bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Infrastructure Investment: A Two-Sector Dynamic Computable General Equilibrium Analysis for Ohio
Authors: Seung Chang K. , Kraybill David S.
Published: July 2003

The effects of increased public investment on regional output and welfare in Ohio are investigated using a regional dynamic computable general equilibrium model. Public investment affects the growth of the state economy, although the magnitude of the effect depends on the public capital elasticity. Our simulations indicate that public capital is underprovided in Ohio in base year 1990. Accounting for congestion in the use of infrastructure diminishes the positive effects of increased public investment only slightly. Beyond some level, more infrastructure investment does not increase the household welfare and can actually reduce it.
Spatial Econometric Models for Simultaneous Systems: Application to Rural Community Growth in France
Authors: Henry Mark S. , Schmitt Bertrand , Piguet Virginie
Published: July 2003

In this article, comparisons are made of several spatial econometric approaches to estimation of multiequation models of small region development applied to rural community growth. Spatial extensions of the Carlino and Mills’s 1987 and Boarnet’s 1994 models are estimated to analyze the spread of population and employment into 3,500 rural communes in six French regions. Results are compared for the Henry, Barkley, and Bao’s 1997 extension of the Boarnet model, the Carlino-Mills and Boarnet models, and three spatial autoregressive models suggested by Rey and Boarnet in 1998. Tests for spread and backwash effects in the spatial autoregressive model, and the Carlino-Mills and Boarnet models, with spatial autoregressive terms added, indicate that population growth spreads to rural communities from nearby areas but that evidence on employment spread is less robust. The Henry et al. modification to Boarnet adds insight into how urban growth affects proximate rural areas by decomposing the spatial cross-regressive term into rural area, urban core, and urban fringe effects.
Measuring the Quality of Regional Innovation Systems: A Knowledge Production Function Approach
Authors: Fritsch Michael
Published: July 2003

This article deals with applying the knowledge production function approach to the measuring and the comparison of the quality of regional innovation systems. It is argued that an embeddedness in a well-functioning innovation system should result in a relatively high propensity to innovate and a high productivity of efforts in research and development (R&D). Based on data for eleven European regions, the author has found a number of such statistically significant differences between the manufacturing firms in these regions. Interregional differences in the productivity of R&D activities correspond to some degree with a center-periphery paradigm, which can be found in the literature. Obviously, there exist considerable agglomeration economies that are conducive to R&D activities.
The Evolution of Technologies in Time and Space: From National and Regional to Spatial Innovation Systems
Authors: Oinas Päivi , Malecki Edward J.
Published: July 2003

Complementing existing approaches on national innovation systems (NISs) and regional innovation systems (RISs), the proposed spatial innovation systems (SISs) approach incorporates a focus on the path-dependent evolution of specific technologies as components of technological systems and the intermingling of their technological paths among various locations through time. SISs utilize spatial divisions of labor among several specialized RISs, possibly in more than one NIS. The SIS concept emphasizes the external relations of actors as key elements that transcend all existing systems of innovation. The integrating role of these relations remains inadequately understood to date. This poses a challenge for future research.
Geography, Endogenous Growth, and Innovation
Authors: Acs Zoltan J. , Varga Attila
Published: July 2003

If one is to understand why some regions grow and others stagnate, there are three fundamental questions that need to be answered. First, Why and when does economic activity become concentrated in a few regions, leaving others relatively underdeveloped? Second, What role does technological change play in regional economic growth? Third, How does technological advance occur, and what are the key processes and institutions involved? To answer these three questions, the authors surveyed three separate and distinct literatures that have a long and distinguished history, and all three have been recently reexamined. They include the new economic geography (Krugman), the new growth theory (Romer), and the new economics of innovation (Nelson).
Location Matters: Comparing the Distribution of Economic Activity in the Canadian and Mexican Urban Systems
Authors: Polèse Mario , Champagne Éric
Published: July 2003

In this article, the authors compare location patterns for sixteen industrial classes (goods and services) in Canada and Mexico at two points in time. They argue that the classical tenets of location theory apply equally to nations at different stages of development. The spatial distribution of activity (measured by employment) is examined with reference to distance and to city size in both nations. They conclude that economic activity in Canada and Mexico, both in the manufacturing and the service sectors, by and large exhibits similar spatial distributions. In both nations, urban industrial specialization varies systematically with city size and distance. Where major differences existed, they could often be explained by differences in geography and levels of development and by the spatial interference of the U.S. border.
Krugman’s Economic Geography of Development: Negs, Pogs, and Naked Models in Space
Authors: David Paul A.
Published: July 2003

Krugman’s models of spatial resource allocation and trade convey robust theoretical insights with a parsimonious lucidity that appeals strongly to modern economists’ tastes. Those great pedagogical virtues also may limit the models’ utility in guiding empirical research on the dynamic processes ostensibly being addressed. Three reasons for this worry are elaborated in this comment: (1) they are meant to explain a set of “stylized” facts that abstract from important observed in homogeneities in the geography of development; (2) the modeling emphasis on demand-side externalities diverts attention from supply-side forces making for industrial localization; and (3) Krugman’s treatment of the role of the state ignores inefficiencies arising from locational tournaments involving local government subsidization of firms in footloose industries.
The Role of Transportation Costs for People
Authors: Rauch James E.
Published: July 2003

Exports can enable developing countries to overcome the problem of small domestic markets. Manufactured exports from developing to industrial countries often require transfer of technological know-how from the latter to the former through repeated movement of engineers and other skilled personnel. The cost of this movement increases with distance. Distance from the temperate industrial world thus becomes an obstacle for productivity increase in the tropics. Export trading companies can help to conquer distance by gathering information and matching domestic producers with foreign buyers.
Geography and Economic Development
Authors: Gallup John Luke , Sachs Jeffrey D. , Mellinger Andrew D.
Published: July 2003

Location and climate have large effects on income levels and income growth through their effects on transport costs, disease burdens, and agricultural productivity, among other channels. Geography also seems to affect economic policy choices. Many geographic regions that have not been conducive to modern economic growth have high population densities and are experiencing rapid increases in population. At particular disadvantage are regions located far from coasts and ocean-navigable rivers, for which the transport costs of international trade are high, and tropical regions, which bear a heavy burden of disease. Moreover, a large portion of population growth over the next thirty years is expected to occur in these geographically disadvantaged regions.
Decentralization Reforms and Regionalism in China: A review
Authors: Zhao X. B. , Zhang L.
Published: July 2003

Since 1978, the decentralization reforms, in general, and the reforms in planning and fiscal systems, in particular, have brought about dramatic changes in the context of central-regional/local relationships, which have in turn generated a tremendous impact on and problems for China’s regional development. This article aims to examine the impacts and consequences of China’s decentralization reform on regional development over the past seventeen years. With a brief review of prereform experiences, this article focuses on the decentralization reforms of planning and fiscal systems in the 1980s and 1990s: the contract-responsibility reforms and the ongoing tax-sharing reforms, and their regional implications and consequences. Special attention is paid to regionalism that is emerging as a result of these reforms. The authors argue that regionalism, in forms of territorial segmentation and confrontation, was planted in the traditional administrative economic system, but grew and was exacerbated by the current flawed or uncompleted decentralization reforms. The current tax-sharing system reform, which centered the functional division between the center and localities, seems to be on the right track, but its fate is hard to predict and far from claiming success.
Community Reinvestment: A Review of Urban Outcomes and Challenges
Authors: HAAG Susan White
Published: July 2003

The Community Reinvestment Act (CRA) of 1977 was designed to increase the availability of credit and financial services to lower income and minority borrowers and their communities and to improve on the ways that depository institutions approach lending in these communities. This article examines the literature on the effects of the CRA on lending patterns in urban areas and discusses challenges to community reinvestment regulation in the future.
Quality Improvement in Health Care
Authors: Colton David
Published: July 2003

During the past decade, quality improvement (QI) has become the primary approach for health care organizations to measure performance and implement change. From a historical perspective, QI has multiple origins: in systems engineering, as a way of defining production processes; in quantitative analysis, as a methodological approach for collecting and analyzing data; and in organizational behavior, as a way of understanding how QI fits with an organization’s structure and management philosophy. Although QI and evaluation share similar goals, as modes of inquiry, they developed in very distinct and separate settings, to fulfill different needs. However, these differences are now beginning to merge as QI gains acceptance as a desirable and legitimate approach for health care organizations to enhance service delivery and outcomes. This article describes the conceptual foundations on which QI is based and identifies historical events that have influenced the development of QI and its adaptation by health care organizations.
Measuring Health Care Quality
Authors: Carey Raymond G.
Published: July 2003

Statistical process control (SPC) was developed in the 1920s as a way of detecting defects in manufacturing processes. During the past decade, SPC has been adopted by service industries and is increasingly being employed by health care organizations. The methodology involves the construction of a control chart to detect variation within processes. Variation is neither good nor bad in itself; therefore, the impact of variation must be interpreted within the context of expected outcomes, acceptable limits, and the process itself. In this article, the concept of statistical process control is explained, and examples are provided to illustrate how SPC can be applied in a clinical setting.
Encouraging Physicians to Respond to Surveys through the Use of Fax Technology
Authors: Lensing Shelly Y. , Gillaspy Stephen R. , Simpson Pippa M. , Jones Stacie M. , James John M. , Smith Juneal M.
Published: July 2003

High response rates to surveys of physicians are difficult to achieve. One possible strategy to improve physicians’ survey participation is to offer the option of receiving and returning the survey by fax. This study describes the success of the option of fax communication in a survey of general practitioners, family physicians, and pediatricians in Arkansas with regard to pediatric asthma. Eligible physicians were given the choice of receiving the survey by telephone, mail, or fax. In this observational study, physicians’ preferences, response rates, and biases for surveys administered by fax were compared with mail and telephone surveys. The overall survey response rate was 59%. For the 96 physicians completing an eligibility screener survey, the largest percentage requested to be surveyed by fax (47%) rather than by telephone (28%) or mail (25%). Faxing may be one strategy to add to the arsenal of tools to increase response rates in surveying physicians.
Assessing Medicaid Recipient Access and Satisfaction
Authors: Bovbjerg Viktor E. , Smith Wally R. , Cotter J. James , McClish Donna K. , Rossiter Louis F.
Published: July 2003

Medicaid increasingly requires enrollment in managed care programs. This study assessed access to care, satisfaction with care, and appointment wait times during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfaction or poorer access among managed care recipients. Fee-for-service recipients, compared to primary care case management, reported greater general (91 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When appointments were required, adult HMO enrollees, compared to case management, had longer waits for routine care in the second (5.8 ± 8.2 days vs. 4.0 ± 6.6) and third surveys(5.5 ± 6.9 days vs. 3.8 ± 7.3); waits for other appointments did not consistently differ by program. There were no significant program differences in overall satisfaction. Findings are tempered by the potential for response bias and geographic confounding. Continued monitoring is crucial to assure that access and satisfaction remain high in Medicaid managed care.
Measuring the Physician Perspective on Quality of Care in Health Plans
Authors: Smith Maureen A. , Brown Margaret E. , Borowsky Steven J. , Davis Margaret K. , Center Bruce , Lurie Nicole
Published: July 2003

Physicians provide one source of information about the quality of care in health plans, but concerns exist that physicians cannot distinguish quality from financial considerations or other underlying attitudes. We examined whether physicians can (a) distinguish different domains of health plan quality and (b) distinguish health plan quality from their under-lying attitudes. We analyzed data on 419 generalist physicians from four health plans. Three scales assessed physicians’ perceptions of facilitators and barriers to high-quality care in the plans and the clinical capabilities of plan physicians. Structural equation modeling indicated that physicians could distinguish domains of health plan quality. Physicians could also distinguish plan quality from their attitudes toward the plan, but plan quality was more highly correlated with general managed care attitudes than expected. These data suggest that physicians can provide information about health plan quality, but it will be important to validate these measures against patient outcomes.
Evaluation of Patients’ Satisfaction with Hospital-At-Home Care
Authors: Dubois Anne , Santos-Eggimann Brigitte
Published: July 2003

On July 1, 1997, in the Canton of Vaud, Switzerland, a pilot experiment of Hospital-at-Home Care (H-Hcare) was set up for a 2-year period at four sites to measure patients’ satisfaction with this type of health care. Out of 174 patients referred to the H-Hcare program for a wide range of treatments, 107 were medical patients admitted for heart failure, community acquired pneumonia, or for an infectious disease requiring IV-antibiotherapy; 95 of these agreed to express H-Hcare satisfaction and dissatisfactions during a semistructured interview conducted 6 weeks after admission. H-Hcare was considered a viable alternative to hospitalization when the illness is not too serious, and for patients who are still independent and need little care. When patients are more severely ill, they prefer to go to hospital to avoid overburdening their caregivers and to feel more secure.
From the General to the Specific
Authors: Tickle-Degnen Linda
Published: July 2003

The purpose of this article is to describe how health practitioners can interpret the results from published meta-analytic reports of intervention effectiveness and efficacy studies, and then communicate those results, in a manner that helps patients make critical clinical and life decisions. The problem of using research evidence in clinical decision making is one of moving from generalized findings about intervention effectiveness to a prediction for a specific patient. To move toward a reasonable prediction, practitioners need information from a meta-analytic report that enables them to identify and understand the distribution of outcome results that are most applicable to a specific patient. Relevancy, effectiveness, and interpretation forms of information are discussed in this article. The focus is on the interpretation of the effect size statistics d and r for understanding the variation in responses that the patient might experience with an intervention.
Evaluation of Alcohol Education Programs on Attitude, Knowledge, and Self-Reported Behavior of College Students
Authors: Sharmer Laurel
Published: July 2003

This research was conducted as a pilot study to evaluate the effectiveness of two different types of alcohol education programs for college students. The educational programs were a teacher-centered motivational speech and “Alcohol 101,” a new student-centered CD-ROM interactive program. The research was conducted at a public university in the Northeastern United States. A pretest/posttest quasi-experimental control group design was used. The instrument used was the Student Alcohol Questionnaire (SAQ). Univariate analysis of covariance was used to test for postintervention differences across groups for attitudes and knowledge about alcohol and self-reported alcohol consumption behavior. A statistically significant difference between groups for the second postintervention measure of attitude was identified. No significant differences in knowledge that could be attributed to the interventions were found, and no statistically significant differences were found for self-reported behavior.
Assessing Attitudes Toward New Names for Chronic Fatigue Syndrome
Authors: Jason Leonard A. , Eisele Heather , Taylor Renee R.
Published: July 2003

A questionnaire was distributed at the American Association of Chronic Fatigue Syndrome’s biannual convention in Washington in January 2001 as well as through various Internet Web sites and listservs during early February and March of 2001. The sample consisted of 432 respondents. Most respondents (86%) indicated they wanted a name change, although more patients than scientists were in favor of this change. It was also apparent that the patients and physicians were clearly split between adopting a name such as myalgic encephalopathy versus one such as neuro-endocrine immune disorder. Also, among those respondents who selected either of these two choices for a new name, less than 30% of them supported the other name. Although the majority of respondents feel the name should be changed at this time, this survey suggests there are different stake-holders involved in the name-change process, each with strong and sometimes disparate feelings about changing the name.
A Brief History of Research Synthesis
Authors: Chalmers Iain , Hedges Larry V. , Cooper Harris
Published: July 2003

Science is supposed to be cumulative, but scientists only rarely cumulate evidence scientifically. This means that users of research evidence have to cope with a plethora of reports of individual studies with no systematic attempt made to present new results in the context of similar studies. Although the need to synthesize research evidence has been recognized for well over two centuries, explicit methods for this form of research were not developed until the 20th century. The development of methods to reduce statistical imprecision using quantitative synthesis (meta-analysis) preceded the development of methods to reduce biases, the latter only beginning to receive proper attention during the last quarter of the 20th century. In this article, the authors identify some of the trends and highlights in this history, to which researchers in the physical, natural, and social sciences have all contributed, and speculate briefly about the “future history” of research synthesis.
To IPD or not to IPD?
Authors: Stewart Lesley A. , Tierney Jayne F.
Published: July 2003

Systematic reviews and meta-analyses that obtain original research data on individual participants enrolled in trials have been described as the gold standard of review. However, they may take longer and be more resource intensive than other types of review. The authors describe potential advantages and disadvantages of the individual patient data (IPD) approach, including benefits from improved data quality, benefits afforded by the type of analyses that can be done, and advantages in achieving consensus around results and interpretation by an international multi disciplinary team. Disadvantages and barriers relating to resource and expertise, negotiating collaboration, and software requirements are also discussed. At the outset, reviewers should consider the methodological factors likely to influence results in their particular review setting, together with time and resource constraints, so that an active decision can be made about whether to extract data frompublished reports, collect addi tional or replacement summary data from trialists, or collect IPD.
The Criticism Management System for the Cochrane Library
Authors: Ober Melissa , Shohara Ryo , Rennie Drummond , Yank Veronica , Bero Lisa A.
Published: July 2003

In April 1997, the Cochrane Collaboration implemented the Criticism Management System for The Cochrane Library, allowing readers to electronically submit criticisms on Cochrane reviews and protocols. As a result of resource constraints and user feedback, the Criticism Management System evolved through three different versions. Major problems have included difficult access to the system, a lack of automation within the system, a low number of submissions (171 criticisms submitted per 1,388 reviews), and a low response rate to these criticisms by authors of reviews (26 criticisms have received published responses). These low figures suggest that users of The Cochrane Library are not commenting on the published reviews or not using the Criticism Management System to make their criticisms known to the authors. An easier-to-use system and better ways of encouraging feedback from readers and responses from reviewers are needed in the future.
Shifting Costs from High-Cost to Low-Cost Diagnosis-Related Groups?
Authors: Saint Sanjay , Rose Judith , Lichter Allen S. , Forrest Sofia , McMahon Laurence F.
Published: July 2003

Hospitals are commonly compared with each other within diagnosis-related group (DRG) categories. Administrators infer that hospitals with a higher cost per case within a DRG are less efficient than hospitals with a lower cost per case after case mix and severity adjustment. The authors assess whether hospitals that carry a heavy load of high-cost DRGs potentially distribute the added expenses of treating these patients onto their lower cost DRGs using data gathered from the 47 hospitals in the University Hospital Consortium database between January 1994 and December 1995. The results indicate that given standard hospital allocation practices, some of the costs associated with high-cost patients were likely shifted downward, thereby inflating the cost per case for less expensive patients. As researchers adopt more benchmarking methodologies, it is important to recognize that standard accounting practices in which cost shifting from one class of patient to another may impair the ability to understand the actual cost structure for classes of patients.
A Qualitative Evaluation of an HIV/AIDS Respite Care Service in Victoria, Canada
Authors: Stajduhar Kelli I. , Lindsey Elizabeth , McGuinness Liza
Published: July 2003

The Victoria AIDS Respite Care Society (VARCS) has provided respite care to people living with HIV/AIDS (PLWAs) since 1991. In 1998, an evaluation of VARCS services was undertaken to gain a better understanding of the VARCS model of community-based care. The evaluation was comprised of four components including an examination of the historical evolution of VARCS, an account of the community development processes used, a description of VARCS services, and an analysis of the impact and outcomes of VARCS services. This article highlights qualitative findings from the impact and outcomes component of this study. Guided by principles of participatory action research, this project included interviews with 85 participants. Eight themes emerged from the analysis that appeared to speak to the qualitative impact and outcomes of VARCS service. Actions taken by VARCS as a result of the evaluation findings are discussed as are the study limitations.
Tracking Procedures for Locating High-Risk Youth
Authors: McCuller William J. , Sussman Steve , Holiday Karen , Craig Sande , Dent Clyde W.
Published: July 2003

Few published works are available that provide a comprehensive description of tracking procedures. This article describes the data collection tracking protocol that was used in Project Towards No Drug Abuse (Project TND), to follow high-risk youth over a 5 1/2 year period. Youth were followed from 1994 through 2000. A total of 35% of these youth were assessed 5 1/2 years later. Collapsing across the last two waves, 46% of these youth were followed an average of 5 years later. These procedures may be helpful in tracking highly mobile youth.
The Biochemical Bases for Reward
Authors: de la Fuentefernández Raúl , Stoessl A. Jon
Published: July 2003

The authors propose that the placebo effect is mediated by reward-related mechanisms. Recent evidence suggests that it is the expectation of reward (in this case, the expectation of clinical benefit) that triggers the placebo response. In Parkinson’s disease, the placebo effect is mediated by the release of dopamine in the striatum. The authors argue that placebo-induced dopamine release in limbic structures, particularly in the nucleus accumbens, could also be a major biochemical substrate for the placebo effect encountered in other medical disorders. Other neuroactive substances involved in the reward circuitry (e.g., opioids) are also likely to contribute to the placebo response, and such contribution may be disorder specific (e.g., opioid release in placebo analgesia; serotonin regulation in response to placebo antidepressants). In addition, placebos may have a role in substitution programs for the treatment of drug addiction.
The Meaning Response and the Ethics of Avoiding Placebos
Authors: Moerman Daniel E.
Published: July 2003

Because the “placebo effect” seems to result from “deception,” it is often disparaged and despised. Rethinking this and realizing that these benefits flow largely from the meaning of medical encounters (and are far better under-stood as “meaning responses”); realizing that there need be no deception to elicit them and that they are often very desirable, engaging fundamental human biological pathways, puts the ethical dilemma in a new light. It seems unethical to avoid—to evade—coming to a full understanding of how meaning can so profoundly improve human well-being.
Placebo Controls in Randomized Trials of Acupuncture
Authors: Vickers Andrew J.
Published: July 2003

Considerable intellectual and practical effort has been expended on designing and evaluating placebo controls in acupuncture studies. Somewhat less attention has been paid to the question: Why use a placebo in a randomized trial of acupuncture? This is partly because placebo controls have generally been seen as an inherent part of randomized trial methodology. As a result, most acupuncture trials have included a placebo-control group. A large number of different placebo techniques have been used in these trials. The design and choice of placebo techniques has typically depended on purely theoretical considerations, without empirical validation of physiological inactivity and psychological credibility. Principles can be developed for deciding whether to use placebo or another form of control in a randomized trial. These include issues of ethics, practicality and methodology. Such principles apply regardless of the intervention; they can and should be applied to acupuncture research.
The Changing Health Care System
Authors: Xu Gang , Hojat Mohammadreza , Veloski J. Jon , Gonnella Joseph S.
Published: July 2003

The volatility in the U.S. health care system due to unprecedented changes in its organization, financing, and delivery, coupled with a growing physician surplus in certain areas, suggests the need for a research agenda to investigate the impact of these forces on the educational programs of medical schools. This article discusses the potential impact of trends in the health care environment on the following key aspects of undergraduate medical education: admissions, faculty, curriculum, and educational outcomes. A representative set of research questions intended to stimulate inquiry and guide empirical studies in each of the four domains is proposed.
Benefits of Multiple Methods for Evaluating HIV Counseling and Testing Sites in Pennsylvania
Authors: Encandela John A. , Gehl Mary Beth , Silvestre Anthony , Schelzel George
Published: July 2003

In 1995-1996, an evaluation was conducted of publicly funded HIV counseling, testing, referral, and partner notification sites in the Commonwealth of Pennsylvania. A collaborative effort of public and private entities, this evaluation used multiple methods that proved to be more powerful in eliciting results than any of the methods used alone, and it did so with budget parameters determined by the public funding agency. This article examines the results of two methods: written mail surveys sent to all of the agencies in the population of publicly funded sites and interviews conducted at a random sample of sites. Results were found to be similar along lines of questions posed similarly by both approaches, and complementary in other areas. Benefits of triangulation in statewide evaluation of HIV/AIDS services are discussed.
When (Not if) Evaluation Flexibility is Desirable
Authors: Hembroff Larry , Perlstadt Harry , Henry Rebecca C. , Hogan Andrew J. , Weissert Carol S. , Bland Carole J. , Harris Dona L. , Knott Jack H. , Starnaman Sandra M.
Published: July 2003

The evaluation literature often debates whether evaluators should be flexible in evaluation design and activities in order to collaborate with program directors and be responsive to programming needs. Two conditions are specified under which evaluation flexibility is not only desirable but essential. Two examples from the cluster evaluation of the W. K. Kellogg Foundation’s Community Partnerships for Health Professions Education initiative are provided to illustrate why flexibility under these conditions proved to be essential. One of the examples, related to the “community” involvement in the initiative, illustrates the need for flexibility as programs experience goals clarification. The other example, related to the coincidental national health care reform efforts, illustrates the need for flexibility both to capture programs’efforts to protect their integrity and to ensure against spurious conclusions as a result of external turbulence in policy environments. How the cluster evaluation team addressed these issues is also described.
Evaluating the Impact on Public Policy of Foundation-Sponsored Programs in the Health Professions
Authors: Knott Jack H. , Weissert Carol S. , Henry Rebecca C.
Published: July 2003

The leaders of national philanthropic foundations have long been active in informing public policy makers about their organizations’ accomplishments and lessons learned in health care and other issues. The public policy context also is seen increasingly as an important factor influencing changes in the health care market. This article outlines how public policy was monitored and evaluated in a recent initiative in health care by a prominent national foundation. The markers of policy change in the evaluation of this initiative represented a mixture of the initiative’s efforts to inform policy makers, the success the participant projects had in making policy makers aware of the initiative’s goals, and actual changes in policy outcomes.
Competency in Community-Oriented Health Care
Authors: Chen Shu-Pi C. , Ervin Naomi E. , Kim Yangsoon , Vonderheid Susan C.
Published: July 2003

To competently deal with changes in the health care system, health professionals for the future must have expanded abilities and new attitudes. Education of health professionals for community-oriented health care (COHC) is being promoted as one approach to achieve this focus. This article reports on the development and testing of the Community-Oriented Health Care Competency Scale, which measures knowledge, attitudes, and intention to practice COHC. Results of testing demonstrate adequate reliability for a new instrument: an alpha coefficient of .95 for the Knowledge subscale, .68 for the Attitude subscale, and .93 for the Intention to Practice subscale. Content validity of the instrument is based on the literature review, focus group sessions, and expert opinion. The instrument may be used to assess competency of health professions students in COHC, but continued testing is needed.
Physicians for the 21St Century
Authors: Patel Kant
Published: July 2003

Since the 1980s, the American medical educational system has come under attack for its failure to train and prepare physicians for the challenges created by the changing health care market. The medical schools have been criticized for producing too many specialists and for not providing sufficient training in ethics and moral reasoning, care of the terminally ill, health care economics, alternative medicine, and the role of spiritual and religious values in healing. This study attempts to ascertain the extent to which medical schools have responded to these criticisms by changing their curriculum. The study is based on a survey of deans of medical schools in the United States. The study finds that medical schools have indeed responded to some of the criticisms by incorporating training in ethics, communication, primary and preventive care, and care of the terminally ill in their curriculum. However, the study concludes that more changes are needed to train physicians for the 21st century.
The Development of the Chronic Fatigue Syndrome Attitudes Test
Authors: Shlaes Jennifer L. , Jason Leonard A. , Ferrari Joseph R.
Published: July 2003

Chronic Fatigue Syndrome (CFS) is characterized by debilitating symptoms including persistent or relapsing fatigue. As a result of CFS, some individuals experience significant stigma that is attached to this illness. Many medical professionals are skeptical of the validity of the illness, and employers often fail to appreciate the seriousness of the symptoms. Although negative attitudes greatly affect the lives of individuals with CFS, there is presently no measurement of attitudes toward this illness and people who have CFS. The purpose of the present studies was to create a scale that measures attitudes toward individuals with CFS—the Chronic Fatigue Attitudes Test (CAT)—and to assess the scale’s reliability and validity. The 13-item scale was created using several constructs outlined in the literature regarding negative attitudes toward people with CFS, disabilities, and AIDS. Theoretical implications of the findings and the utility of the CAT are discussed.
Grand national narratives and the project of truth commissions: a comparative analysis
Authors: Andrews Molly
Published: July 2003

This article will compare the narrative projects of nation building and dismantling as represented in the truth commissions of South Africa and East Germany. One of the most important aspects of truth commissions is that personal suffering on a wide scale is publicly acknowledged and written into the national fabric. The relationship between individual and collective memory is a powerful one; through the testimonies that it has documented, the Truth and Reconciliation Commission has created the possibility for South African citizens to participate in the writing of a new official version of their country’s recent history. It has helped to establish a break with the past, so that the country as a whole can move forward. In contrast, the truth commission set up in East Germany was important in the dismantling of that country. While most truth commissions cover a relatively limited period of time, the truth commission of East Germany was unusual, if not unique, in that it covered the whole of that country’s history. And unlike South Africa, and other countries, where truth commissions function as a pivotal bridge between past and future, in East Germany, the truth commission marked the completion of the national narrative.
Deliberative institutional economics, or DoesHomo oeconomicus argue?
Authors: van Aaken Anne
Published: July 2003

Institutional economics and discourse theory stand unconnected next to each other, in spite of the fact that they both ask for the legitimacy of institutions (normative) and the functioning and effectiveness of institutions (positive). Both use as theoretical constructions rational individuals and the concept of consensus for legitimacy. Whereas discourse theory emphasizes the conditions of a legitimate consensus and could thus enable institutional economics to escape the infinite regress of judging a consensus legitimate, institutional economics has a tested social science paradigm (rational choice) of explaining and predicting the functioning of institutions. The article outlines a theoretical synthesis of the two theories by finding points in common and possibilities of fruitful combinations concerning the problem of legitimacy, institutional design and effectiveness of legal norms.
The desire for freedom and the consumption of politics
Authors: Orlie Melissa A.
Published: July 2003

In this essay I argue that commodity consumption is to the regime of political capitalism at the turn of this century what Michel Foucault claimed for discourses of sexuality in the bio-political state. If I am right, then understanding contemporary subjectivities requires granting greater political credence to practices of commodity consumption than they generally receive and a correlative paradigm shift in our notion of desire – from discourses of sexuality to erotics of appetite. But whatever ‘ethical substance’ we focus upon when we analyze our contemporary situation I think we must give greater consideration to practices of individual conduct. We must grant due attention to the uses to which our bodies, skills and resources are put, and to our active as well as passive participation in that usage, because our everyday conduct may be the missing link between our professed convictions and our actual political prospects.
Anti-racism, multiculturalism and the ethics of identification
Authors: Cornell Drucilla , Murphy Sara
Published: July 2003

In theoritical and political writings, multiculturalism is most frequently understood in the language of recognition. Multiculturalist initiatives responds to the demands of minority cultures for political and cultural recognition so long denied them with devastating effects. In this article, we argue that the politics of recognition may have implicit dangers. In so far as it is articulated as a demand placed upon a dominant group and integrally tied to the substantiation of pre-given or fixed identity, it can easily mask or even reiterate cultural hierarchization associated with Eurocentrism. We argue that it is necessary to understand recognition in terms of equal dignity; at the core of our argument is the insistence that all of us must have our potential to shape our identifications recognized by the state, such that we – and not the state – are the source of the meaning that they have to us, as individuals and as members of groups.
Toward a Sociology of (Gendered) Disgust
Authors: ISAKSEN LISE WIDDING
Published: July 2003

Based on a reinterpretation of 105 relations between the elderly and their adult children, this article discusses incontinence as a social and cultural phenomenon. Social norms and cultural symbols that surround the intimate parts of the body affect the way care work is organized, gendered, culturally understood, and socially stratified. To lose bodily control over bodily fluids seems to put the individual's identity and human dignity at risk. The disturbing presence of odors, sights, and textures seems to have a disruptive effect on close relationships. The article further discusses how bodily dimensions of care add new burdens to modern family life in different social contexts and contribute to expand the gender gap in different cultures of care. This seems to be related to how ideas of individualism structure and are structured by economic and social conditions in which people live their everyday lives.
Informal Caregiving and Retirement Timing among Men and Women
Authors: DENTINGER EMMA , CLARKBERG MARIN
Published: July 2003

Informal caregiving, or the provision of unpaid, voluntary care to elderly or disabled family and friends, is an increasingly common experience for both men and women in late midlife. The authors examine the ways in which informal caregiving influences the transition to retirement and how this relationship is shaped by gender. Our data are 763 pension-eligible men and women in the 1994-1995 Cornell Retirement and Well-Being Study. Results from discrete-time event history analyses indicate that certain types of caregiving shape the timing of retirement but that the association depends on the relationship between caregiver and care recipient and is fundamentally moderated by gender. For example, wives caring for their husbands have retirement odds 5 times greater than women who are not caregivers, whereas husbands caring for their wives are substantially slower to retire. Our evidence suggests that in this sample, caregiving responsibilities lead to increased sex role-typical employment behavior in late midlife.
Evaluation of the Effects of a Smoking Cessation Intervention Using the Multilevel Thresholds of Change Model
Authors: Freels Sally A. , Warnecke Richard B. , Johnson Timothy P. , Flay Brian R.
Published: July 2003

The multilevel thresholds of change model is used to analyze the effect of a smoking cessation intervention on stage of readiness to quit across a 2-year follow-up period. The intervention, targeted to females with high school or less education, consisted of a televised component and a written manual. Any exposure to the intervention had a significant effect on stages that precede quitting but not on quitting; participation in the intervention had significant effects at all levels of change, including quitting. The written component had a stronger independent effect than the televised component. Intervention effects were strongest within women who were initially precontemplative.
The Impact of an Integrated Family Planning Program in Russia
Authors: Sherwood-Fabre Liese , Goldberg Howard , Bodrova Valentina
Published: July 2003

In 1995, the U.S. Agency for International Development implemented an integrated program of family planning education and services in six Russian cities to increase physicians’and women’s contraceptive knowledge and change current contraceptive use. Large population-based surveys of women ages 15-44 were carried out at the beginning of project implementation (in 1996) and 3 years later in two project sites and a comparison site. Results from these surveys indicate that project activities affected women’s knowledge of family planning methods, and caused women to have more favorable attitudes toward modern contraception. In addition, abortion rates decreased in project sites while remaining virtually unchanged in the comparison site. Because of uneven implementation of project interventions in the demonstration sites, however, the intervention’s actual impact on abortion rates remains unclear.
The Development of Science Achievement in Middle and High Schoolr
Authors: Ma Xin , Wilkins Jesse L. M.
Published: July 2003

Using data from the Longitudinal Study of American Youth (LSAY), hierarchical linear models (HLMs) were used to model the growth of student science achievement in three areas (biology, physical science, and environmental science) during middle and high school. Results showed significant growth in science achievement across all areas. The growth was quadratic across all areas, with rapid growth at the beginning grades of middle school but slow growth at the ending grades of high school. At the student level, socioeconomic status (SES) and age were related to the rate of growth in all areas. There were no gender differences in the rate of growth in any of the three areas. At the school level, variables associated with school context (school mean SES and school size) and variables associated with school climate (principal leadership, academic expectation, and teacher autonomy) were related to the growth in science achievement. Initial (Grade 7) status in science achievement was not associated with the rate of growth in science achievement among either students or schools in any of the three areas.
Cross-Cultural Hospital Care as Experienced by Mi’kmaq Clients
Authors: Baker Cynthia , Daigle Monique Cormier , Biro Anne , Joe Jennie R.
Published: July 2003

The hospitalization experiences of members of a Mi’kmaq, First Nation Community in New Brunswick, Canada, were examined to understand cultural sensitivity from their perspectives. Interpretive interactionism, a qualitative methodology, guided the study. In-depth interviews were conducted with 10 participants from the Big Cove First Nation Community. Recurring themes in their narratives revolved around understanding. Participants often felt misunderstood by caregivers in a way that made them feel lessened as persons. They also had difficulty understanding the hospital milieu and felt that they were strangers in it. Each, however, had experienced valued encounters with at least one caregiver when they felt understood. They felt these caregivers had been kind to them, accepted the Mi’kmaq custom of family visiting, and treated them as social equals. Compassion and a nondiscriminatory attitude were more important than cultural knowledge in this context in which the caregivers’culture rather than the care recipients’ culture predominated.
Mexican Americans’ Perceptions of Culturally Competent Care
Authors: Warda Maria R.
Published: July 2003

Although the literature abounds with authors’discussions of the need for nurses and other health care providers to deliver safe and optimal care to patients of diverse ethnic groups, little work has focused on defining and measuring the dimensions of culturally competent care. The purpose of this research was to identify culturally competent concepts from the perspective of Mexican Americans. Focus group interviews with Mexican American registered nurses and Mexican American lay recipients of health care were used to explore the participants’subjective perceptions regarding the indicators of culturally competent care. For this group of Mexican American registered nurses, the influence of culture remained strong despite nursing professional experience and knowledge of Western biomedical system. The predominance of themes emphasizing respect, caring, understanding, and patience in health care encounters support the critical importance of personal processes of health care with Hispanics.