Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge

Background Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients' expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life. Methods A prospective longitudinal cohort investigation of agreement between patients' anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients' cognitive ability. Results Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses. Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate the discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

BACKGROUND Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients' future health states are accurate. METHODS A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists' (n = 23) prediction of patients' discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n = 272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients' cognitive ability. RESULTS Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37-0.57 (58%-83%) across EQ-5D-3L domains in the lower cognition group and 0.53-0.68 (81%-85%) in the better cognition group. CONCLUSIONS Physiotherapists in this subacute rehabilitation setting predicted their patients' discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition.

Do Households Have Rational Expectations on Future Consumption? Evidence from the Finnish Consumer Survey

Ever since its initial introduction some fifty years ago, the rational expectations paradigm has dominated the way economic theory handles uncertainty. The main assertion made by John F. Muth (1961), seen by many as the father of the paradigm, is that expectations of rational economic agents should essentially be equal to the predictions of relevant economic theory, since rational agents should use information available to them in an optimal way. This assumption often has important consequences on the results and interpretations of the models where it is applied. Although the rational expectations assumption can be applied to virtually any economic theory, the focus in this thesis is on macroeconomic theories of consumption, especially the Rational Expectations–Permanent Income Hypothesis proposed by Robert E. Hall in 1978. The much-debated theory suggests that, assuming that agents have rational expectations on their future income, consumption decisions should follow a random walk, and the best forecast of future consumption level is the current consumption level. Then, changes in consumption are unforecastable. This thesis constructs an empirical test for the Rational Expectations–Permanent Income Hypothesis using Finnish Consumer Survey data as well as various Finnish macroeconomic data. The data sample covers the years 1995–2010. Consumer survey data may be interpreted to directly represent household expectations, which makes it an interesting tool for this particular test. The variable to be predicted is the growth of total household consumption expenditure. The main empirical result is that the Consumer Confidence Index (CCI), a balance figure computed from the most important consumer survey responses, does have statistically significant predictive power over the change in total consumption expenditure. The history of consumption expenditure growth itself, however, fails to predict its own future values. This indicates that the CCI contains some information that the history of consumption decisions does not, and that the consumption decisions are not optimal in the theoretical context. However, when conditioned on various macroeconomic variables, the CCI loses its predictive ability. This finding suggests that the index is merely a (partial) summary of macroeconomic information, and does not contain any significant private information on consumption intentions of households not directly deductible from the objective economic variables. In conclusion, the Rational Expectations–Permanent Income Hypothesis is strongly rejected by the empirical results in this thesis. This result is in accordance with most earlier studies conducted on the topic.

E-learning in traditional industries: balancing the preferences of an ageing workforce with the expectations of a technoloigy-savvy generation

There is widespread argument that traditional organisations and industries with a predominantly older workforce who are not using computers as an integral part of their work, are unlikely to embrace the opportunities afforded by e-learning. However, the challenge remains to engage a younger generation of learners who seem comfortable learning with technology, whilst not alienating those older learners who may prefer to learn in more traditional ways. This paper analyses data from five case organisations within the Australian rail industry to identify how the potential of e-learning can be realised whilst acknowledging the technological divide between younger and older workers.

The gender wage gap in Australia - The path of future convergence

The paper attempts to project the future trend of the gender wage gap in Australia up to 2031. The empirical analysis utilises the Income Distribution Survey (1996) together with Australian Bureau of Statistics (ABS) demographic projections. The methodology combines the ABS projections with assumptions relating to the evolution of educational attainment in order to project the future distribution of human capital skills and consequently the future size of the gender wage gap. The analysis suggests that female relative pay will continue to rise up to 2031. However, gender wage convergence will be relatively slow, with a substantial gap remaining in 2031.

Journalism students' motivations and expectations of their work in comparative perspective

Based on a survey of 4,393 journalism students in Australia, Brazil, Chile, Mexico, South Africa, Spain, Switzerland, and the United States, this study provides much-needed comparative evidence about students’ motivations for becoming journalists, their future job plans, and expectations. Findings show not only an almost universal decline in students’ desire to work in journalism by the end of their program but also important national differences in terms of the journalistic fields in which they want to work, as well as their job expectations. The results reinforce the need to take into account national contexts when examining journalism education across the globe.

Energy efficiency investments in the home: Swiss homeowners and expectations about future energy prices

Using conjoint choice experiments, we surveyed 473 Swiss homeowners about their preferences for energy efficiency home renovations.We find that homeowners are responsive to the upfront costs of the renovation projects, governmentoffered rebates, savings in energy expenses, time horizon over which such savings would be realized, and thermal comfort improvement. The implicit discount rate is low, ranging from 1.5 to 3%, depending on model specification. This is consistent with Hassett and Metcalf (1993) and Metcalf and Rosenthal (1995), and with the fact that our scenarios contain no uncertainty. Respondents who feel completely uncertain about future energy prices are more likely to select the status quo (no renovations) in any given choice task and weight the costs of the investments more heavily than the financial gains (subsidies and savings on the energy bills). Renovations are more likely when respondents believe that climate change considerations are important determinants of home renovations. Copyright © 2013 by the IAEE. All rights reserved.

Family caregivers' ideal expectations of Canada's Compassionate Care Benefit

We present the findings of 57 interviews conducted in 2007-2008 with Canadians who have cared for a dying family member to examine their ideal expectations of the Compassionate Care Benefit (CCB) - a social programme providing job security and income support for workers caring for a dying person. Our aims are to (1) appreciate how intended users and other family caregivers view the programme's very nature; (2) identify programme challenges and improvements that emerge from considering family caregivers' ideal expectations; and (3) contribute to a larger evaluative study designed to make policy-relevant recommendations for CCB improvement. Review of transcripts across three respondent groups reveals four categories of ideal expectations: (1) eligibility, (2) informational, (3) timing and (4) financial. Ideal expectations were typically derived from respondents' experiences of care-giving, their knowledge of the programme and, for some, of applying for and/or receiving the CCB. Findings reveal that there are gaps between respondents' ideal expectations and their experienced realities. Such gaps may lead to disappointment being experienced by those who believe they should be eligible for the programme but are not, or should be entitled to receive some form of support that is not presently available. This analysis plays an important role in identifying potential changes for the CCB that may better support family caregivers, in that the ideal expectations serve as a starting point for articulating desirable programme amendments. This analysis also has wider relevance. For jurisdictions looking to create new social programmes to support caregivers based upon labour policy strategies and legislation, this analysis identifies considerations that should be made at the outset of development. For jurisdictions that already have employment-based caregiver support programmes, this analysis demonstrates that programme challenges may not always be met through legislative changes alone but also through measures such as increasing awareness. © 2011 Blackwell Publishing Ltd.

Economic shocks and crime: evidence from the crash of ponzi schemes

In November 2008, Colombian authorities dismantled a network of Ponzi schemes, making hundreds of thousands of investors lose tens of millions of dollars throughout the country. Using original data on the geographical incidence of the Ponzi schemes, this paper estimates the impact of their break down on crime. We find that the crash of Ponzi schemes differentially exacerbated crime in affected districts. Confirming the intuition of the standard economic model of crime, this effect is only present in places with relatively weak judicial and law enforcement institutions, and with little access to consumption smoothing mechanisms such as microcredit. In addition, we show that, with the exception of economically-motivated felonies such as robbery, violent crime is not affected by the negative shock.

Dreaming up the right career: an exploratory study of the career aspirations of low-income adolescents living in urban São Paulo

No Brasil, os jovens de baixa renda estão propensos ao desemprego, o que é particularmente problemático em uma economia emergente onde a desigualdade de renda é relativamente alta, e onde o desenvolvimento socioeconômico futuro pode depender do crescimento e da estabilidade de uma classe média já vulnerável. Além disso, o desemprego entre os jovens, especialmente em cidades urbanas, está associado a elevada incidência de violência, comportamento ilegal, aumento da desigualdade e instabilidade sociopolítica. Este estudo complementa tentativas existentes de promover as perspectivas de emprego da juventude brasileira, investigando as aspirações profissionais de 25 adolescentes que vivem em comunidades de baixa renda na zona urbana de São Paulo. A pesquisa foi realizada através de grupos de foco durante o período de quatro encontros nas comunidades paulistanas de Vila Albertina, Heliópolis, Vila Prudente e Vila Nova Esperança. Os resultados da pesquisa repetem, em grande parte, o conhecimento existente que diz respeito a adolescentes; eles confirmam o papel importante que o mérito individual, o microambiente e os modelos exemplares (isto é, familiares, colegas e educadores locais) têm de moldar e possibilitar (ou impedir) os planos de carreira de jovens adultos, e destacam a flexibilidade e a diversidade de interesses profissionais nesta faixa etária. Ademais, os resultados revelam atitudes paradoxais face às comunidades de baixa renda em São Paulo. Todos os participantes pareciam empoderados por elementos dentro de seu microambiente, exibiam sentimentos de orgulho e que faziam parte de sua comunidade; porém, muitos pareciam perturbados pela maneira como pessoas de fora estereotipam ou estigmatizam os moradores da "favela". Ao todo, o estudo destaca tendências que sustentam razões para maiores investimentos no desenvolvimento profissional dos jovens de baixa renda. Na qualidade de um ecossistema com potencial para desenvolvimento socioeconômico, as comunidades de baixa renda podem constituir uma fonte rica não apenas de recursos humanos, mas também de oportunidades comerciais e empregos.

Skin and mucosa care in systemic sclerosis - patients' and family caregivers' experiences and expectations of a specific education programme: a qualitative study

BACKGROUND Skin and mucosal manifestations such as skin thickening, pruritus, reduced microvascular circulation, digital lesions, appearance-related changes, and dryness of the eyes and mucosa are common in systemic sclerosis (SSc). A specific skin and mucosa care education programme for patients and their family caregivers should increase their self-efficacy and improve coping strategies. AIMS The aims of this qualitative study were to explore the participants' experiences of both everyday life with skin and mucosal manifestations and the programme itself, while identifying unmet needs for programme development. METHODS Narrative interviews were conducted with eight SSc patients and two family caregivers of individuals with SSc. Using qualitative content analysis techniques, the transcribed interviews were systematically summarized and categories inductively developed. RESULTS The findings illustrated participants' experiences of skin and mucosal symptoms and revealed them to be experts in finding the right therapy mix alone (before diagnosis) and also in collaboration with health professionals (after diagnosis). Participants emphasized that the programme gave them useful education on skin and mucosa care. They described how they had to cope alone with the lack of information on pathophysiology, people's reactions, and the impact on their family and working lives. Nevertheless, participants said that they maintained a positive attitude by not dwelling on future disabilities. CONCLUSIONS Patients and family caregivers benefited from the individualized and SSc-specific education on skin and mucosa care. Future improvements to the programme should focus on imparting understandable information on SSc pathophysiology, dealing with disfigurement and seeking reliable disease information, as well as facilitating peer support.

The acculturation of middle income Hispanic households

Research on the consumer behavior of the Hispanic population has recently attracted the attention of marketing practitioners as well as researchers. This study's purpose was to develop a model and scales to examine the acculturation process of Hispanic consumers with income levels of $35,000 and above, and its effects on their consumer behavior. The proposed model defined acculturation as a bilinear and multidimensional change process, measuring consumers' selective change process in four dimensions: language preference, Hispanic identification, American identification, and familism. A national sample of 653 consumers was analyzed. The scales developed for testing the model showed good to high internal consistency and adequate concurrent validity. According to the results, consumers' contact with Hispanic and Anglo acculturation agents generates change or reinforces consumers' language preferences. Language preference fully mediates the effects of the agents on consumers' American identification and familism; however, the effects of the acculturation agents on Hispanic identification are only partially mediated by individuals' language preference change. It was proposed that the acculturation process would have an effect on consumers' brand loyalty, attitudes towards high quality and prestigious brands, purchase frequency, and savings allocation for their children. Given the lack of significant differences between Hispanic and Anglo consumers and among Hispanic generations, only savings allocation for children's future was studied intensively. According to these results, Hispanic consumers' savings for their children is affected by consumers' language preference through their ethnic identification and familism. No moderating effects were found for consumers' gender, age, and country of origin, suggesting that individual differences do not affect consumers' acculturation process. Additionally, the effects of familism were tested among ethnic groups. The results suggest not only that familism discriminates among Hispanic and Anglo consumers, but also is a significant predictor of consumers' brand loyalty, brand quality attitudes, and savings allocation. Three acculturation segments were obtained through cluster analysis: bicultural, high acculturation, and low acculturation groups, supporting the biculturalism proposition. ^

Effects of nutrition education on the nutrition knowledge of future aerobic dance instructors

The effectiveness of nutrition education on the nutrition knowledge of future aerobic instructors was studied. Forty-seven subjects participated in the study. The experimental group (n=31) chose to and paid for a two-hour per week session of structured nutrition education for four weeks, the control group (n=16) did not. A nutrition knowledge test was completed by all subjects before and after the intervention. Results were analyzed for relationships between subject's nutrition knowledge and age, gender, educational background, income, and body mass index. No significant differences were found between the groups. The results showed that prior to any formal nutrition education, fitness instructors in the experimental and control groups had low nutrition knowledge (8.06%±16.4% and 4.38%±4.12%, respectively). Post-intervention nutrition knowledge significantly improved (p