Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

Predictors of Problem Gambling in the U.S.

In this article we examine data from a national U.S. adult survey of gambling to determine correlates of problem gambling and discuss them in light of theories of the etiology of problem gambling. These include theories that focus on personality traits, irrational beliefs, anti-social tendencies, neighborhood influences and availability of gambling. Results show that males, persons in the 31–40 age range, blacks, and the least educated had the highest average problem gambling symptoms. Adults who lived in disadvantaged neighborhoods also had the most problem gambling symptoms. Those who attended religious services most often had the fewest problem gambling symptoms, regardless of religious denomination. Respondents who reported that it was most convenient for them to gamble had the highest average problem gambling symptoms, compared to those for whom gambling was less convenient. Likewise, adults with the personality traits of impulsiveness and depression had more problem gambling symptoms than those less impulsive or depressed. Respondents who had friends who approve of gambling had more problem gambling symptoms than those whose friends did not approve of gambling. The results for the demographic variables as well as for impulsiveness and religious attendance are consistent with an anti-social/impulsivist pathway to problem gambling. The results for depression are consistent with an emotionally vulnerable pathway to problem gambling.     

Changes in the gender structure: Inequality at the individual,interactional, and macro dimensions

As a society, we've made tremendous progress toward gender equality over the past several decades. Yet there remains significant inequality between women and men. Furthermore, when we look closely at some of the progress made toward gender equality, we find it considerably less impressive than surface appearances. In this article, we review the updated framework of Risman's (2017) gender structure theory and argue that it can help us make sense of the progress we've made as well as analyzing inequality as it persists between women and men. Using gender structure theory, we then show how gender is simultaneously reproduced and contested across the individual, interactional, and macro levels of society within 3 major social domains: work, family, and gender identity.     

The Self-Employment of Men and Women: What are their Motivations?

Do men and women carry different motivations for entering self-employment? Earlier researchers have suggested that, as primary care givers for children and families, women face a more stringent time constraint relative to men. Thus, where men see self-employment as a chance for greater financial opportunity, women see a chance to take work that allows more time at home. This paper investigates this hypothesis using unique data that allow analysis of individual self-employment as a function of traditional economic and demographic variables as well as variables that partially capture individuals’ opinions and perceptions of pecuniary and nonpecuniary aspects of entrepreneurism. Results suggest that men who choose self-employment are influenced principally by pecuniary concerns, while women are influenced principally by family concerns and by the opinions of their family, friends, and peers.     

Competing Frameworks in Planning for the Aged in the Growth Corridors of Melbourne

The Ageing in the Growth Corridors Project was initiated as a partnership between the University of Melbourne and the Department of Health in the Northwest Metropolitan Region of Melbourne, Australia. It involved a research team working with six project officers appointed to stimulate development in relation to an aging population in the sprawling outer metropolitan growth corridors. This article identifies the key lessons learned in terms of project implementation relating to attitudinal and structural barriers to the development of an age-friendly environment in areas of rapid urban growth. The findings illustrate some of the dilemmas raised by competing program conceptions, a dynamic and changing federal/state policy context, and local resource and strategic management constraints. The partnership with the university, nevertheless, provided a point of stability and continuity for the project officers in implementing their mandate.     

MANAGING ACADEMIC INTERDISCIPLINARY RESEARCH PROJECTS*

This field study provides variables that can be used by practitioners as action levers and by future researchers as the basis for theoretical development. Conclusions from relevant literature and findings from interviews with interdisciplinary research management identified forty variables that were viewed as important to interdisciplinary research project success. After adjusting the data for reliability attenuation, these variables were further analyzed to identify the best prediction equation. The findings suggested that project age or the longevity of the project and open discussion of disagreements were the best predictors of performance.     

Reexamining the moving to opportunity study and its contribution to changing the distribution of poverty and ethnic concentration

For the past decade and a half a concerted effort has been undertaken to determine whether policy interventions in residential location can solve the problems of inner-city poverty and racial concentration. Studies based on data from the Gautreaux litigation and the U.S. Department of Housing and Urban Development (HUD)-sponsored Moving to Opportunity (MTO) program have provided an overall optimistic interpretation of the possibilities of improving inner-city lives via mobility vouchers and counseling. A reanalysis of the data from the MTO program, focusing specifically on African American households, suggests greater caution in the interpretation of the findings from either Gautreaux or the MTO program. No statistically significant difference exists between the percentage of poor or the percentage of African Americans in the current neighborhoods between MTO and Section 8 experimental groups. In some cases, there is no statistically significant difference between those who move with a voucher and those who move without any assistance at all. Although there is some evidence that MTO programs have brought specific gains for individual families, claims for the MTO program as a whole need to be treated with a great deal more caution than they have been to date.