Can a Sector‐Wide Approach Underpin and Advance Universal Health Coverage?

Fragmented management approach makes the provision of comprehensive health care for achieving universal health coverage very unlikely. This article aims to explore the potential contribution of a systemic approach—the sector‐wide approach (SWAp)—to achieving universal health coverage (UHC), using the Mongolian context as an example. The paper describes UHC and factors that hinder its achievement in developing countries, based on the Mongolian experience. The analysis focuses on the root factors hindering the achievement of UHC and examines how these affect system and local capacity critical for achieving UHC. Two principally different approaches, a sector‐wide (holistic) approach and a standalone project (fragmented) approach are compared in terms of their contribution to the main indicators of achieving UHC. The current stage of the Mongolian health SWAp is identified and early rewards of a SWAp are presented. The paper proposes a SWAp as a potential approach to tackle these root factors to help in achieving UHC, because it is a promising instrument that promotes a systems‐strengthening and capacity‐building approach to enable effective coordination of standalone projects in alignment with the national priorities.     

Sexual Risk Behavior in Young Adulthood: Broadening the Scope Beyond Early Sexual Initiation

A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation was a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10 to 15) and sexual risk taking (ages 21 to 24 and 30 to 33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood.     

Mortality in China 1964-2000

This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China from the 1960s to 2000. We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People's Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973-75 Cancer Epidemiology Survey. Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at. Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964-82 to nearly 70 years in the period 1990-2000, with a further improvement to over 71 years by 2000. We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage.     

A Long-Term Family-Oriented Treatment for Adolescents with Substance-Related Disorders: An Outcome Study

Treatment programs for substance-disordered adolescents increasingly use family and Twelve-Step orientations. Pathway Family Center adds to that model a long term stay (9 to 15 months), a day treatment setting, and the unique feature of temporarily placing the client with the family of another client who has progressed further in the program. This outcome study surveyed the 100 clients and their parents from the first five years of the program, using mailed questionnaires and telephone interviews. Information was collected from 51% of clients and 61% of parents, and client-parent agreement was high. Ninety-eight percent of adolescents reported that they did not return to prior drug severity, 51% reported no use since discharge, 23% reported one or two relapses, 88.2% reported improved family relations, and 90.2% reported improved quality of life. In comparing those who remained completely abstinent with those who relapsed, the non-relapsers were twice as likely to have a diagnosis of uni-polar depression at admission. We hypothesize that the depression is associated with hitting bottom, an indication that the client may be motivated to commit to major change. These outcomes compare very favorably with those of other adolescent treatment programs.     

Only sane: Autistic barriers in “boring” patients

This paper addresses needs of patients whom Winnicott called boring. Although often functioning well in the work world, they lack a rich inner life and a capacity for intimacy. Thus, psychotherapy is particularly problematic for them. To develop a model for working with this group of patients, the authors elaborate the concept of autistic barriers from British object relations theory, and suggest a changing role for the therapist in four successive phases of the treatment.     

Further developments in indirect mortality estimation

Summary A variety of indirect estimators of mortality; survival of children by marriage duration of mother, survival of first spouse by marriage duration and by age, maternal orphanhood, and survival of siblings, are investigated by the use of a wide range of model fertility and mortality situations. Survival probabilities are then related by regression analysis to the proportions with a particular characteristic, to yield an equation which can then be used to estimate the survival probability in a population. Maternal orphanhood and survival of first spouse by age have already shown themselves to be useful, and the new developments are only simplifications of the existing methodology. Survival of first spouse by duration of marriage, and survival of siblings are, however, new methods which have yet to be justified by field experience. In conclusion, the features common to all indirect mortality estimation procedures are outlined, and the direction future developments may take in response to gradually improving data quality is suggested.     

A New Framework for Manufacturing Planning and Control Systems*

This paper presents a new framework for manufacturing planning and control systems which we call iterative manufacturing planning in continuous time (IMPICT) that appears to have several advantages over the well-known material requirements planning (MRP) framework. IMPICT explicitly considers capacity constraints and total system cost (including tardiness) to determine order sizes, order release/due dates, and operation schedules in a deterministic, multi-level, finite horizon, dynamic demand environment. Continuous time scheduling variables allow setups to be carried over from one period to the next. Three new heuristics built on the IMPICT framework are presented and tested in a simulation-based, full-factorial experiment with a wide variety of problem environments. The benchmark for the experiment was materials requirements planning with operations sequencing (MRP/OS) implemented with best-case, fixed planned lead times. The experiment showed that all three heuristics were statistically better than MRP/OS. The total cost for the order merging (OM) heuristic was 25 percent better than the total cost for MRP/OS. Computational times for OM were substantially larger than for MRP/OS; however, the computational times in the experiment suggest that OM is still computationally viable for large-scale batch manufacturing environments found in industry. IMPICT is superior to standard MRP systems because it explicitly considers capacity constraints and total system costs when it creates a materials plan. IMPICT is superior to linear programming-based approaches to finite loading and scheduling found in the literature because it allows setups to be carried over from one period to another and because it is computationally viable for realistic-sized problems.     

Sampling Weights for Analyses of Couple Data: Example of the Demographic and Health Surveys

In some surveys, women and men are interviewed separately in selected households, allowing matching of partner information and analyses of couples. Although individual sampling weights exist for men and women, sampling weights specific for couples are rarely derived. We present a method of estimating appropriate weights for couples that extends methods currently used in the Demographic and Health Surveys (DHS) for individual weights. To see how results vary, we analyze 1912 estimates (means; proportions; linear regression; and simple and multinomial logistic regression coefficients, and their standard errors) with couple data in each of 11 DHS surveys in which the couple weight could be derived. We used two measures of bias: absolute percentage difference from the value estimated with the couple weight and ratio of the absolute difference to the standard error using the couple weight. The latter shows greater bias for means and proportions, whereas the former and a combination of both measures show greater bias for regression coefficients. Comparing results using couple weights with published results using women’s weights for a logistic regression of couple contraceptive use in Turkey, we found that 6 of 27 coefficients had a bias above 5 %. On the other hand, a simulation of varying response rates (27 simulations) showed that median percentage bias in a logistic regression was less than 3 % for 17 of 18 coefficients. Two proxy couple weights that can be calculated in all DHS surveys perform considerably better than either male or female weights. We recommend that a couple weight be calculated and made available with couple data from such surveys.     

Barriers children face complaining about social work practice: A study in one English local authority

Despite the introduction of guidelines and procedures aimed at encouraging and supporting children and young people to complain about the services they receive, children in care still face barriers to doing so in practice. This paper explores what happens when children in care are dissatisfied with the services they receive. Specifically, this study examines the complaints procedure for children in care. The findings are based on semistructured interviews with children in care, social workers, senior managers, and independent reviewing officers from one English local authority. Thematic analysis of these data identified five emergent themes: (a) complaints by children in care are managed at the lowest possible level, (b) senior managers have an overly optimistic view about children in care being informed of complaint procedures and being encouraged to do so, (c) children in care are worried about complaining, which is recognized by professionals, (d) children's voices are often not heard, and (e) when issues are clearly defined, independent reviewing officers have some degree of success in resolving complaints from children in care.     

Confidence in preferences

Indeterminate preferences have long been a tricky subject for choice theory. One reason for which preferences may be less than fully determinate is the lack of confidence in one’s preferences. In this paper, a representation of confidence in preferences is proposed. It is used to develop and axiomatise an account of the role of confidence in choice which rests on the following intuition: the more important the decision to be taken, the more confidence is required in the preferences needed to take it. This theory provides a natural account of when an agent should defer a decision; namely, when the importance of the decision exceeds his confidence in the relevant preferences. Possible applications of the notion of confidence in preferences to social choice are briefly explored.