Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

The Culture of High-Risk Alcohol Use Among Club and Intramural Athletes

Abstract

Objective: The purpose of this study was to examine the drinking patterns of club and intramural college athletes and compare their alcohol consumption, perceived norms around the excessive use of alcohol, experience of negative consequences, and employment of protective strategies with those of campus varsity athletes. Participants: A total of 442 undergraduate students attending a private, suburban institution in the Northeast participated in the American College Health Association National College Health Assessment-II Web survey in spring 2011. Thirty-five students identified themselves as varsity athletes, 76 identified as club sport athletes, and 196 students identified themselves as intramural athletes. Methods: Survey responses were analyzed using Statistical Package for the Social Sciences. The Pearson's correlation coefficient and test for independence were applied to identify significant relationships between athlete status and identified variables related to alcohol use. Results: Results indicated that there were significant correlations between athlete status and all variables, to varying degrees. Conclusions: These findings have implications for campus health promotion professionals and athletics program coordinators seeking to address high-risk alcohol use among college athletes.     

The Eating Disorders NOS Diagnostic Profile Among College Women

Abstract

The authors examined a proposed profile of eating-related behaviors, associated features, developmental issues, and help-seeking behavior among college women, using an eating disorder response program. The most common symptom scenario was a pattern of regular binge eating, together with daily exercise and occasional purging. The most common associated features were distressing or dysfunctional overconcern about body image and self-esteem, usually with day-to-day stress and intermittent depression. The women who fit this pattern also presented developmental issues of perfectionism, conflictual relationships with parents, and struggles for independence; and they tended to be ambivalent about seeking services. Implications for practice, including the need to develop a framework for eating disorder responses on campus that includes preventive programs and developmental interventions to target emerging and moderate concerns are discussed; limitations and the preliminary nature of the findings are explicated.     

Social Work with the Osteoporotic Woman

A chronic, progressive, and potentially debilitating condition, osteoporosis has a multitude of currently untapped implications for effective social work practice. A working knowledge of the medical framework of the disease process itself is a prerequisite to informed practice. This article presents such information, along with the psychological and social components, in order to provide the social worker with the comprehensive biopsyehosaial knowledge base necessary for effective practice with the osteoporotic woman and her family.     

Social Connectedness,Self-Esteem,and Depression Symptomatology Among Collegiate Athletes Versus Nonathletes

Objective: The authors compared collegiate athletes and nonathletes to see whether there were significant differences in the perceived levels of social connectedness, self-esteem, and depression and if an interaction among the variables of athlete status, gender, GPA, BMI, and levels of weekly exercise and sleep were associated with depression symptomatology. Participants: Participants were 227 college students. Method: The authors surveyed students using the Center for Epidemiologic Studies Depression Scale, the Rosenberg Self-Esteem Scale, and the Social Connectedness Scale-Revised. Results: Athletes had significantly greater levels of self-esteem and social connectedness, as well as significantly lower levels of depression, than did nonathletes. However, the statistically strongest predictors of depression in this cohort were the variables of gender, self-esteem, social connectedness, and sleep. Conclusion: This study adds to the limited and inconsistent research in the empirical knowledge base regarding depression among collegiate athletes.     

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.     

A comparison of social work education across South Africa and Japan in relation to the Global Standards for Social Work Education and Training

Sakaguchi H, Sewpaul V. A comparison of social work education across South Africa and Japan in relation to the Global Standards for Social Work Education and Training Int J Soc Welfare 2011: 20: 192–202 © 2009 The Author(s), International Journal of Social Welfare © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article draws on a one‐year study visit to the University of KwaZulu‐Natal, South Africa, interviews with field supervisors and students in Japan and reviews of the national frameworks of education in Japan and in South Africa. In doing so, the authors identify the similarities and differences in social work education across the two countries and they explore some of the historical and socio‐cultural factors that might account for the differences. There are some identifiable peculiarities in social work education in Japan, especially with the coalescing of care work and social work education. The lack of differentiation between care work and social work makes it difficult to narrow the scope of social work education and practice. National social work standards have been approved in South Africa and regulatory frameworks for social work education and practice have been long accepted, thus rendering ‘social work’ a protected title and a profession that is more entrenched compared with social work in Japan. The codes of ethics in Japan and South Africa are discussed with specific reference to their control functions in South Africa. The article concludes by discussing these comparisons in relation to the Global Standards for Social Work Education.     

藏汉中学生心理健康水平比较研究综述

心理健康教育是教育者应用心理学、教育学、社会学乃至精神医学等多种学科的理论和技术,通过多种途径与方法,培养学生良好的心理素质,提高心理机能,充分发挥其心理潜能,从而促进学生整体素质全面提高和发展的教育。藏族学生在学校学习的过程实际上是两种或两种以上文化之间交流并融合的过程,所有影响交流的因素都有可能对藏族学生的心理发展产生影响。教育落后是制约西部地区经济发展的根本原因。因此,研究西部少数民族学生的心理与教育,对于加快发展西部教育事业具有强烈的现实意义。     

Competition and The Operational Performance of Hospitals: The Role of Hospital Objectives

We examine the effect of a hospital's objective (i.e., non‐profit vs. for‐profit) in hospital markets for elective care. Using game‐theoretic analysis and queueing models to capture the operational performance of hospitals, we compare the equilibrium behavior of three market settings in terms of such criteria as waiting times and patient costs from waiting and hospital payments. In the first setting, a monopoly, patients are served exclusively by a single non‐profit hospital; in the second, a homogeneous duopoly, patients are served by two competing non‐profit hospitals. In our third setting, a heterogeneous duopoly, the market is served by one non‐profit hospital and one for‐profit hospital. A non‐profit hospital provides free care to patients, although they may have to wait; for‐profit hospitals charge a fee to provide care with minimal waiting. A comparison between the monopolistic and each of the duopolistic settings reveals that the introduction of competition can hamper a hospital's ability to attain economies of scale and can also increase waiting times. Moreover, the presence of a for‐profit sector may be desirable only when the hospital market is sufficiently competitive. A comparison across the duopolistic settings indicates that the choice between homogeneous and heterogeneous competition depends on the patients' willingness to wait before receiving care and the reimbursement level of the non‐profit sector. When the public funder is not financially constrained, the presence of a for‐profit sector may allow the funder to lower both the financial costs of providing coverage and the total costs to patients. Finally, our analysis suggests that the public funder should exercise caution when using policy tools that support the for‐profit sector—for example, patient subsidies—because such tools may increase patient costs in the long run; it might be preferable to raise the non‐profit sector's level of reimbursement.     

基于灰色系统建模技术的人体疾病早期预测预警研究

传统健康体检主要通过对单次体检指标进行横向比较和静态分析,忽略个体差异,纯粹从指标高低来判断体检者健康状况与身体状态,难以及时发现体检者可能存在的疾病隐患。由于个体体检指标具有样本量小、信息不确定、数据类型异构、影响因素构成复杂等特征,传统以大样本为基础的数学模型均难以适应此类小数据系统的建模要求。为此,通过建立适用于人体主要指标趋势预测的灰色系统模型（简称HIGM（1,1）模型）,实现对人体主要健康指标的动态建模与趋势分析,从而可以掌握体检者未来一段时间身体指标的变化趋势及可能存在的疾病隐患。研究成果对提升体检效果、强化体检意义,促进灰色理论与现实问题的有效对接等方面,均具有积极意义。