"How much do you spend gambling?" ambiguities in survey questionnaire items

The validity of a survey's findings is dependent upon the clarity and lack of ambiguity contained in each individual item yet minimal attention has been directed to this issue in most prevalence studies. Researchers have shown a tendency to accept the uncritical assumption that respondents interpret seemingly simple and straightforward items such as 'how much do you spend gambling?' in a consistent manner. No attempt is made to confirm the uniformity of responses by clarifying the mathematical formulae used by respondents to derive their answers. The purpose of this paper was to examine the consistency shown by a sample of 181 medical undergraduate subjects in estimating the level of gambling expenditure in a series of five case vignettes describing various scenarios of wins and losses during a session of gambling. Results revealed a wide variation in calculated figures depending upon whether or not subjects interpreted the item to mean net expenditure or turnover. Only two thirds or less of subjects calculated the figure to be the difference between the initial amount risked and the residual at the conclusion of the session. It is suggested that more attention be paid in prevalence and clinical studies to providing subjects with clear instructions on how to calculate expenditure estimates.     

Implementing a gender policy in ACORD: strategies,constraints, and challenges

ACORD, a consortium of 11 nongovernmental organizations from Europe, Asia, and North America devoted to poverty alleviation in Africa, formally adopted a gender policy in 1990 aimed at reducing gender-based inequities in communities where ACORD works. A 1994-96 survey of field programs indicated that the greatest gains for women had been recorded in the areas of welfare, access to resources, conscientization (awareness of and will to alter gender inequalities), and, to a lesser extent, participation; minimal progress was noted in shifting the prevailing gender-based imbalance of power and control in public or private spheres. The research identified several programming and organizational strategies that have promoted positive outcomes for women: gender-awareness training for staff and community members, working with mixed groups, working with women-only groups, promotion of female leadership, gender-aware participatory planning and evaluation, spreading responsibility throughout the organization for implementing the gender policy, recruitment and promotion of women staff, networks for women staff, and direct field involvement in research. Also identified were internal and external factors that weakened policy implementation: a lack of clarity as to its aims, culture-based resistance, confusion regarding responsibilities and procedures, weak accountability mechanisms, lack of gender impact indicators, training inadequacies, underrepresentation of women staff, and inadequate resources. As a result of the review process, ACORD has given gender issues centrality in its current 5-year strategic plan.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Shifts in household demographics herald economic changes for Thailand

In Thailand, dramatic changes in households and the health status of the population have led to important implications for the economic sector. These changes affect health, education, housing, employment and transportation. A new book on the economic impact of demographic change by Andrew Mason and Burnham O. Campbell is referred to as a full discussion of the issues. National planning and projections must include household characteristics as well as numerical projections. The analysis of Mason and Campbell is summarized in this article. Important changes are occurring in the size, rate of growth, and age structure of Thailand's population. Life expectancy has risen to 63 years for men and 68 years for women. Fertility has fallen to 2 children/woman. Population growth was 1.9% in 1990. In 1990, there were only 1 in 3 under the age of 15, and these numbers are expected to shrink to 1 in 4 by the year 2000. 60% of the population is of working age; this is expected to increase to 65% by the year 2000. The 60 years old population is expected to be 7.5% of the total in the year 2000. The average household has 1.6 children. 96% of households live with a relative. The expectation is that household size will continue to decrease and the number of households will continue to grow. The number of elderly heads of households is expected to rise to 11% by 2010. Households will become "adultified." The policy implications for education are that the school age population will gradually decreases but the number enrolled will increase. Primary school enrollment will stabilize and then decline after 1995. Secondary school enrollment will increase and level off in 2005. Total enrollment will increase from 10.5 million in 1990 to 11.4 million in 2000 and decline to 10.7 in 2015. These changes will allow for improvements in the quality of education and expand educational attainment. In health care, the demand for maternal and child health services will decline; changes will occur in the kinds of medical care needed.     

Comparing measures of poverty and relative deprivation: an example for Belgium

This paper presents three different poverty standards. A first approach takes the disposable income as an indicator of poverty. A second approach uses the Leyden approach. Finally an aggregate index of deprivation, based on the observation of consumption events, is constructed through a particular econometric procedure proposed by Desai and Shah (1988). These alternative measures are then compared on a sample composed of 6380 Belgian households. Such an analysis can be expected to provide some further insight into the problem of measuring poverty, which has been the subject of a recent controversial debate.We thank the participants of the Second Annual Meeting of the European Society for Population Economics, June 23–25, 1988, Mannheim (FRG), L. Gevers, J. Lindsey, P. Pestieau, B. Sak, K. Van den Bosch and two anonymous referees for their comments and suggestions.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

Under new management: the changing role of the state in the care of older people in the United Kingdom

This article examines recent changes and those currently being introduced in the formal care of older people in the United Kingdom. These are part of a general trend in all welfare states towards welfare pluralism but, in addition, the United Kingdom represents something of a special case because of the radical ideological engine that has driven the restructuring of the role of the state. The first part of the article outlines the main changes--the promotion of the private sector, the residualization of the public social services, and the new managerial role of the state in the care of older people. The second part considers the implications of these changes for older people and their informal helpers (or caregivers). The conclusion refers to both the particular changes taking place in the United Kingdom and, in general terms, to welfare pluralism as a policy goal.     

The private practitioner in hospital quality assurance

External forces continue to dictate the necessity of delivering high-quality health care along with methods of proving that the claimed quality is attained. Gone are the days when both the institution and its practitioners could answer quality questions simply by stating that they were delivering excellent health care to their patient population. The federal government, via the Health Care Financing Administration, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are mandating that institutions prove, without question, that they are delivering health care of the highest quality. The essential key to attaining these goals is cooperative private practitioners.