A macrodynamic analysis of changes in mortality indexes in the United States, 1946–75: Some preliminary results

This paper extends earlier research by Brenner and by Land and Felson on the specification and estimation of macrodynamic structural-equation models to explain changes in American mortality indexes as a function of exogenous changes in societal conditions (social, demographic, economic, and health care). After reviewing the record of annual changes in several general and cause — specific mortality indexes for the post-World War II United States, patterns of temporal covariation in the indexes are discussed and some tentative structural-equation models are described. Among other findings, these models indicate: (1) that changes in the age structure of the American population have substantial impacts on changes in mortality rates for diseases of the respiratory and circulatory systems as well as on deaths due to cirrhosis of the liver, accidents, and violence; (2) that the infective and parasitic diseases mortality rate is more closely related to per capita public health expenditures than to improvements in the general level of living in this post — war period; (3) that the business cycle, as indexed by the unemployment rate, has significant impacts on the cardiovascular, accident, and violence mortality rates; (4) that Brenner's finding of a positive association of an increase in the unemployment rate with an increase in cardiovascular diseases mortality two to three years later is partially mediated by an increase in per capita cigarette consumption during the economic recovery following a recession; (5) that an increase in the per capita level of cigarette consumption increases the respiratory systems mortality rate; (6) that both the general and the respiratory neoplasms mortality rates are more strongly affected by long-term moving averages of annual per capita levels of cigarette consumption than by single-years levels; (7) that the level of the degenerative diseases mortality rate is positively affected by an increase in per capita liquor consumption and negatively affected by an increase in health care utilization; (8) that the percentage of all vehicles traveling on highways at high speed is the exposure index most closely associated (of several that were studied) to the motor vehicle accident mortality rate; (9) that the levels of the maternal and infant mortality rates are positively related to an increase in the fertility rate (exposure) and negatively related to those advances in health care services associated with hospital births; (10) that the accuracy with which short-term changes in the crude mortality rate can be predicted from a knowledge of cause-specific mortality rates and how the latter are affected by societal conditions is effectively limited by the degree of accuracy of predictions of the respiratory diseases mortality rate because of its volatile influenza, pneumonia, and bronchitis component; and (11) that short-term changes in the life expectancy index can be somewhat more accurately predicted from such knowledge. Although most of these relationships have been noted before in mortality studies, only a small fraction have been studied in a macrodynamic structural-equation models context. These findings thus constitute a baseline of statistical evidence which can be explored in future research.     

Would Palliative Care Patients Benefit from Social Workers' Retaining the Traditional 'Casework' Role rather than Working as Care Managers? A Prospective Serial Qualitative Interview Study

Social workers have made a significant contribution to the developmentand delivery of palliative care. Both palliative care and socialwork are rapidly evolving but, given their changing contextsand increasing workloads, can they sustain compatibility? Advancesin treatment of life-threatening illness mean that people livelonger in a period of palliative care. Social work has undergoneradical change in the wake of the 1990 NHS and Community CareAct and subsequent local-authority modernizations, with socialworkers now given the role of care managers, rather than themore traditional ‘casework’ or therapeutic role.This paper aims to explore the current and potential role ofthe social worker in palliative care for people with cancerand other prolonged life-threatening illness. It draws uponevidence from a prospective qualitative, patient-centred researchstudy, which detailed the experiences of forty people with lungcancer and advanced cardiac failure, and their personal andprofessional carers (Murray et al., 2002). A total of two hundredand nineteen qualitative interviews were carried out. We found that social workers were conspicuous by their absencefrom the lives of these forty vulnerable adults, who were livingand dying in the community with many unmet needs which, potentially,could be met by social-work input. The study highlights sixareas of concern in which social-work assessment and interventioncould have impacted on dying patients’ quality of lifeand that of their carers: loss and dependency, family-centredissues, carers’ needs, practical tasks, emotional andspiritual struggles, and finally, support needs of staff. Theseareas are outlined to explore the territory which a social workermight inhabit if resources and policies permitted.     

Parenting: Can Skills be Learned?

The effectiveness of parent education courses conducted in the northern suburbs of Sydney was assessed in terms of Hereford's Parent Attitude Scale after norms for this area had been established. The results indicated that on completion of these courses participants had greater confidence in their abilities as parents, were more aware of the influence of environment on their children and had a more trusting relationship with their children. Kavanagh doubted the relevance of a course such as PET to parents of lower socioeconomic status—these parents have also been shown to score lower on the PAS. However in this study participants who scored lowest initially improved most, showing that the course is reaching those who are not very well informed about childrearing.     

Cooperating,reflecting, making open and meta-dialogue — Outline of a systemic approach on constructivist grounds

In this paper the authors first describe the theoretical background of their constructivist approach to therapy: the Kiel-Meyn-Consultation-Model. They then outline their guidelines “cooperating, reflecting, making open” for interviewing, briefly describe the “meta-dialogue” and point out some basic helpful attitudes consultants can hold. Annotated excerpts from a consultation are then presented to give an idea of how the model works. The paper closes with summaries of follow-up sessions and their evaluation by the therapist.     

Agreement Between Scales in the Measurement of Breast Cancer Risk Perceptions

The objective of this article is to compare the accuracy and numeric responses of breast cancer risk perception as measured by a frequency scale and percentage scale. A cross-sectional survey was conducted. Perceptions of five-year and lifetime breast cancer risk were measured using a frequency and a percentage scale. Estimation error was calculated as the absolute difference between actual breast cancer risk as determined by the Gail model and perceived risk. Agreement between scales was determined by calculating the mean and standard deviation of the difference between numeric responses. The study was conducted among women enrolled in two primary care clinics associated with an academic medical center. Two-hundred-fifty-four participants were recruited from one of the two participating internal medicine clinics. Inclusion criteria included female gender and age 40-84 years. Exclusion criteria included a history of breast cancer, dementia, or a life expectancy of less than two years. The frequency scale was more accurate than the percentage scale in estimating lifetime risk (p= 0.05), but less accurate in estimating five-year risk (p < 0.02). Only 79 participants (31%) were considered consistent scale users, providing identical responses when using the frequency and percentage scale for a given risk estimate. Although the mean difference (percentage-frequency scale) for estimates of breast cancer lifetime risk was only 2.4, the empirically determined 90% limits of agreement between the frequency and percentage scale for lifetime risk were wide, from -30 to 40. Higher numeracy was associated with consistent use of scales (OR 1.61, 95% CI; 1.09-2.37). We report disagreement in breast cancer risk perceptions when measured by a frequency and a percentage scale. The accuracy and direction of bias associated with each scale varies according to the time frame of risk being assessed.     

What recruiters can't/won't tell you. 6 questions that good headhunters won't answer.

If you're frustrated because a headhunter won't give you certain information about a hiring organization, get over it. There are some very good reasons why a respectable recruiter won't answer particular questions from job candidates. Find out the questions and why they won't answer them.     

Osteoporosis: an invisible, undertreated, and neglected disease of elderly men

This article highlights a silent disease that threatens the health and vitality of older men. Among elderly men and women, osteoporosis is among one of the leading causes of morbidity and mortality in the United States. Once perceived as only a female dominated disease, osteoporosis is now known to be gender blind. The following discussion will review the epidemiology and pathology of osteoporosis, and identify the concerns raised for men, including neglect. Special management considerations for older men and recommendations for future research into this overlooked major health problem will be explored. Better understanding of how osteoporosis affects older men may help to encourage prevention strategies earlier in life, appropriate screening and monitoring, as well as more effective treatment later in life.     

Language and the Shaping of Social Work

This article is concerned with the power of language to shapeand confirm social work’s identity and to control itsessential direction and task. Social work has perennially concerneditself with communication but paid surprisingly little attentionto the more abstract concept of language. The authors tracethe changing language used throughout social work’s UKhistory, placing this into socio-political and socio-economiccontext and analysing the discourses thus created and promoted.We identify three broad periods in the development of socialwork, characterized as the moral enterprise, the therapeuticenterprise and the managerial enterprise. We conclude by connectingthis discussion with some key challenges, issues and dilemmascurrently facing social work in the criminal justice and communitycare arenas, highlighting the language and discourse of punishment,risk management, consumerism and the market economy. The articleconcludes by arguing that social work must reclaim the languageof its activity as it engages with the challenges to its identity.     

Working with Me,Working at Me: Fathers' Narratives of Child Welfare

This article examines the experiences of fathers involved in the child welfare system. Fathers who were interviewed as part of a multiyear Canadian project were atypical in that they were actively engaged with the child welfare system. Their stories show how, although not always physically present, child welfare's ghostly form is still very much a part of the daily lives of fathers and their families. These fathers had to be resourceful and resilient as they endeavored to look “promising” to the child welfare system. The critical analysis offers insights into a more father-inclusive approach to child welfare that has implications for policy and practice development.