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VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations - Many non-profit organizations rely on volunteers to further their mission, but volunteer rates linger at only 25% of the...  相似文献   
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Evidence suggests that problem gambling is an unstable state where gamblers move into and out of risk over time. This article looks at longitudinal changes in risky gambling and the factors associated with an increased risk (measured by the Problem Gambling Severity Index [PGSI]) in the current New Zealand context, which has experienced a doubling of the electronic gaming machine (EGM) market over the last two decades. Respondents from a nationally representative baseline sample (n = 2672) were recontacted two years later to assess changes in gambling behaviours. Among the 901 respondents reached at follow-up, average gambling risk increased over time, and the prevalence of those who had at least some level of gambling risk (i.e. low-risk or greater) more than doubled (from 4.7% to 12.4%). The majority (80.2%) of those who were at risk at follow-up had not been at risk at baseline. Multivariate linear regression analyses show that the predictors of low to moderate increased risk include Pacific ethnicity; high neighbourhood deprivation status; baseline frequent, continuous gambler type; baseline PGSI status; and playing EGMs. These findings highlight the need to develop theories of gambling addiction trajectories and to identify the earliest point along the trajectory where public health interventions should occur.  相似文献   
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The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.  相似文献   
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Decision analysis tools and mathematical modeling are increasingly emphasized in malaria control programs worldwide to improve resource allocation and address ongoing challenges with sustainability. However, such tools require substantial scientific evidence, which is costly to acquire. The value of information (VOI) has been proposed as a metric for gauging the value of reduced model uncertainty. We apply this concept to an evidenced‐based Malaria Decision Analysis Support Tool (MDAST) designed for application in East Africa. In developing MDAST, substantial gaps in the scientific evidence base were identified regarding insecticide resistance in malaria vector control and the effectiveness of alternative mosquito control approaches, including larviciding. We identify four entomological parameters in the model (two for insecticide resistance and two for larviciding) that involve high levels of uncertainty and to which outputs in MDAST are sensitive. We estimate and compare a VOI for combinations of these parameters in evaluating three policy alternatives relative to a status quo policy. We find having perfect information on the uncertain parameters could improve program net benefits by up to 5–21%, with the highest VOI associated with jointly eliminating uncertainty about reproductive speed of malaria‐transmitting mosquitoes and initial efficacy of larviciding at reducing the emergence of new adult mosquitoes. Future research on parameter uncertainty in decision analysis of malaria control policy should investigate the VOI with respect to other aspects of malaria transmission (such as antimalarial resistance), the costs of reducing uncertainty in these parameters, and the extent to which imperfect information about these parameters can improve payoffs.  相似文献   
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Restructuring in the financial services industry has altered the relationship between small business owners and capital. In the past small businesses have relied on relational, or soft data, lending from locally owned banks for capital. The proliferation of absentee‐owned local branch networks brought standardized practices, thus eliminating the autonomy of local loan officers to utilize soft data in loan decisions. In this article we examine the changes in the percentage of traditional financial services that are locally owned in three county types: metropolitan, micropolitan, and noncore. We utilize the Longitudinal Business Database at the U.S. Census Bureau Center for Economic Studies. We examine changes in local ownership of traditional financial services between 1976 and 2007. We find that the rate of decline of local ownership has been greatest in the noncore (most rural) counties. We also explore to what extent these patterns are related to the emergence of alternative financial services during the same period. We find that such alternative services are growing in all three county types, but at rates not significantly different than the population growth for these county types. We supplement our analysis with data from qualitative interviews with small business owners throughout rural Texas. We conclude with a discussion of implications and plans for future research.  相似文献   
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