Parent/carer views on personal health budgets for disabled children who use rehabilitation therapy services

Personalised budgets are promoted as the person-centred alternative to generically provided services. Nine parents/carers of disabled children (aged 18 years or younger) who accessed at least two rehabilitation therapy services (physiotherapy, occupational therapy, and speech and language therapy) were recruited from one region in England. Focus group/interviews explored their views on the proposed introduction of personalised budgets. Parents and carers viewed a personal health budget with caution and perceived benefits were tempered by their experiences of current provision. Concerns were raised about entitlement and how a personal budget would work in practice.     

Choice of Parametric Accelerated Life and Proportional Hazards Models for Survival Data: Asymptotic Results

We discuss the impact of misspecifying fully parametric proportional hazards and accelerated life models. For the uncensored case, misspecified accelerated life models give asymptotically unbiased estimates of covariate effect, but the shape and scale parameters depend on the misspecification. The covariate, shape and scale parameters differ in the censored case. Parametric proportional hazards models do not have a sound justification for general use: estimates from misspecified models can be very biased, and misleading results for the shape of the hazard function can arise. Misspecified survival functions are more biased at the extremes than the centre. Asymptotic and first order results are compared. If a model is misspecified, the size of Wald tests will be underestimated. Use of the sandwich estimator of standard error gives tests of the correct size, but misspecification leads to a loss of power. Accelerated life models are more robust to misspecification because of their log-linear form. In preliminary data analysis, practitioners should investigate proportional hazards and accelerated life models; software is readily available for several such models.     

Social policy options and fuel poverty

The concept of ‘fuel poverty’, the inability to afford adequate warmth at home has become a focus for social policies in recent years. Increasing numbers of households dependent on social security and the likelihood that fuel will become more expensive mean that the existing problem of fuel poverty may become even greater. The data on fuel expenditure and related variables from three national surveys are used to evaluate various policy options for relieving fuel poverty. Three policies for increasing incomes to pay for fuel costs are considered, increasing benefits, introducing a fuel allowance or extending the existing scheme of additional heating requirements. The policies for reducing fuel expenditure are also considered, restructuring tariffs, changing payment methods and conservation measures. The case is made for priority to be given to an advice and information campaign and a conservation programme aimed at poor households who are unable to respond to existing price signals and grants.     

A unified approach to multilevel sample selection models

Abstract

We propose a unified approach for multilevel sample selection models using a generalized result on skew distributions arising from selection. If the underlying distributional assumption is normal, then the resulting density for the outcome is the continuous component of the sample selection density and has links with the closed skew-normal distribution (CSN). The CSN distribution provides a framework which simplifies the derivation of the conditional expectation of the observed data. This generalizes the Heckman’s two-step method to a multilevel sample selection model. Finite-sample performance of the maximum likelihood estimator of this model is studied through a Monte Carlo simulation.     

‘Drink a 12 box before you go’: pre-loading among young people in Aotearoa New Zealand

The practice of pre-loading—drinking large amounts of alcohol rapidly in private spaces prior to socialising in the night-time economy—has come to notice recently in the study of alcohol-related harm, but no studies have explored these phenomena in Aotearoa New Zealand. We used a theoretical framework developed with public health alcohol studies for understanding drinking cultures that conceptualises patterns of behaviours as arising within a dynamic interaction between forces of hedonism, function and control. We report findings from 34 focus groups conducted with 18–25 year olds as part of a project supported by the Marsden Fund, between 2011 and 2012, to investigate drinking cultures among young people. Our thematic analyses of participants’ accounts of pre-loading show that the term is in common use, applying to a range of practices motivated by price of alcohol but influenced by the pleasures of intoxication, the importance of peer processes and certain aspects of the regulatory system. We conclude with a discussion of the usefulness of the framework and the implications of the findings for public health policy that aims to reduce alcohol consumption and the harm that arises from it.     

Groups for Incest Survivors; A New Context

This article outlines a new context for group work with young women who have experienced incest. It describes how ideas from the work of White, Epston, Kamsler and de Shazer on the evolution, maintenance and resolution of problems can be applied to enhance the therapeutic effectiveness of group work with teenage survivors of incest. Externalisation, exploration of beliefs and restorying are found to assist the young women greatly to reconnect with their own resourcefulness.     

INFLUENCE OF MISSING ATTRIBUTES ON SELECTING A BEST MULTIATTRIBUTED ALTERNATIVE

Alternatives involving many factors arc difficult to evaluate because of multiple underlying competing objectives. If evaluation is based on an incomplete set of factors, and if the purpose of the evaluation is to select a single overall best alternative, inferior alternatives may be selected with surprising frequency and/or severe negative impact. At the same time, sensitivity analysis of evaluation scores based on statistical criteria can easily mask the impact and the frequency of selection of inferior alternatives. In this paper, criteria appropriate to reflect the decision impact are developed and both the frequency and impact of the selection of inferior alternatives are demonstrated empirically. Previous studies based on statistical criteria [1] [9] indicated minimal impact on overall evaluation and selection. This paper demonstrates that high statistical criterion values coexist with frequent and/or serious errors of selection.