Sex Of Respondent Research Articles

Participation in UTZ-RA voluntary cocoa certification scheme and its impact on smallholder welfare: Evidence from Ghana

The study analyzed the determinants and extent of participation in UTZ-RA cocoa certification program as well as its impacts on smallholder farmers' welfare. Using cross-sectional data collected from 296 cocoa farmers in Ghana and employing the Cragg double hurdle model to analyse participation, the study also controls for sample selection bias using propensity score matching technique. The results revealed that household size, years of formal education, non-farm income, sex of respondent, quantity of man-hours of labour used in cocoa production as well as dependency ratio influenced participation. The findings also reveal that the UTZ-RA cocoa certification program increased yield and household income. It however had a negative impact on the food security status of cocoa farming households. Data from this paper has demonstrated that increased productivity and income from certification of commodities might not necessarily lead to enhanced food security status of enrolled farmers. The study recommends that, the Rainforest Alliance scheme should consider food security indicators in the next revised edition of their code of conduct which has since been finalized for implementation. Employment of different food security measurement tools in the revised codes is highly recommended. This will provide a better understanding of the synergies and trade-offs that exist or are likely to exist between cash crop production and food security.

Moving Beyond Sex: Measuring Gender Identity in Telephone Surveys

While researchers have long understood that sex and gender are theoretically distinct concepts, much survey research continues to rely on the sex of respondents as a proxy for their gender. Recent work on political and social attitudes has shown that gender has far-reaching consequences for attitudes that are not neatly summed up by measures of sex, but measures of gender identity have generally been used either in forms that are too lengthy for most survey research or have only been used in online modalities. Longer sets of gender identity items may be theoretically desirable, but a gender identity item embedded in a live-caller random digit dialing survey in New Jersey shows that just one gender identity item can account for a great deal of within-sex variance in political and social attitudes without leading to an overly high rate of refusals.

Unfavorable Attitude and Perceived Stigma towards Leprosy: A Concern for Status Perpetuation in a Community in Cross River State, Nigeria

Background: Negative attitude and stigma against leprosy patients constrain them to resort to concealing their status thus resulting in delayed detection, treatment, complications and perpetuation of the condition in the locality. This study was aimed at finding out the prevailing attitude and stigma toward leprosy in the community with a view to addressing the fueling factors.
 Materials and Methods: It was descriptive cross sectional study. Semi-structured interviewer administered questionnaires were used for data collection. Explanatory Model Interview Catalogue (EMIC), was used to grade stigma against leprosy amongst participants. Answers to questions in the questionnaire were assigned scores which were summed up into percentage breakpoints. A respondent was interpreted as having favorable or unfavorable attitude to leprosy depending on his or her percentage sum of score.
 Stigma was categorized based on the sum of an individual’s EMIC score as high, moderate or low level of stigma. Data were analyzed using SPSS version 20.
 Results: The study revealed that only 44(15%) of respondents had favorable attitude towards leprosy whereas 250(85%) had unfavorable attitude towards this group. Attitude to leprosy was observed to be significantly related to age and sex of respondent, religion and ethnicity, p-value< 0.05. EMIC profile of the study respondents revealed that 47(16%) demonstrated low stigma, 81(28%) demonstrated moderate stigma and 166(56%) demonstrated high stigma towards leprosy. There was no statistically significant relationship between stigma and socio-demographic variables.
 Conclusion: Misunderstanding and misconceptions about leprosy and leprosy patients is still well rooted in the norms and culture of the people of Ikun, breeding negative attitude and stigma toward leprosy. Vigorous leprosy awareness programs structured along the lines of attitude-stigma influencing socio-demographic variables, with emphasis on the cause, transmission, diagnosis and treatment of leprosy will help to stem the tide of myths and misconceptions.

Risk factors associated with high malaria incidence among communities in selected wards in Binga district, Zimbabwe: a case-control study

Background: Malaria remains a global problem with 216 million cases reported in 2016 and 90% of these cases were recorded in African countries. In 2018 Binga district in Zimbabwe experienced epidemics which resulted in an increase in malaria incidence from 14/1000 in 2015 to 34/1000 in 2018. This occurrence reversed the progress of wards that were moving towards malaria elimination. This study, therefore, was conducted to investigate risk factors that were associated with high malaria incidence in selected wards in Binga District. Methods: A case-control study was conducted on sixty-one systematically randomly selected malaria cases that were matched with one hundred and eighty-three controls to identify risk factors associated with malaria infection in selected wards. The sample size was determined using EPI INFO sample size calculator and matching is done using geographic location and sex of respondents. Information on previous exposure to a risk factor(s) was obtained through a researcher administered questionnaire. Multiple Logistic Regression was conducted to determine the relationship between risk factors and malaria incidence in cases and controls on STATA Version 12 SE. Results: On comparison, cases were more likely to have been sleeping in poorly constructed shelters with one or more house openings [OR= 5.47; CI=2.39-12.51], their household located near an active/potential mosquito breeding site or water body [OR= 5.86; CI= 2.61- 13.17] and did not own a treated bed net [OR= 9.14; CI=4.08-20.45]. Early Treatment seeking behaviour had a significant protective effect [OR= 0.51; CI= 0.39-0.86] and delay to seek treatment was influenced by distance to a health facility [OR=5.91; CI=3.02-11.55] just to mention a fewAU: Please confirm that the provided email ''18851726962@163.com" is the correct address for official communication, else provide an alternate e-mail address to replace the existing one. Conclusions: Findings of this study highlight important risk factors that are influential in the transmission of malaria. There is a need for the district to invest in source reduction by use of larvicides and reduction of possible breeding sites so as to minimise breeding. There is need to also embark on awareness campaigns to educate the community members on how they could eliminate some of the risk factors that are related to attitudes and practices. These strategies if adopted could improve the community's outcomes in as far as malaria is concerned.

Psychological Problems among 12th-Grade Students Predicting Military Enlistment: Findings from the Monitoring the Future Survey

Objective: Rates of some psychological disorders are higher among enlisted U.S. military personnel than socio-demographically matched civilians. Indirect evidence suggests some internalizing and externalizing psychological problems among enlistees onset prior to enlistment. However, the consistency and strength of the associations between pre-enlistment psychological problems and enlistment over time is unknown. We address this uncertainty by examining whether internalizing and externalizing problems in high school predicted subsequent military enlistment using a large cohort-sequential panel study. Method: The Monitoring the Future study administered baseline surveys from 1989–2014 and biennial follow-up surveys two and four years later to national samples of high-school seniors (N = 20,823). Validated self-report scales assessed internalizing (depression, low self-esteem) and externalizing (risk-taking, school misbehavior, conduct disorder, interpersonal violence, alcohol, and drug use) problems in each survey. Follow-up surveys assessed military enlistment. Logistic regression models were used to estimate associations of problems scales with subsequent enlistment. Results: School misbehavior in 12th grade, and risk-taking in 12th grade and two years after graduation were associated with significantly elevated odds of enlistment at follow-up. Although modest, these associations were linear and invariant across respondent sex and baseline survey year. Conclusions: School misbehavior and risk-taking predicted subsequent enlistment and there was no evidence of historical changes in these associations over the course of 25 years; these pre-enlistment psychological problems do not fully explain the high rates of psychological disorders among enlisted military personnel. Further research is needed to determine whether these predictors are associated with negative outcomes during or after military service.

Anti-retro viral therapy adverse drug reaction and associated factors among human immuno deficiency virus infected adult patients at Nigist Eleni Mohammed Memorial hospital, South Ethiopia.

Recent increases in access to HAART have made the management of drug toxicities an increasingly crucial component of HIV care in developing countries. The aim of this study was to determine prevalence of antiretroviral therapy adverse drug reactions and associated factors among HIV-infected adult patients at Nigist Eleni Mohammed memorial hospital. A cross sectional study was conducted by retrospective review of patients' medical records. From a total 721 adult patient records, 231 patients record were selected by simple random sampling technique. The study was conducted April 15-25, 2015.The association between dependent and independent variables was measured by using OR at 95% CI. P-value <0.05 was considered as statistically significant. About 53(22.9%) patients developed ADRs (adverse drug reactions). Female (AOR=2.72, CI=1.177-6.30), patients with WHO stage III and IV (AOR= 13.06, CI=4.17-40.90) were found more likely to develop ADRs. Commonly identified ADRs were fatigue (18.1%), diarrhea (7.7%), nausea (6.5%), headache (3.6%) and anemia (2%). Nearly one in five patients develop ADRs. Sex of respondents, WHO stage and functional status were associated with ADRs. The health care providers should give due attention to ambulatory, bedridden, and WHO stage III and IV patients.

Factors contributing to the consumption of bushmeat in Odeda Local Government Area, Ogun State, Nigeria

This paper x-rays the factors that contribute to the consumption of bushmeat in Odeda Local Government Area (LGA) of Ogun State, Nigeria. Questionnaires were used in collecting primary data from four communities in the Local Government Area. Each community represents one of the four divisional districts recognized by the Odeda LGA headquarter for administrative functions. Fifty questionnaires were randomly administered in each of the four communities, making a total of 200 questionnaires. Data were analyzed using descriptive statistics such as frequency table and pie chart, regression and chi Square. Gender was the only variable that significantly (p&lt;0.10; r=0.54) contributed to the consumption of bushmeat in the study area. Chi square analysis revealed a relationship (p&lt;0.99; X2=3.202) between sex of respondents and consumption of bushmeat in the study area.&#x0D; Keywords: Determinant factors, Consumption, Bushmeat, Odeda Local Government Area

Arterial hypertension and antihypertensive treatment in the unorganized Moscow population

Background. The epidemiology of hypertension (HTN) and antihypertensive treatment (AHT) in the Russian Federation was repeatedly estimated in epidemiology trials with various methodology, but situation in Moscow region has not been fully explored.Objective. To examine the rate, age and gender features of HTN and AHT in unorganized Moscow cohort.Design and methods. 532 participants older than 16 years old were interviewed in Moscow park after signing informed consent. Information about sex, age, rate of diagnosed HTN, AHT and its effectiveness was collected based on a questionnaire. Arterial blood pressure (BP) was measured consequently three times.Results. Median and interquartile range of participants age was 57 (38–66) years, 71,1 % were women. Women were significantly older than men (59 (46–67) and 48 (31–61) years respectively, p = 0,0001). 42,7 % reported previously diagnosed HTN, 62,5 % received AHT. 79,7 % participants receiving AHT (49,8 % HTN patients) considered it effective. Home BP self-monitoring was performed by 43,7 % respondents (sex- and age-adjusted rates). While measured, 29,7 % participants had optimal BP level, 22,6 % — normal and 15,2 % — high normal. BP &gt; 140 and/or 90 mm Hg was measured in 32,6 % of participants (rates are sex and age adjusted). BP &gt; 140 / 90 mm Hg at assessment was found in 48,8 % HTN patients and 16,4 % participants without previously diagnosed HTN (8,7 % in entire studied cohort). There were no significant differences in the rate increased BP level at assessment and in HTN patients who received AHT or not (49,5 and 46,9 %). HTN rate was 39,6 % in participants who considered their AHT effective, and 75,5 % — ineffective, p &lt; 0,0001. 63,4 % participants taking AHT could specify the drugs (65,3 % received monotherapy, 27,1 % — 2 drugs and 7,6 % — 3 drugs; fixed combinations received 17 %). BP levels and HTN did not differ in HTN patients who received one or more drugs.Conclusions. In unorganized Moscow cohort age and gender adjusted rate of HTN at BP measurement was 32,6 %. In 8,7 % participants high BP was detected at first time. Only 62,5 % patients with previously diagnosed HTN received AHT. 39,6 % participants who considered AHT effective demonstrate high BP at assessment. AHT was not associated with the lower HTN rate or BP level, which may be attributed to excessive use of monotherapy and insufficient application of fixed combinations.

Obstetrician-gynecologists' screening and management of depression during perimenopause.

Depression in women is more common during perimenopause (the time period around and during menopause) than pre and postmenopause. Obstetrician-gynecologists (ob-gyns) play a vital role in the detection and management of depression symptoms in women because for many women ob-gyns are the first and most frequent point of medical contact. This study assessed ob-gyns' screening practices and management of depression in perimenopause. A survey regarding depression during perimenopause was sent to 500 practicing ob-gyns who were fellows of the American College of Obstetricians and Gynecologists and members of the Collaborative Ambulatory Research Network. The survey response rate was 41.8% (209 of 500 surveys returned). Over a third of respondents (34.1%) reported that they did not regularly screen perimenopausal patients for depression. Higher-quality education about depression, respondent sex, and personal experience with depression were associated with higher rates of screening. While 85.7% of respondents believed that they could recognize depression in perimenopausal women, only about half (55.8%) were confident in their ability to treat these patients. Increased education of ob-gyn physicians related to depression during perimenopause may increase the screening and treatment of women during this phase of life.

Practice Patterns Surrounding Pregnancy After Heart Transplantation.

Pregnancy after heart transplantation (HT) is a concern for many female recipients. The International Society for Heart and Lung Transplantation has guidelines regarding reproductive health, but limited data exist regarding providers' attitudes and practices surrounding pregnancy post-HT. We conducted an independent, confidential, voluntary, web-based survey sent electronically to 1643 United States heart transplant providers between June and August 2019. There were 122 responses, the majority from cardiologists (n=85, 70%) and nurse or transplant coordinators (n=22, 18%). Thirty-one percent (n=37) of respondents indicated that pregnancy should be avoided in all HT recipients, and only 43% (n=52) reported that their center had a formal policy regarding pregnancy following HT. The most commonly reported contraindications included nonadherence (n=109, 89%), reduced left ventricular ejection fraction (n=104, 85%), coronary allograft vasculopathy (n=86, 70%), prior rejection (n=76, 62%), presence of donor-specific antibodies (n=69, 57%), and prior peripartum cardiomyopathy pretransplant (n=57, 47%). Respondent sex, specialty, transplant volume, or prior experience with pregnancy after HT were not associated with recommendations to avoid posttransplant pregnancy. Transplant providers' attitudes regarding posttransplant pregnancy vary widely. Despite International Society for Heart and Lung Transplantation guidelines, a significant proportion indicates that pregnancy is contraindicated in all recipients and the majority of programs have no center-specific policy to manage such pregnancies. While the low response rate limits the generalizability of the findings, they do suggest that education on the feasibility of pregnancy post-HT is indicated as many recipients are of, or survive to, childbearing age.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEMAMPUAN KELUARGA DALAM PENCEGAHAN KEKAMBUHAN PASIEN SKIZOFRENIA

One problem in treating schizophrenia is recurrence. Recurrence indicates the return of symptoms of the previous disease is quite severe and disturbing daily activities and requires further treatment. Prevention of recurrence in schizophrenia can be sought by the family. This study aims to identify factors related to family abilities in preventing recurrence of schizophrenic patients. This study used a cross sectional design. The sample in the study were 82 families with family members of schizophrenic patients obtained using simple random sampling. The results of the analysis have a relationship between the age range of the family (p value 0.012), the role of respondents in the family (p value 0.032), duration of treating schizophrenic patients (p value 0.001) but there is no relationship between the ability to prevent recurrence with the sex of respondents (p value 0.835) and education level of respondents (p value 0.508). Recommendations from this study for health workers provide health education to families to provide an understanding of the ability to prevent recurrence in schizophrenic patients.&#x0D; &#x0D; Keywords: Schizophrenia, Prevention of recurrence, Family

The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States.

To determine and compare the prevalence and odds of chronic diseases among ex- and current miners. Fourteen-year pooled data from the National Health Interview Survey between 2004 and 2017 were analyzed. Ex- and current miners ages 18 to 64 years were defined based on employment status at the time of National Health Interview Survey (NHIS) interview. We calculated age-adjusted prevalence rates and odds ratios of association of chronic diseases. The analysis was adjusted for respondent's age, sex, race, marital status, poverty-income ratio, health insurance, and smoking status. Ex-miners have significantly increased prevalence of most chronic diseases. The age-adjusted prevalence and the adjusted odds of heart disease, cancer, hypertension, diabetes, and psychological stress were significantly higher among ex-miners as compared with current miners. Ex-miners have worse health outcomes that may persist for years after leaving the mining industry.

Are housing property rights important for fertility outcomes in China? Empirical evidence and policy issues

This is the first econometric study of the impact of housing property rights on family fertility in China. It is important policy-wise because China’s government wants to raise China’s birth rate. This analysis is based on relevant samples drawn from the 2016 China Family Survey and utilizes linear probability, Probit and two-stage least square models. Having housing property rights is found to have a statistically significant positive influence on fertility in China. This result is consistent with most research results for other countries. Other significant influences on fertility include income levels, the sex of respondents, age, whether they are employed, their health and level of education. Furthermore, it is found (in China) that if the first-born child is a boy, parents are less likely to have a second child; and that rural families have substantially more children than urban ones. These features (as observed in the literature) are common in patriarchal societies and in developing ones. It is argued that China’s economic reforms and structural economic change (especially rapid urbanization) have led to a substantial reduction in its birth rate. Given our research results, it is unlikely that the cessation of China’s ‘One Child’ policy will in itself result in a sizeable rise in its fertility rate. Nevertheless, given our findings, public policies facilitating the purchase of housing by first-home buyers should contribute positively to China’s fertility rate.

Innovative Identification of Substance Use Predictors: Machine Learning in a National Sample of Mexican Children.

Machine learning provides a method of identifying factors that discriminate between substance users and non-users potentially improving our ability to match need with available prevention services within context with limited resources. Our aim was to utilize machine learning to identify high impact factors that best discriminate between substance users and non-users among a national sample (N = 52,171) of Mexican children (i.e., 5th, 6th grade; Mage = 10.40, SDage = 0.82). Participants reported information on individual factors (e.g., gender, grade, religiosity, sensation seeking, self-esteem, perceived risk of substance use), socioecological factors (e.g., neighborhood quality, community type, peer influences, parenting), and lifetime substance use (i.e., alcohol, tobacco, marijuana, inhalant). Findings suggest that best friend and father illicit substance use (i.e., drugs other than tobacco or alcohol) and respondent sex (i.e., boys) were consistent and important discriminators between children who tried substances and those that did not. Friend cigarette use was a strong predictor of lifetime use of alcohol, tobacco, and marijuana. Friend alcohol use was specifically predictive of lifetime alcohol and tobacco use. Perceived danger of engaging in frequent alcohol and inhalant use predicted lifetime alcohol and inhalant use. Overall, findings suggest that best friend and father illicit substance use and respondent's sex appear to be high impact screening questions associated with substance initiation during childhood for Mexican youths. These data help practitioners narrow prevention efforts by helping identify youth at highest risk.

Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Reasons for Leaving Surgery

An impending surgeon shortage looms in the US due to increasing demand and a stagnant number of surgeons entering practice. We sought to evaluate the state of our surgical workforce by exploring current practice patterns, job satisfaction, and reasons why surgeons consider leaving surgery. In 2018, a link to a detailed survey was distributed by email to Fellows of the American College of Surgeons (ACS) who actively practice in the US and have completed a general surgery residency or integrated cardiothoracic, vascular, or plastic surgery fellowship. Detailed questions regarding practice attributes, surgical training, professional choices, and career satisfaction were included. Nonresponse weights were adjusted for respondent sex, age, and presence of subspecialty training between respondents and the total surveyed ACS population. All estimates and analyses were weighted to account for potential nonresponse bias. There were 3,807 surgeons who responded (15% response rate). Overall, 81% reported career satisfaction and 80% would choose surgery over again. Twenty-six percent were considering leaving surgery within the next 2 years. Stratified by age groups 40 to 49, 50 to 59, and 60 to 69 years, the survey found that 9%, 17%, and 45% of respondents were considering leaving surgery within the next 2 years, respectively. Thirteen percent of surgeons less than 60 years old were considering leaving surgery, and only 49% of these surgeons reported career satisfaction. Among surgeons less than 60 years old who were considering leaving surgery, the top 3 reasons rated as very important were overall stress (79%), work time demands (77%), and personal time requirements (73%). Reported surgeon job satisfaction was high, but a surprising number of surgeons reported that they were considering leaving surgery. Work time requirements and lack of personal time are leading factors contributing to surgeons leaving practice.

Factors Affecting Consumer Satisfaction to Online Shopping

Most companies are expanding their network through an online platform. Under various scenarios (e.g. pandemic situations), market vendors should be versatile and adaptable to different types of distribution channels. This paper described the factors affecting consumer satisfaction to online shopping such as reliability and responsiveness, assurance and empathy, and tangibility. This paper determined the significant difference between the sex of respondents and the factors affecting consumer satisfaction to online shopping. This paper used a descriptive method, a total of 487 online consumers (219 Male and 268 Female) within Cabanatuan City were involved in this study using adopted questionnaire with adopted likert-scale responses. Based on the gathered data, the researchers drew four conclusions. First, the respondents have a strong degree of confidence in their respective website/application for online shopping. Hence, it is recommended that owners of online shopping website/application should work on improving their order cancelation and returns. Second, the respondents trusted online shopping websites/applications because of their marketing tactics, such as word of mouth, to boost their credibility. Hence, it is highly suggested that the owners of online shopping website/application should track the problems involving product delivery. Third, respondents have been literate in using and searching online shopping websites/applications. Hence, it is recommended that the owners of the online shopping website/application continuously improve their system to keep their consumers satisfied. Finally, the null hypothesis is retained. It implies that sex does not affect the consumer satisfaction to online shopping factors. Thus, it is suggested to look for other variables that may affect consumer satisfaction.

Occupational Stress and Associated Factors among Nurses working in Public Hospitals of Arsi Zone, Oromia Regional State, Central Ethiopia, 2018

Nursing, by its nature, is an occupation subject to a high degree of stress. This profession involves working with people who are themselves suffering a considerable degree of stress. Occupational stress compromised quality of service delivery and also leads as employees’ burnout, turnover and absenteeism. The Objective of the study is to determine the level of occupational stress and associated factors among nurses. The study employed facility based cross sectional study was conducted from August 13 –September 02, 2018. All nurses who served at least for 6 months in Arsi zone public hospitals were asked using self-administered structured questionnaire. The collected data was checked manually, edited, coded and entered into Epi-data version 3.1 and finally it was exported in to statistical package for social science version 24 for cleaning and analysis. Descriptive statistics were used to estimate frequency percent and mean. Dependent variables (occupational stress) were computed based on the respondents having average score of mean and above in expanded nursing stress scale. Then, associations between independent and dependent variables were analyzed first using bivariate binary logistic regression. Variables that had p<0.25 on bivariate binary logistic regression were entered into multivariable binary logistic regression and adjusted odds ratio (AOR) with 95% CI were reported. The study finding showed that 202 (53%) with (95% CI: 48.2-58.1) of nurses were occupationally stressful. Factors significantly associated with occupational stress among nurses were sex of respondents (female: AOR=2.37, 95% CI: 1.41, 3.97), marital status (ever married: AOR=2.49, 95% CI: 1.35, 4.60), Role ambiguity (nurses who had Role ambiguity: AOR=3.01, 95% CI: 1.79, 5.05) and working hours. (≥8hrs hours per day: AOR=2.85, 95% CI: 1.10, 7.36). In this study, more than half of nurses had occupational stress, Thus, Arsi zone public hospitals collaborative with concerned stakeholders to design stress reduction program for tackling occupational stress among nurses.

Assessing employers’ satisfaction with Indian engineering graduates using expectancy-disconfirmation theory

PurposeCasting employers as customers, the purpose of this paper is to investigate the association between expectations, perceptions and disconfirmation beliefs with the satisfaction of employers regarding the competencies possessed by fresh engineering graduates hired by such employers in the Indian context.Design/methodology/approachUsing data collected from 284 employers, the authors have hypothesized and examined a partial mediation model in which disconfirmation beliefs mediate the relationships between expectations and perceptions, and employer satisfaction. Furthermore, the authors have tested if this mediated relationship is moderated by the age and sex of respondents representing employers.FindingsResults indicate that employers’ satisfaction can be explained from the framework of the expectancy-disconfirmation theory. Employers’ expectations and perceptions are established to be associated with employers’ satisfaction with new hires, and positive disconfirmation mediates these relationships. Results also indicate that age moderates the effect of predictor variables employers’ expectations and employers’ perception on the mediator disconfirmation. Sex, however, did not moderate any relationship.Practical implicationsThe results demonstrate the usefulness of the expectancy-disconfirmation theory for studying employer satisfaction with competencies of recent engineering graduates in India. Findings are relevant to multiple stakeholders including employers hiring engineering graduates, engineers and technical institutions.Originality/valueExpectancy-disconfirmation theory has been successfully applied to measure customer satisfaction in consumer behaviour research, while satisfaction of employers has been studied in the field of organizational behaviour. The paper stands out in the literature as one of its major implications is to extend the expectancy-disconfirmation theory to predict employers’ satisfaction.

Surrogate Decision Making for Children: Who Should Decide?

To identify caregivers' views on preferred surrogate decision makers for their children. A respondent-anonymous survey was distributed to a convenience sample of adults who accompanied a child to general and subspecialty pediatric care at 2 different institutions or were at the bedside of a child in the pediatric intensive care unit at a third institution in Chicago. We collected 462 valid surveys. The average age of the legal guardian and accompanying child was 36.8years and 6.6years, respectively. Most legal guardians designated "other parent with legal authority" as their first choice surrogate decision maker (70%). Respondent's sex, respondent's age, child's age, and child's ethnicity had no effect on first choice surrogate decision maker. "Other parent with legal authority" was less likely to be first choice surrogate if respondents had Medicaid insurance, less than a college degree, or lived in a non-nuclear household (P<.01 for all factors). The surrogacy ladder selected by 31% of legal guardians was "other parent with legal authority," "child's grandparent(s)," and "child's aunt(s) or uncle(s)." No other sequence received more than 10% designation. Study site had no effect on surrogate preference (P=.30). A surrogacy priority ladder for minors needs to include relatives who are often not included in state surrogacy statutes (eg, grandparents, aunts and uncles). The most popular surrogacy ladder will not be ideal for many families. Parents need to be informed and empowered to choose alternate surrogates, and documented preferences must be easily and widely accessible.

Global water policy and local payment choices in rural Africa

Sub-Saharan Africa is least likely to meet the Sustainable Development Goal for safely-managed drinking water. Africa is estimated to require at least three times more annual investment, as a share of the gross regional product, than any other region to achieve ‘basic’ drinking water for everyone by 2030. If rural water users are to share some of these costs then the performance of current services needs to improve. In Africa, when a rural waterpoint fails, it takes a month or more to repair. We model water user choices across maintenance service models delivered by public, private and community providers with trade-offs in speed of repairing faults, payment levels and cash management. We find higher payments are associated with higher education and faster repair times. Household wealth, sex of respondent, seasonality, and waterpoint congestion, reliability and quality all influence payment choices. Understanding local payment choices provide behavioural clues to design more sustainable funding and service delivery models to align global and local drinking water goals.