Mathematical Structures in Group Decision-Making on Resource Allocation Distributions.
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ABSTRACT:
SUBMITTER: Friedkin NE
PROVIDER: S-EPMC6361985 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: A balance of care approach was used to assess resource allocation across six dementia case types, from low to high needs. Workshops were held with 24 HSCPs from multiple disciplines. Participants allocated services in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants were proficient in making decisions, using 'decision rules' or heuristics to help them make decisions under fixed budget rules and sticking to conventional provision when constraints were in place. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.
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Project description:The dual-hormone hypothesis proposes that testosterone's relationship with status-seeking behavior is moderated by cortisol. However, research testing this hypothesis has focused on basal cortisol; the potential moderating effect of the acute cortisol response to stress has been largely overlooked. The present research investigated the moderating role of cortisol responses to an acute stressor on basal testosterone's link with dominant, status-relevant decision-making. Also, given the multifaceted nature of the response to acute stress, cardiovascular and affective responses to the stressor were examined as alternative moderators of the testosterone-behavior relationship. Participants (N?=?112; 56% female) were exposed to a social-evaluative stressor, and their stress responses were measured. Participants subsequently engaged in a one-shot dictator game, wherein they were asked to split money ($10) with a confederate counterpart. The amount of money participants decided to keep for themselves was treated as a metric of dominant status-seeking behavior. For individuals who demonstrated lower cortisol responses to the stressor, basal testosterone was positively associated with more dominant behavior (i.e., keeping more money for oneself), but for those who showed higher cortisol responses, the testosterone-behavior relationship was suppressed. Moreover, other aspects of the stress response (i.e., cardiovascular and affective responses) did not moderate the relationship between basal testosterone and dictator game behavior. These results provide unique support for the dual-hormone hypothesis using markers of stress-induced cortisol change. The findings also suggest that the antagonistic effects of stress on testosterone's role in motivating status-relevant behavior may be specific to cortisol's role in the acute stress response.
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Project description:ContextThe prevalence of hypertension in developing countries is coming closer to values found in developed countries. However, surveys usually rely on readings taken at a single visit, the option to implement the diagnosis on readings taken at multiple visits, being limited by costs.ObjectiveTo estimate more accurately the magnitude and extent of the resource that should be allocated to the prevention of hypertension.DesignPopulation-based cross-sectional survey with triplicate blood pressure (BP) readings taken on two separate home-visits.SettingRural and urban locations in three areas of Yemen (capital, inland and coast).ParticipantsA nationally representative sample of the Yemen population aged 15-69 years (5063 men and 5179 women), with an overall response rate of 92% in urban and 94% in rural locations.Main outcome measureHypertension diagnosed as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or self-reported use of antihypertensive drugs.ResultsHypertension prevalence (age-standardised to the WHO world population 2001) based on fulfilling the same criteria on both visits (11.3%; 95% Cl 10.7% to 11.9%), was 35% lower than estimation based on the first visit (17.3%; 16.5% to 18.0%). Advanced age, blood glucose ≥7 mmol/l or proteinuria ≥1+ at dipstick test at visit one were significant predictors of confirmation at visit 2. The 959 participants found to be hypertensive at visit 1 or at visit 2 only and thus excluded from the final diagnosis had a rate of proteinuria (5.0%; 3.8% to 6.5%) comparable to rates of the general population (6.1%; 5.6% to 6.6%), and of subjects normotensive at both visits (5.6%; 5.1% to 6.2%). Only 1.9% of Yemen population classified at high or very high cardiovascular (CV) risk at visit 1 moved to average, low or moderate CV risk categories after two visits.ConclusionsHypertension prevalence based on readings obtained after two visits is 35% lower than estimation based on the first visit, subjects were excluded from final diagnosis belonging to low CV risk classes.
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