization.This study was supported in part by grant no. 1R03 HSO 2417-01 from the National Center for Health Services Research, HHS.Laurence Miners received his Ph.D. in economics from the University of North Carolina at Chapel Hill. He is currently an Associate Professor at Fairfield University and his research interests are focused mainly in the areas of health and labor economics. Correspondence concerning this article should be addressed to Laurence Miners, Department of Economics, Fairfield University, Fairfield, CT 06430.     

Nonparametric estimation of the limiting availability

The point availability of a repairable system is the probability that the system is operating at a specified time. As time increases, the point availability converges to a positive constant called the limiting availability. Baxter and Li (1994a) developed a technique for constructing nonparametric confidence intervals for the point availability. However, nonparametric estimators of the limiting availability have not previously been studied in the literature. In this paper, we consider two separate cases: (1) the data are complete and (2) the data are subject to right censorship. For each case, a nonparametric confidence interval for the limiting availability is derived. Applications and simulation studies are presented.deceased after the paper was accepted     

Transdiagnostic mechanisms involved in nonsuicidal self-injury,risky drinking and disordered eating: Impulsivity,emotion regulation and alexithymia

Abstract

Objective: The aim of the present study was to explore common and differential relationships between nonsuicidal self-injury (NSSI), risky drinking, and disordered eating attitudes and impulsivity, emotion dysregulation, and alexithymia. Methods: We investigated these associations in a sample of 951 college students (79.4% female, Mage = 21.86?years) by means of self-report questionnaires assessing the constructs of interest. Results: Overall, 28% of the students reported a history of NSSI, one third engaged in risky drinking, and less than 5% reported disordered eating symptoms. Negative urgency and difficulties in emotion regulation were both related to each of the three behaviors and can be considered as common transdiagnostic mechanisms. Conclusions: We discuss the implications of transdiagnostic mechanisms involved in these three dysregulated behaviors with respect to their assessment and treatment in college counseling settings.     

A new class of measurement-error models,with applications to dietary data

Measurement-error modelling occurs when one cannot observe a covariate, but instead has possibly replicated surrogate versions of this covariate measured with error. The vast majority of the literature in measurement-error modelling assumes (typically with good reason) that given the value of the true but unobserved (latent) covariate, the replicated surrogates are unbiased for latent covariate and conditionally independent. In the area of nutritional epidemiology, there is some evidence from biomarker studies that this simple conditional independence model may break down due to two causes: (a) systematic biases depending on a person's body mass index, and (b) an additional random component of bias, so that the error structure is the same as a one-way random-effects model. We investigate this problem in the context of (1) estimating distribution of usual nutrient intake, (2) estimating the correlation between a nutrient instrument and usual nutrient intake, and (3) estimating the true relative risk from an estimated relative risk using the error-prone covariate. While systematic bias due to body mass index appears to have little effect, the additional random effect in the variance structure is shown to have a potentially important effect on overall results, both on corrections for relative risk estimates and in estimating the distribution of usual nutrient intake. However, the effect of dietary measurement error on both factors is shown via examples to depend strongly on the data set being used. Indeed, one of our data sets suggests that dietary measurement error may be masking a strong risk of fat on breast cancer, while for a second data set this masking is not so clear. Until further understanding of dietary measurement is available, measurement-error corrections must be done on a study-specific basis, sensitivity analyses should be conducted, and even then results of nutritional epidemiology studies relating diet to disease risk should be interpreted cautiously.     

Art at the Edge of Texas

This review examines the work of the artist Forrest Bess. Sexuality, hermaphroditism, and gender are discussed as possible determinants of Bess's studio practice.     

On intertemporal poverty measures: the role of affluence and want

This paper proposes classes of intertemporal poverty measures which take into account both the debilitating impact of prolonged spells in poverty and the mitigating effect of periods of affluence on subsequent poverty. The weight assigned to the level of poverty in each time period depends on the length of the preceding spell of poverty or of non-poverty. The proposed classes of intertemporal poverty measures are quite general and allow for a range of possible judgements as to the overall impact on a poor period of preceding spells of poverty or affluence. We discuss the properties of the proposed classes of measures and axiomatically characterize these measures.     

Gender difference in physical performance, body composition and dietary intake in homebound elders

Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of homebound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 homebound elders (81% women, 48% black, > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.