bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Provider Attitudes in Prescribing Antidepressants to Older Adults: Leverage Points for Effective Provider Education
Authors: Arean Patricia A. , Alvidrez Jennifer , Feldman Mitchell , Tong Lowell , Shermer Rebecca
Published: May 2005

Objectives:

The purpose of this study was to determine if primary care provider knowledge of late-life depression, attitudes about treatment of depression in late life, and experience treating late-life depression affect the likelihood internists would prescribe antidepressants to older patients.

Methods:

This study was a primary care provider survey study. From a pool of 456 eligible mailed surveys, 253 providers completed (55% response rate) a survey assessing provider self-reported knowledge about treating late-life depression with antidepressants, their attitudes about older patients' acceptance and response to antidepressant medications, their professional and personal experience with antidepressant medication, and their comfort with prescribing antidepressants to older patients was created for this study.

Results:

Univariate analyses indicated that 75% of primary care providers were knowledgeable about the use of antidepressant treatment in older people, and 86% said they felt comfortable treating depression in older patients. Multivariate analyses indicated that the decision to treat older patients with antidepressants was largely influenced by time to treat patients, provider belief that antidepressants could treat late-life depression, their comfort with treating late-life depression, and having had older patients respond to anti-depressant treatment in the past ( R2 = .52, p < .001).

Conclusions:

This study shows that attitudinal and experiential factors play an important role in the likelihood that a provider will treat an older, depressed patient with an antidepressant, more so than knowledge about how to prescribe an anti-depressant to older patients. Residency programs for primary care practitioners should include education about the efficacy of antidepressant treatment in older people and should involve hands-on experience in treating late-life depression.
Some Indices of Health and Social Behavior Associated with the Avoidance of the Ontological Confrontation
Authors: Thauberger Patrick C. , Thauberger Eileen M. , Cleland John F.
Published: May 2005

As part of a series of studies designed to document some of the implications associated with an avoidance versus confrontation approach to the harsh realities of existence, this article reports the results of analyses pertaining to the general avoidance of existential-ontological1 confrontation as well as the specific avoidance of the ontological confrontation of death in relation to several social behavior and health related variables. High scorers on the Avoidance of the Ontological Confrontation of Death Scale (avoiders) were found to report increased use of tranquilizers, and less consumption of alcoholic beverages than the medium scorer group. In addition, low scorers on the Avoidance of Existential Confrontation Scale (confronters) reported increased use of stimulants as compared to the medium scorer groups, while the medium group reported more absenteeism from work-employment than low scorers. These results suggest there are both advantages and disadvantages associated with different awareness strategies.
A Primary Prevention Action Programme: Psychiatric Involvement following a Major Rail Disaster
Authors: Raphael Beverley
Published: May 2005

A primary prevention program implemented immediately following a major rail disaster is described. Because of the high mortality, services were oriented towards the provisions of preventive counselling for bereaved families as well as support for the injured. Emergency counselling services were provided at the City Morque. Subsequently, coordinating consultative and educative programmes were instituted in the affected health region. Counselling bereaved families was continued through appropriate specialised community services. High-risk groups of bereaved were delineated and special emphasis given to individual care of these persons. Recommendations are made concerning the relevance of such a programme to the personal disasters of life.
Cuba and the Philippines: Contrasting Cases in World-System Analysis
Authors: de Brun Suzanne , Elling Ray H.
Published: May 2005

Cuba and the Philippines are countries with broad similarities in historical background yet sharp divergences in political economic developments and relations to the capitalist world-system in recent times. U.S. economic and political interests dominated both countries during the first half of the 20th century. The changes generated by the Cuban revolution resulted in the end of U.S. power in Cuba in 1959. The Philippines, however, remain profoundly dependent on the United States. The approach taken in this article contrasts these countries, asking what the results of their divergent paths are in terms of health and health services. The ability of Cuba and the Philippines to support the primary health care (PHC) approach by fostering socioeconomic justice, authentic citizen participation, and a regionalized health system is examined. It is clear that the last 25 years of socialist-oriented development in Cuba reversed the negative effects of the previous market economy by providing improved social and health services. The success of the political economy and the fully regionalized health system, supportive of the PHC approach in Cuba, is reflected in the high-level health status of the people. In contrast, poverty, gross social and economic inequities, high prevalence of infectious disease, and inaccessible, inadequate, and uncoordinated health services persist in the Philippines after some 85 years of international and national capitalist development. The poor health status of the Philippine people is a direct reflection of this underdeveloped system.
The Family, Research, and Prime-Time Television in Alcohol Education
Authors: De Foe James R. , Breed Warren
Published: May 2005

Television programs contain materials relevant to health practices generally, and to drinking problems in particular. Research has found that these materials are often inaccurate and misleading. A method called cooperative consultation has succeeded in transmitting these findings to writers and producers in the industry. The response from the industry has been encouraging. The method is illustrated by using two programs and their contrasting depiction of how family members responded to an alcoholic husband and father.
A Fundamental Shift in the Approach to International Health by Who, Unicef, and the World Bank: Instances of the Practice of “Intellectual Fascism” and Totalitarianism in Some Asian Countries
Authors: Banerji Debabar
Published: May 2005

Navarro has used the term “intellectual fascism” to depict the intellectual situation in the McCarthy era. Intellectual fascism is now more malignant in the poor countries of the world. The Indian Subcontinent, China, and some other Asian countries provide the context. The struggles of the working class culminated in the Alma-Ata Declaration of self-reliance in health by the peoples of the world. To protect their commercial and political interests, retribution from the rich countries was sharp and swift. they “invented” Selective Primary Health Care and used WHO, UNICEF, the World Bank, and other agencies to let loose on poor countries a barrage of “international initiatives” as global programs on immunization, AIDS, and tuberculosis. These programs were astonishingly defective in concept, design, and implementation. The agencies refused to take note of such criticisms when they were published by others. They have been fascistic, ahistorical, grossly unscientific, and Goebbelsian propagandists. The conscience keepers of public health have mostly kept quiet.
Community Care and the Elderly in Great Britain: Theory and Practice
Authors: Walker Alan
Published: May 2005

Analysis of the postwar record in Great Britain shows that the state's response to the needs of the elderly has been increasingly centered on the provision of care in the community, or in the family. This community care policy is examined in relation both to some of the implicit functions of this policy and to performance of the policy in practice, particularly in relation to its effects on the sexual division of labor within the family. Also discussed are the processes which create dependency, and the possible conflict between increasing dependency and other social changes, specifically the changing status and aspirations of women. The article concludes with some tentative remarks about the future of community care.
The Impact of Salient Role Stress on Trajectories of Health in Late Life among Survivors of a Seven-Year Panel Study: Analyses of Individual Growth Curves
Authors: Shaw Benjamin A. , Krause Neal
Published: May 2005

The purpose this study is twofold: 1) to model changes in health over time among older adults; and 2) to assess the degree to which stress arising in salient social roles accounts for individual variation in these changes. Individual growth curve analyses using Hierarchical Linear Modeling (HLM) software were employed with longitudinal data collected from a nationwide sample of 465 older adults between 1992–1999. The data suggest that, throughout the course of the study, the sample as a whole experienced linear deterioration in self-rated health. After accounting for the effects of non-salient role stress and demographic characteristics, variance in health changes was not accounted for significantly by salient role stress in an additive model. However, the inclusion of a multiplicative term showed that as respondent age increased, the association between salient role stress and adverse changes in health strengthened significantly. These results support the idea that the oldest-old may be particularly vulnerable to the effects of stress. This finding has important implications for targeting interventions and should stimulate further study regarding how and why responses to stress change progressively with age.
Attitudes of Cancer Specialists toward Their Patients in Greece
Authors: Manos Nikolas , Christakis John
Published: May 2005

A three-part questionnaire was mailed to Greek cancer specialists practicing in the two largest cities of Greece. Part I addressed the question of telling the truth to the cancer patient, Part II the question of telling the truth to the terminal cancer patient, and Part III investigated the psychological difficulties of the above specialists in the care of their patients.

Most of Greek cancer specialists (73%) choose not to tell the true diagnosis to the cancer patient and an even greater majority (95%) prefer not to inform the terminal cancer patient of his impending death. A considerable number of them, though (41%), favor a change towards telling the cancer patient his true diagnosis. Furthermore, two thirds of them admit to psychological problems in their contact with the cancer patient and subscribe to the need for specific psychiatric training to improve the care of their patients.
The Relationship between the Number of Students per Computer and Educational Outcomes
Authors: Alspaugh John W.
Published: May 2005

The purpose of this study was to determine if there is a relationship between the number of students per computer in schools and traditional educational outcomes. The educational outcomes of four comparable groups of school districts with different numbers of students per computer were compared. The analysis found no statistically significant differences among the mean reading/language arts, mathematics, science, and social studies achievement scores among the four groups of schools. Likewise, there were no differences among the mean attendance and high school dropout rates. This implies that the allocation of class time and resources to educational computing is not associated with a loss in traditional outcome measures while the students are accumulating computer experience and skills.
Death and the Construction of Reality: A Revisit to the Literature from 1960
Authors: Steinzor Bernard
Published: May 2005

The turn into the 1960's has been remarkable for the emergence of many liberation movements including consciousness raising regarding sensibilities toward death. Despite the proliferation of death studies, systematic-cognitive research has hardly advanced beyond pre-1960 work. This review concentrates on the report of observations of pre-adult years, including dying children and parent absence and loss. Most studies do not clearly distinguish eternal death and the question of an after life, from the question of immortality or the longing to be remembered. Images of world building are different from images of nature and the cycle of life.
The United States Commitment to International Family Planning and Population Programs
Authors: Piotrow Phyllis T.
Published: May 2005

The United States Government has moved in a decade and a half from a policy of sharp repudiation of birth control to broad federal support for family planning at home and overseas. Private organizations and members of Congress were influential in urging government agencies to act. Presidents Kennedy, Johnson, and Nixon gave high level support. Throughout the country, the concept that nations and families could help to improve their economic position and the quality of life by avoiding unwanted children was widely accepted. For a number of reasons, Congressional support of family planning is strong even though other economic pressures may reduce foreign aid and domestic health and welfare expenditures. Since family planning is an important element in development programs, successes in this field could encourage continuing U.S. support for overseas assistance in general.
Factors Contributing to Preservice Teachers' Discomfort in a Web-Based Course Structured as an Inquiry
Authors: Spector Barbara S. , Burkett Ruth S. , Steffen Cherry O.
Published: May 2005

This is a report of a qualitative emergent design study of a Science, Technology, Society Interaction (STS) Web-enhanced course. Students' discomfort during the pilot test provided insight to the intellectual scaffolding preservice secondary science teachers needed to optimize their performance when required to develop understanding through open-ended inquiry in a Web environment. Eight factors identified contributed to students' discomfort: computer skills, paradigm shifts, trust, time management, thinking about their own thinking, systematic inquiry, self-assessment, and scientific discourse. These factors suggested developing understanding through inquiry by conducting a self-designed, open-ended, systematic inquiry required autonomous learning involving metacognitive skills and time management skills. To the extent students either came into the course with this scaffolding, or developed it during the course, they were successful in learning about STS and its relationship to science teaching. Changes in the Web site made to accommodate learners' needs as they surfaced were described.
Longitudinal Study of the Effects of Logo Programming on Cognitive Abilities and Achievement
Authors: Clements Douglas H.
Published: May 2005

The Logo computer language was developed to serve as a conceptual framework for teaching problem-solving skills and subject-matter content. As such, its effects may not be immediate and direct, but delayed and diffusive. This study investigated the delayed effects of Logo programming on the cognitive abilities and achievement of primary grade children. Eighteen first grade children were pretested, randomly assigned to Logo computer programming or computer-assisted instruction treatments (3 months duration), and tested on achievement and cognitive abilities eighteen months following the end of the training (i.e., near the beginning of their third grade year). After the tests had been commercially scored, children's responses were analyzed item by item. Based on these analyses, questions were planned and the children were interviewed five months after the administration of the tests. Results indicated that Logo programming affected certain areas of cognitive functioning and achievement; however, the analyses and interviews demonstrated that these effects were not simple or straightforward.
Tentative, Intermediate Criteria for the Selection of Instructional Packages
Authors: Poole Richard L.
Published: May 2005

Although the ultimate criterion for the selection of an instructional package appears to be empirically oriented in the amount of student learning which it engenders, intermediate and more immediate criteria of a judgmental character which could serve as proxies to this ultimate criterion appear non-existent. Consequently, the theme of this article is to identify and illustrate seven criteria which may serve in this intermediate capacity and which could be subsumed by the rubric “potential for student learning.” These criteria are: (1) accuracy, (2) clarity, (3) conductibility-practicality, (4) consistency, (5) propriety, (6) relevancy, and (7) social-sensitivity.
How Knowledge of Extenuating Circumstances Influences Community Reactions toward Suicide Victims and their Bereaved Families
Authors: Range Lillian M. , Martin Stephen K.
Published: May 2005

Since suicide is self-determined, the circumstances of the victim's life may influence people's responses. To assess this possibility, 180 undergraduate volunteers read a fictitious newspaper article about a thirty-five-year-old man who committed suicide following one of eight extenuating circumstances: psychological pain (bankruptcy, incarceration, bereavement, graduate school), physical pain (burns, arthritis), or terminal illness (AIDS, terminal bone cancer). A control group received no information about any extenuating circumstances. As expected, victims of terminal illness and their families were seen in a more favorable light. Notably, reactions were about the same when psychological pain was reported as they were when no information about extenuating circumstances was given. Apparently medical problems were viewed as more acceptable reasons for suicide than were psychological problems.
Cahokia: The Political Capital of the “Ramey” State?
Authors: O'Brien Patricia J.
Published: May 2005

Cahokia, a prehistoric site in the American Midwest, had massive human sacrifice which shows that a small elite had control over the legitimate use of force, probably had political and economic classes, had a hierarchical bureaucracy, and had a settlement system of at least four decision-making levels. As such it was probably the capital of a society organized at a “state” level.
Coping Behavior and Intelligence in the Prediction of Vocational Rehabilitation of Dialysis Patients
Authors: De-Nour Atara Kaplan , Shanan Joel , Garty Ichak
Published: May 2005

As part of an intensive psychiatric and psychological examination before starting hemodialysis, forty-seven patients with terminal renal failure, thirty-one men and sixteen women with an age range from the late teens to the mid fifties, had been administered with WBII and the Shanan Sentence Completion technique. The hypothesis was that coping style would predict adaptation to hemodialysis as assessed by vocational rehabilitation. Intelligence, level of education, and the tendency to perceive sources of conflict in the outer world rather than within oneself, were found predictive of subsequent adaptations for the whole group. On all these variables, men and women showed different patterns of significant correlations between the different aspects of coping and vocational rehabilitation. Subsequent multiple step-wise regression showed women (percentage of explained variance: 75) to be more predictable than men (40%) with different variables contributing differentially to predictability. These findings, interpreted to support the general working hypothesis, are discussed in terms of their implications for treatment.
A Comparison of Three Decision Models for Adapting the Length of Computer-Based Mastery Tests
Authors: Frick Theodore W.
Published: May 2005

Three extant methods of adapting the length of computer-based mastery tests are described and compared: 1) the sequential probability ratio test (SPRT), 2) Bayesian use of the beta distribution, and 3) adaptive mastery testing based on item response theory (IRT). The utility of the SPRT has been empirically demonstrated by Frick [1]. Research has also demonstrated the effectiveness of use of the beta function in the Minnesota Adaptive Instructional System by Tennyson et al. [2]. Considerably more empirical research has been conducted on IRT-based approaches [3]. No empirical studies were found in which these three approaches have been directly compared. As a first step, computer simulations were undertaken to compare the accuracy and efficiency of these approaches in making mastery and nonmastery decisions. Results indicated that the IRT-based approach was more accurate when simulated examinee ability levels were clustered near the cut-off. On the other hand, when ability levels were more widely dispersed—as would likely be the case in pre- and posttest situations in mastery learning—all three approaches were comparably accurate. While the IRT approach tended to be the most efficient, it is the least practical to implement in typical classroom testing situations.
A Functional Classification for Artifacts from 19th and 20th Century Historical Sites
Authors: Sprague Roderick
Published: May 2005

Artifact classification systems derived primarily from prehistoric archaeology are generally based on the material of manufacture. Such classification systems not only are not suited to historical archaeology, but actually retard the analysis and result in reports that are difficult to use for comparative purposes. The use of a classification based on the artifact function is suggested and several previous schemes are evaluated. The classification system advocated here comes closer than previous attempts to the goal of mutually exclusive categories and comprehensive coverage of artifacts from 19th and 20th century sites. Examples are presented for each of the categories in the system.
Medically and Surgically Treated Coronary Patients in Cardiovascular Rehabilitation: A Comparative Study
Authors: Soloff Paul H.
Published: May 2005

Mood and physical performance were assessed in medically and surgically treated patients with coronary artery disease referred to a cardiovascular rehabilitation program early in convalescence. Surgically treated patients reported less mood disturbance prior to training and demonstrated greater gains in exercise tolerance. Medically managed patients had more mood disturbance prior to training and greater mood improvement in the six week rehabilitation program. Improvements in mood were independent of improvement in exercise tolerance. Group differences in mood state could not be attributed to the use of defensive denial, time from discharge, severity of coronary disease, or age of patient. The psychological and physical impact of bypass surgery contributes to the mood and physical performance of postoperative patients.
Concept Learning in Preschool Children: Effects of a Short-Term Logo Experience
Authors: Degelman Douglas , Free John U. , Scarlato Michelle , Blackburn Janice M. , Golden Thomas
Published: May 2005

The ability of kindergarten children to solve rule-learning problems following five weeks of LOGO computer experience was compared with that of children not having such experience. Fifteen children were randomly assigned either to a LOGO experience condition or a wait-list control condition. A single-keystroke LOGO was gradually introduced to the children in the LOGO condition. All children were subsequently tested on affirmative and conjunctive rule-learning tasks. Children receiving LOGO instruction had a significantly higher proportion of correct responses on two problem-solving tasks than children in the control condition ( p < .05). Frequencies of subjects correctly solving each problem revealed no statistically significant differences between conditions ( p's > .10). The kindergarten children adapted easily to the use of the computer and the single-keystroke LOGO. Suggestions for future research are presented.
Geoarchaeology of the Kilmer Site: A Paleoindian Habitation in the Appalachian Uplands
Authors: Tankersley Kenneth B. , Holland John D. , Kilmer Royce L.
Published: May 2005

Kilmer is a multicomponent Paleoindian site located in the Appalachian Uplands of New York State. It is situated on high and low late Pleistocene outwash terraces (T2 and T1). In mountainous areas, these landforms are susceptible to weathering and erosional processes. The paucity of sites in the Appalachian Uplands is likely the result of geologically active landscapes. The occurrence of Paleoindian sites in the mountainous terrain of eastern North America suggests economic diversification, a cultural response to unpredictable food resources near the end of the Pleistocene.
A Behavior Analysis of the Promotion of Oral Rehydration Therapy (ORT) in Guatemala
Authors: Elder John P. , Pradesaba Maria Eugenia , Pineda Olga Polanco , Enge Kjell I. , Graeff Judith A. , Urban Diane , Romero Jose
Published: May 2005

The present report presents the results and preliminary recommendations of a behavior analysis study of an oral rehydration therapy (ORT) promotion in four localities in San Marcos, Guatemala. In this study, we used behavioral observation techniques to look at one-to-one communication and health education efforts in health clinics as well as to evaluate the effectiveness of these health education efforts by observing mothers' behavioral skills in their own homes. Subsequently, we also observed canalización (outreach) strategies to see whether we could learn more from these health workers' activities, and conducted “behavioral focus group” research with teams of health workers to determine how best to promote effective health education activities to other health workers. Results of our study indicate that health workers already spent a substantial amount of time doing health education and primary prevention, and were fairly effective at doing so. Their communication, however, tended to be relatively unilateral and failed to involve some of the more progressive aspects of behavioral skills training.
An Instructional Web Site for Student Research on the Internet
Authors: Bushallow-Wilbur Lara , Meacham Jack
Published: May 2005

A faculty member and a librarian describe their collaboration in constructing an instructional Web site that is unique in providing both a variety of links to course-relevant Internet resources as well as links to resources on how to conduct successful research on the Internet. The Web site and the procedures for instructing students and involving them in Internet research are briefly described. The results of an evaluation by seventy-three students of their experiences in learning about the Web site and conducting Internet research are summarized, followed by a discussion of instructional changes that were introduced as a result of the evaluation. Two principles contributed to the success of the project: first, attend both to the informational content of the Internet and to the research skills that students will need; and second, build evaluation into the project from the beginning so that problems can be discovered and improvements can be quickly implemented.
Prevalence of Somatic Indicators of Distress in Diabetes Patients: Comparison to Psychiatric Patients and Community Nonpatients
Authors: Aikens James E.
Published: May 2005

Objective:

Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients.

Method:

The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms.

Results:

Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients.

Conclusions:

Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.
Dreams as Problem Solving: A Method of Study — Part II: The Oral Defense Dream
Authors: Baylor George W. , Deslauriers Daniel
Published: May 2005

This article (Part II) presents the detailed analysis of one dream in order to illustrate the Dream Understanding Exercise (DUE), a method of study presented in Part I. In the five-step method the dream and associations are recorded, followed by an analysis of content; an identification and expansion of the underlying script; an investigation of the dream characters' problem solving; and a look at problem solving at the organismic level. The method is evaluated and discussed in terms of the problem-solving function of dreams.
Drug Use and Policy in Poland in the 1980S
Authors: Watson Margaret
Published: May 2005

In this article, the author describes the recent changes in patterns of drug use in Poland in the light of available data. A much higher incidence of use has been seen in the 1980s, and there are indications that this can be accounted for by increased use among young people from the manual working class. Social deprivation may play a part in the etiology of the 1980s “epidemic,” and evidence is put forward in support of this view. Both patterns of use and the policies that have been introduced to deal with them are viewed in terms of the political, economic, and social context of post-Solidarity perestroika.
Multiple Uses of Mental Imagery by Professional Modern Dancers
Authors: Hanrahan Christine , Vergeer Ineke
Published: May 2005

The present qualitative study has revealed a range of mental imagery strategies which professional modern dancers used for different purposes during their training, during the creation and rehearsal of a choreography, as well as prior to, during, and after a performance. The dancers' use of imagery tended to be multi-modal, multi-dimensional, seeking to integrate mind, body, and spirit not only in their dance activities but also in their lifestyle. Many of these personalized images had common characteristics and similar effects, which made possible their organization into eight imagery categories: inspiration, atmospheric, specific movement, metaphysical, emptying out, filling up, projection, and imagery rehearsal. Suggestions are made for the inclusion of similar types of images into the dance classroom and into other movement contexts.
Conformity, Peer Pressure, and Adolescent Receptivity to Treatment for Substance Abuse: A Research Note
Authors: Raniseski Jean M. , Sigelman Carol K.
Published: May 2005

To explore the possibility that peer influences not only contribute to adolescent substance abuse but shape feelings about being in treatment for substance abuse, forty adolescent inpatients were surveyed. Misconduct, including substance abuse, was predicted best by perceived peer pressure toward misconduct, low opinions of the value of treatment by disposition to conform to antisocial peers, and sense of stigma associated with being treated by perceived peer pressure toward conformity. Concerns over peer acceptance may be one basis for resistance to substance abuse treatment.
Rationalization of Health Services: Political and Social Assumptions
Authors: Battistella R. M.
Published: May 2005

Confronted with deep—seated problems of spiralling health care costs, the United States is actively considering rationalization as a means for improving efficiency and effectiveness in the operation of health services. The application of managerial and organizational principles characteristic of large—scale business and industry, i.e. quantification of decision—making, consolidation of production, money rewards for cost savings, and economies of scale, is increasingly seen as the key to successful control of the health economy. The drive for rationalization is assessed in terms of its probable impact on the following issues: (a) the scope of health—field boundaries and program responsibilities; (b) the influence of health professionals in policy and planning; (c) the role of altruistic ideals as compared to market values in conditioning provider behavior; and (d) the relationship of health services to larger social and philosophic aims. Because of the tendency toward convergence in the problems governments face in the financing and delivery of health care, it is suggested that developments in the United States may be relevant to other countries in similarly advanced stages of economic growth.
Hear No Secrets, See No Secrets, Speak No Secrets: Secrecy in the Canadian Drug Approval System
Authors: Lexchin Joel
Published: May 2005

Systemic bias in the form of a lack of transparency in the operation of the Canadian drug regulatory agency, the Health Protection Branch, seriously undermines our knowledge of how well the agency is functioning. In recent years this secrecy has combined with deregulation, downsizing, and privatization to compromise safety and could lead to deleterious consequences in the way that drugs are being used. Finally, these forces are threatening the ability of the Health Protection Branch to set priorities for the overall system of drug regulation. This article provides concrete examples of each of these problems. The author then discusses why secrecy is so firmly entrenched in the regulatory approval system, and offers some suggestions on how to tackle this issue.
Coherent Deformation in Scientific and Technical Writing
Authors: Minor Dennis E.
Published: May 2005

The fact that some ideas seem to be inexpressible directly in language and that the induction-hypothesis sequence in scientific thinking does not completely account for new ideas may be due to the peculiar abilities of the right and left hemispheres of the brain. Study of the mind and philosophers of perception suggest that perception and imagination or fact and intuition are combined in language, which then takes on new meaning through “coherent deformation” and leads to new thinking. This new thinking then can best be replicated in the reader through nondirect means such as metaphors and visual materials.
The Paradoxical Impact of Health Care Restructuring in Canada on Nursing as a Profession
Authors: Heitlinger Alena
Published: May 2005

This article draws on the concept of “countervailing powers” to explore some of the contradictory effects of Canadian health care restructuring on nursing. The main focus is on key institutional powers in the nursing field, the major individual and collective strategies nurses have adopted in response to restructuring, and the ways in which the interaction between global and national market forces and the aggregate responses of nurses has created a severe shortage of nurses. The global shortage has led to a global competition for nurses' labor. This, along with government budget surpluses, has increased nurses' bargaining power, forcing governments and hospital managers to reverse nursing spending cuts; to offer more secure professional jobs, as opposed to casual work; to engage in aggressive, bonuses-laden recruitment of nurses, both within Canada and abroad; and, more generally, to rethink some of their restructuring strategies. However, since the bargaining power of nurses is largely market dependent and, as such, highly variable, there does not seem to be much potential for a sustained increase in the institutionalized power of the nursing profession.
A Community Trial Involving Religious Leaders to Improve Water Preparation Hygiene as Part of Diarrheal Disease Prevention in South Kalimantan, Indonesia
Authors: Prihartono Nurhayati , Damayanti Rita , Adisasmita Asri , Tarigan Lukman
Published: May 2005

In an earlier study we found that there is a habit of mixing boiled and unboiled water to prepare drinks, particularly cold tea, in South Kalimantan, Indonesia. Ulamas (Islamic religious leaders) have a very influential role in that community. This study was designed to implement and evaluate a health educational campaign using local ulamas. Three study communities were selected. The first intervention area received education through Al Quran (Koranic) reading clubs. In the second area the intervention was implemented by home visits as well as by Al Quran reading clubs, since participation in Al Quran reading clubs was low. The third area served as the control. A message and intervention development was designed by the ulamas and the investigators using sarasehan ( ulamas' meeting). A positive impact on knowledge and practices of drinking water preparation was observed in the first area where the community members were active participants in the Al Quran reading club. Involving ulamas in a health education campaign was indicated to be effective in changing knowledge and practices.
Pedagogically Sound Use of Microcomputers in Classroom Instruction
Authors: Winkler John D. , Shavelson Richard J. , Stasz Cathleen , Robyn Abby E. , Feibel Werner
Published: May 2005

This article discusses criteria for evaluating whether classroom instruction using microcomputers is “pedagogically sound.” We argue that the pedagogical soundness of classroom microcomputer use is characterized by teachers' decisions for integrating microcomputers into their ongoing instruction. Based on literature describing teachers' instructional decision-making, we define five domains in which teachers may make decisions regarding classroom microcomputer use. They are: goals sought for students, curricula coordinated by microcomputers, learning activities surrounding microcomputer use, pedagogical implications of integrating microcomputers, and methods for obtaining feedback regarding microcomputer-based instruction. Implications for how studies of classroom microcomputer use might be conducted are discussed.
The Effects of the Balint Group on its Members and Leader
Authors: Knoepfel Hans-Konrad
Published: May 2005

Balint's work promotes better psychological and medical treatment of many so-called “problem patients.” With understanding, these patients often lose the characteristic of being a heavy burden and even become interesting and gratifying. Time invested at the beginning phase of treatment often brings considerable saving of time over extended periods. The doctor's need for intensive involvement diminishes and psychological emergencies become less frequent.

Balint helped to make these goals possible by teaching psychoanalytic principles in a simple way, talking in clear, comprehensible language and creating for physicians the possibility for emotional experience and growth through group work. Such experience is indispensable for the training of the family doctor.

This paper summarizes essential elements of the group work, in which the leader profits as well as the family doctor. The leader has to learn to formulate clinical experience in clear, non-technical language which describes how patients are treated in the practice of hospital and office medicine. The group experience, furthermore, helps the physician to develop his capacity for empathy by better understanding himself.
Thanatologists View Death: A 15-Year Perspective
Authors: Feifel Herman , Strack Stephen
Published: May 2005

This study examined the death attitudes of a number of prominent thanatologists over a 15-year span. In 1973, 40 (30 men, 10 women) invited participants at a conference on death and dying were surveyed concerning their attitudes toward dying and death using Feifel's Death Attitudes Questionnaire, a Death Semantic Differential Test, and a Death Metaphors Test. Fifteen years later, 25 (62.5 percent) of these individuals again gave their responses to the three measures. Analyses were limited to basic group comparisons because the original raw data were unavailable. Respondents were primarily behavioral scientists (64 percent), but sizeable minorities were from medicine/nursing (24 percent) and religion/philosophy (12 percent). They were about equally divided in the religious (45 percent) versus non-religious (55 percent) categories, and rated themselves as being fairly satisfied with themselves and life in general. Almost two-thirds reported some fear of death (64 percent at both time points), and only 20 percent indicated that the idea of their own death was “easy to accept.” Most (60–64 percent) reported a fear of the personal consequences of death, including pain and an inability to have experiences or complete projects, with the next most pervasive fear (36–40 percent) being the consequences to loved ones, including pain, loss, and financial difficulties. Concerning what occurs after death, about half of the respondents (48–52 percent) indicated that death is the end of existence, another 24–30 percent were uncertain and 16–17 percent believed in the continued existence of a soul. Death attitudes were remarkably stable over the 15-year interval. The major difference found was a lessening of death fear from 1973 to 1988 ( p < .002), that subjects attributed primarily to their ongoing conversations about death and dying (56 percent), and the deaths of family and friends (32 percent).
What is the Afterlife Like? Undergraduate Beliefs about the Afterlife
Authors: Lester David , Aldridge Megan , Aspenberg Christine , Boyle Kathleen , Radsniak Pam , Waldron Chris
Published: May 2005

A study of American undergraduates indicated that the beliefs about the nature of life after death were quite complicated. A 41-item questionnaire produced 12 independent groups of beliefs. Belief in an internal locus of control and that one's life is owned by God were associated with a more positive view of the afterlife, as was being Roman Catholic rather than Protestant. The most common beliefs were that one is reunited with family and friends, that the afterlife is comforting, that there is Heaven and that the transition is peaceful, all believed by more than 90 percent of the students.
How to Define Quality in Engineering Manuscripts
Authors: Michaelson Herbert B.
Published: May 2005

All of the elements of quality contribute separately to the overall merit of an engineering manuscript. Inadequate content cannot masquerade under the cloak of fine writing. Nor can outmoded engineering concepts hide behind a facade of logical structure and orderly presentation of ideas. Literary style must be combined with effective organization, and results need to be fortified with the kind of balanced interpretation that identifies a manuscript of quality.
Costs of Occupational Injury and Illness within the Health Services Sector
Authors: Waehrer Geetha , Leigh J. Paul , Miller Ted R.
Published: May 2005

Knowledge of costs is essential to allocate medical resources efficiently. The authors' goal was to estimate and compare costs across occupations, industries, gender, race, and types of nonfatal injuries and illnesses. This is an incidence study of nationwide data, 1993. Nonfatal incidence data were drawn from the Bureau of Labor Statistics Annual Survey. Medical costs were from the Detailed Claims Information data set. Productivity (wage) costs were calculated using the Current Population Survey. Pain and suffering costs were estimated from data on jury verdicts. Injuries and illnesses to nursing aides and orderlies cost $2,200 million; costs were $900 million for registered nurses and $40 million for licensed practical nurses. The ranking of health services industries in terms of costs was: hospitals (52 percent of all costs), nursing care facilities (38 percent), home care services (6 percent), physicians' offices (4 percent), and laboratories (<1 percent). Types of injuries (sprains, strains, fractures) were similar across occupations and industries, but types of illness (carpal tunnel syndrome, respiratory diseases) varied. The most costly injured body parts were: back, shoulder, knee, wrist, and neck. Injuries and illnesses comprised roughly 90 percent and 10 percent, respectively, of total costs. The hospital industry was the third most expensive of 313 U.S. industries. Costs of occupational injury and illness in the health services industry were high and varied across occupation, industry, disease, race, and gender.
Creating, Testing, and Evaluating a Communication Experiment for Community College Students
Authors: Scofield Richard J.
Published: May 2005

Because innovation without evaluation is often fruitless, the creator of a communication-oriented community college freshman English course converted a segment of this course into an individualized program and solicited detailed student appraisals. The sequence begins with dictionary study, reviews the principles of subordination, continues with studies in semantics and communication, and ends with practice in improving skills in writing letters and reports. The specific unit, converted into an individualized learning package, uses film and tape and enables the student to evaluate his own communication skills and teaches him how to write a concrete communication objective. Students' evaluations conclude the article and explicit student endorsements and criticisms are quoted.
A People Resource Approach to Humanizing Computer Based Management Systems
Authors: Pogrow Stanley
Published: May 2005

This article describes the limitations inherent in the traditional modes of establishing computerized information systems in school districts. Characteristics of more flexible, humanistic systems are described, and techniques for taking advantage of new technology to establish such systems are discussed. The changing role of non-technicians with respect to assuming responsibility for direct communication with computers is emphasized.
Physical Self-Concept Changes in a Mildly, Facially Disfigured Neurofibromatosis Patient following Communication Skill Training
Authors: Roback Howard B. , Kirshner Howard , Roback Ellen
Published: May 2005

The authors discuss the case of a mildly disfigured patient with Neurofibromatosis from the perspectives of his distorted body image, need to attribute problems in his social and work lives to unrealistic assessment of his disfigurement, changes in his self-concept following communication training, and the need for physicians and others working with these persons to treat their emotional, as well as physical, pain.
The Business of Good Doctoring or Doctoring as Good Business: Reflections on Freidson's View of the Medical Game
Authors: McKinlay John B.
Published: May 2005

This paper reflects on selected aspects of the work of Eliot Freidson and is based mainly on his three latest books — Profession of Medicine, Professional Dominance, and Doctoring Together—in which he draws together his various contributions and elaborates a substantial argument concerning the dominant position of physicians within the institution of medicine in particular and, more generally, their unique position within the broader society. Freidson's work is considered from the perspective of political economy. The paper discusses, on a broad level, some of the assumptions underlying his analysis, the adequacy of his theoretical orientation and level of analysis for understanding the House of Medicine in the United States, and some implications that follow.