Co‐producing innovation or innovating co‐production? Responding to the contact needs of non‐resident parents in the Republic of Ireland

The empowerment and participation of children and families in both the design and the delivery of services oriented towards them is now an accepted norm, if not always the accepted practice. Yet, challenges still remain, particularly where parents are separated and contact issues are problematic. Although contact centres are common in some Western countries including Australia, New Zealand, the UK, France, and the USA, this is not the case in the Republic of Ireland. The relatively recent introduction of divorce, increases in separation and childbirth outside of marriage have led to the need for service planners to respond to the growing issue of non‐resident contact with children. Using Bovaird's co‐production framework, the purpose of this paper is to outline and discuss specific findings relating to service user involvement emanating from a formative evaluation of an innovative supported contact service in Ireland. What emerges from the findings is a picture of co‐production where the broad parameters of the service are professionally defined and where the specifics of service user involvement in delivery vary from family to family but within the bounds of professional control.     

Beyond Self‐Reports: Changes in Biomarkers as Predictors of Mortality

The proliferation of biosocial surveys has increased the importance of weighing the costs and benefits of adding biomarker collection to population‐based surveys. A crucial question is whether biomarkers offer incremental value beyond self‐reported measures, which are easier to collect and impose less respondent burden. We use longitudinal data from a nationally representative sample of older Taiwanese (aged 54+ in 2000, examined in 2000 and 2006 with mortality follow‐up through 2011) to address that question with respect to predicting all‐cause mortality. A summary measure of biomarkers improves mortality prediction (as measured by the area under the receiver operating characteristic curve) compared with self‐reports alone, but individual biomarkers perform better than the summary score. We find that incorporating change in biomarkers over a six‐year period yields a small improvement in mortality prediction compared with one‐time measurement. But, is the incremental value worth the costs?     

The Best Predictors of Survival: Do They Vary by Age,Sex, and Race?

We consider a broad set of variables used by social scientists and clinicians to identify the leading predictors of five‐year survival among American adults. We address a question not considered in earlier research: Do the strongest predictors of survival vary by age, sex or race/ethnicity? The analysis uses hazard models with 30 well‐established predictors to examine five‐year survival in the National Health and Nutrition Examination Survey. We find that the simple measure of self‐assessed health and self‐reported measures of functional ability and disability are the strongest predictors in all demographic groups, and are generally ranked considerably higher than biomarkers. Among the biomarkers, serum albumin is highly ranked in most demographic groups, whereas clinical measures of cardiovascular and metabolic function are consistently among the weakest predictors. Despite these similarities, there is substantial variation in the leading predictors across demographic groups, most notably by race and ethnicity     

Determinants of Mortality at Older Ages: The Role of Biological Markers of Chronic Disease

Researchers have had a longstanding interest in understanding the determinants of mortality. This article examines the impact of a broad array of biological markers, together with self‐reports of physical and mental health status, on the probability of dying for older adults. The estimates are derived from logistic regression models based on data from a national survey in Taiwan. The analysis confirms previous studies demonstrating the effects of clinical measures related to metabolic syndrome on mortality and identifies detrimental effects of neuroendocrine and immune‐system markers. The results reveal that biomarkers provide independent explanatory power in the presence of self‐reported health measures. The associations between biomarkers and mortality found here provide new avenues for projecting future mortality and elucidating differences in longevity across populations.     

Quare Eire

In this position piece we will briefly introduce The(e)ories: Advanced Seminars for Queer Research, which we founded and have convened at University College Dublin, Ireland, since January 2003. We will do this in an effort to illustrate how the aims and development of The(e)ories have mirrored, but also deviated from the US/UK-centric model of Queer Theory which (although largely a myth) continues to dominate discussions of sexuality. In this, we endeavor here to show how Queer Theory and Lesbian Studies, while not interchangeable, intersect with each other in important ways in our praxis in Ireland and thus, are not reducible to the 'collision model' (Doan, this volume) forwarded by proponents and critics alike.     

A Bayesian model for longitudinal count data with non-ignorable dropout

Asthma is an important chronic disease of childhood. An intervention programme for managing asthma was designed on principles of self-regulation and was evaluated by a randomized longitudinal study.The study focused on several outcomes, and, typically, missing data remained a pervasive problem. We develop a pattern-mixture model to evaluate the outcome of intervention on the number of hospitalizations with non-ignorable dropouts. Pattern-mixture models are not generally identifiable as no data may be available to estimate a number of model parameters. Sensitivity analyses are performed by imposing structures on the unidentified parameters.We propose a parameterization which permits sensitivity analyses on clustered longitudinal count data that have missing values due to non-ignorable missing data mechanisms. This parameterization is expressed as ratios between event rates across missing data patterns and the observed data pattern and thus measures departures from an ignorable missing data mechanism. Sensitivity analyses are performed within a Bayesian framework by averaging over different prior distributions on the event ratios. This model has the advantage of providing an intuitive and flexible framework for incorporating the uncertainty of the missing data mechanism in the final analysis.     

Prenatal and delivery care and childhood immunization in guatemala: Do family and community matter?*

In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or “modern ”) health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.     

Marriage selection and mortality patterns: Inferences and fallacies

Researchers have long wondered whether marital-status differences in mortality arise largely from selection mechanisms or from causal processes typically known as marriage protection. Unfortunately, many investigators have relied on aggregate patterns of mortality differentials—such as age schedules of excess mortality in the single population or the relationship between the level of excess mortality and the relative size of the single population—to make inferences about the relative importance of selection and causal processes. In this paper, a simple mathematical simulation model is used to demonstrate that many inferences derived from observed patterns are simply not justified. This finding highlights the importance of prospective data for assessing the relative importance of selection and causal factors in accounting for the excess mortality of the unmarried.     

Dietary Sodium Intakes and Food Sources of Sodium in Canadian-Born and Asian-Born Individuals of Chinese Ethnicity at a Canadian University Campus

Abstract

Objective: To document the sodium intake and food sources of sodium of Canadian-born Chinese (CBC) and Asian-born Chinese (ABC) individuals at a Canadian university campus. Participants: Healthy adults aged 18–58 years originating from Canada, China, Hong Kong, or Taiwan were recruited from the University of Alberta (n = 40 CBC, n = 41 ABC) between May and December 2010. Methods: Two in-person multipass 24-hour dietary recall interviews were administered for 1 weekday and 1 weekend day. Results: The mean sodium intake was 3,623 ± 1,406 mg/day. The major food sources of sodium were commercially prepared and processed foods for both CBC and ABC (59.9% and 54.7% of sodium, respectively). Condiments contributed substantially to dietary sodium intake of CBC and ABC (27.8% and 35.1% of sodium, respectively). Conclusions: Efforts to reduce dietary sodium among students and other adults of Chinese ethnicity should focus on limiting consumption of commercially processed foods and moderation in discretionary use of salt and soy sauce.     

Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.