Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

FAMILY THERAPISTS' RESPONSE TO AIDS: AN EXAMINATION OF ATTITUDES,KNOWLEDGE, AND CONTACT*

As the number of individuals and families impacted by AIDS continue to multiply, family therapists will increasingly be asked to become engaged in the challenge of caring for those affected. To date, little has been written in family therpy journals regarding the response of family therapists to this crisis. This paper represents an initial attempt to examine the atitudes of clinical members of the American Association for Marriage and Family Therapy toward AIDS and persons with AIDS. Included in the study are data regarding the therapists' contact with persons with AIDS, gays, and lesbians, and the impact of such contact on attitudes. Implications for future research, training, and treatment of those affected by AIDS are also provided.     

A research note on Keyfitz's ‘The demographics of unfunded pensions’

Keyfitz (1985), The demographics of unfunded pensions, discusses the performance of pay-as-you-go old age insurance plans under different financial structures. One arrangement is to pay a fixed pension to retirees and collect the necessary contributions from the working population. Another is to fix the contribution per worker and distribute whatever monies are collected to the retirees. Unfortunately, equity problems arise in a pay-as-you-go plan when the population is not stable. Generally, large cohorts will receive greater rates of return than small cohorts when the pension is fixed, while small cohorts will receive greater rates of return when the contribution is fixed. Social security analysts in the U.S. have been concerned with minimizing inequities in cohort rates of return. In considering the US population in 1980, Keyfitz shows that disparities in cohort rates of return are less under a fixed contribution scheme than under a fixed pension scheme. This research note points out that Keyfitz's finding is limited to the specific situation in 1980. When analyzing in a broader framework the mechanics of unfunded pensions and their interaction with nonstable populations, the reverse is true: fixing the pension yields less disparity in cohort rates of return than fixing the contribution.Keyfitz (1985) a déjà discuté dans cette revue des résultats d'un système de répartition pour le financement des pensions de retraite sous diverses conditions financières. Une solution consiste à payer une pension fixée aux retraités et à collecter les fonds nécessaires auprès de la population active. Une autre solution est de fixer la contribution par actif et de distribuer ce qui a été ainsi collecté aux retraités. Malheureusement des problèmes d'équité surviennent dans ces systèmes de répartition lorsque la population n'est pas stable. Généralement, les cohortes nombreuses bénéficieront de plus forts taux de rendement que des cohortes moins nombreuses lorsque la pension est fixée, tandis que l'inverse se produit lorsque la contribution par actif est fixée. Aux Etats-Unis les analystes des systèmes de sécurité sociale ont cherché à minimiser les inégalités dans les taux de rendement. Lorsque Keyfitz considérait la population des Etats-Unis en 1980, il avait montré que les disparités dans les taux de rendement des cohortes étaient moindres sous la condition d'une contribution par actif fixée que sous celle d'une pension par retraité fixée. Cette note the recherche indique que le résultat obtenu par Keyfitz est propre à la situation spécifique de l'année 1980. Lorsque l'on analyse d'un point de vue général le fonctionnement des pensions de retraite et leurs interactions avec des populations non-stables, l'inverse est vérifié : le fait de fixer la pension conduit à moins de disparités dans les taux de rendement des cohortes que le fait de fixer la contribution des actifs.

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This research was undertaken when the author was completing her dissertation at the Graduate Group in Demography at the University of California, Berkeley. The author now operates Lapkoff Demographic Research, a private research consulting firm.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Batch sampling to improve power in a community trial. Experience from the Pawtucket Heart Health Program

Experiments involving large social units, such as schools, work sites, or whole cities, are commonly limited in statistical power because the number of randomized units is small, leaving few degrees of freedom for residual (between-unit) error. The authors describe a method for increasing residual degrees of freedom in a community experiment without substantially increasing cost or difficulty. In brief, they propose that the experimental units should be divided into random subsamples (batches). Batch sampling can improve statistical power if the community endpoint means are stable over time or if their temporal variation is comparable in period to the batch-sampling schedule. The authors demonstrate the theoretical advantages of the batch system and illustrate its use with data from the Pawtucket Heart Health Program, in which such a design was implemented.     

Substance use disorders and referral to treatment in substantiated cases of child maltreatment

Parents with substance use disorders (SUD) require treatment and support in order to provide children with appropriate care and protection. Using the 2012 National Child Abuse and Neglect Data System (NCANDS), this paper analysed 464 313 substantiated child maltreatment reports to determine (i) the proportion and characteristics of reports involving substance abuse; and (ii) the child and caregiver/perpetrator (C/P) characteristics that predicted referral to treatment as recorded in service plans. Findings indicate that 12% (N = 53 234) of maltreatment reports involved C/P SUD. Yet, of those reports, only (19%) (N = 10 088) were referred to substance abuse treatment as part of their service plan, indicating a large gap between those who need treatment and those who receive it. This finding is important given that parental SUD is consistently linked to poorer child outcomes. Amongst other variables, reports indicate that C/P with co‐occurring emotional disturbance were three times more likely to be referred to treatment for SUD as part of service plans. Additional research is needed regarding the characteristics that distinguish C/P who receive referrals for SUD treatment in substantiated cases of child maltreatment.     

Bounding Optimal Expected Revenues for Assortment Optimization under Mixtures of Multinomial Logits

We consider assortment problems under a mixture of multinomial logit models. There is a fixed revenue associated with each product. There are multiple customer types. Customers of different types choose according to different multinomial logit models whose parameters depend on the type of the customer. The goal is to find a set of products to offer so as to maximize the expected revenue obtained over all customer types. This assortment problem under the multinomial logit model with multiple customer types is NP‐complete. Although there are heuristics to find good assortments, it is difficult to verify the optimality gap of the heuristics. In this study, motivated by the difficulty of finding optimal solutions and verifying the optimality gap of heuristics, we develop an approach to construct an upper bound on the optimal expected revenue. Our approach can quickly provide upper bounds and these upper bounds can be quite tight. In our computational experiments, over a large set of randomly generated problem instances, the upper bounds provided by our approach deviate from the optimal expected revenues by 0.15% on average and by less than one percent in the worst case. By using our upper bounds, we are able to verify the optimality gaps of a greedy heuristic accurately, even when optimal solutions are not available.