bluuebunny/crossref_metadata_2025 huggingface dataset:
Drugs in the Spanish Health System
Authors: Laporte Joan-Ramon , Porta Miquel , Capellà Dolors , Arnau Josep Maria
Published: May 2005

This paper presents data on drug consumption in Spain, analyzed from a cultural as well as from a medical point of view. The overuse of medicines is an economic rather than a pharmaceutical problem, and the main characteristic of drug use in Spain seems to be the misuse of pharmacologic therapeutic strategies. Four factors which influence the quantity and quality of drug consumption are identified and analyzed: 1) the structure of the primary health care system, 2) general requirements for marketing drugs and the characteristics of pharmaceutical supply, 3) information about drugs used by health professionals, and 4) development and activities—pre-graduate teaching and continuing education—in the field of clinical pharmacology. Some recent activities in this area are also presented. These are intended as a contribution to the development of clinical pharmacology with the aim of turning benefit-risk ratios to the side of the benefit, through the promotion of a more rational drug therapy.
Conjugal Bereavement and Well-Being of Elderly Men and Women: A Preliminary Study
Authors: Nieboer Anna P. , Lindenberg Siegwart M. , Ormel Johan
Published: May 2005

Considerable variation in the effects of the loss of the spouse have been reported, and there is lack of agreement regarding the effects of gender and bereavement on well-being. The objective of this article is to examine time-differences in the consequences of bereavement for men and women. Cross-sectional data are used on 4642 married or widowed late mid-life and elderly people. Analyses show that bereaved participants score significantly lower on well-being, and a clear gender-effect is found in connection with the time period of bereavement. Men score considerably lower than women when they are up to two years bereaved, but not when they are bereaved longer than two years. Hence, analyses of variance revealed an interaction effect for gender * time period. In addition, while the largest part of the variance in well-being can be explained by different means of achieving well-being, the effects of marital status, gender, and adjustment to widowhood over time do not disappear completely.
Isolating the Impact of Psychiatric Consultations in the General Hospital: Psychiatric Comorbidities and Nursing Intensity
Authors: Lyons John S. , Scherubel Janet C. , Anderson Rachel L. , Swartz James A.
Published: May 2005

The amount of nursing services represents a substantial portion of the total cost of hospital treatment of medical/surgical patients. Patients receiving psychiatric consultations were compared to matched patients (DRG and LOS) who did not receive psychiatric services on the intensity of their nursing service needs. These two groups were then compared on the measure of nursing intensity before and after the timing of the consultation. Those who received a consultation had significantly lower intensity scores prior to seeing the psychiatrist Although patients receiving psychiatric consultations did not show a significantly greater reduction in nursing acuity relative to their baseline levels than did the matched control patients, the amount of time the psychiatrist spent with consultation patients was positively related with the change in nursing intensity post-consultation.
Musical Aesthetics and Creativity in Beethoven: A Computer Analysis of 105 Compositions
Authors: Simonton Dean Keith
Published: May 2005

A fundamental task in empirical aesthetics is to determine why some artistic creations earn the label “masterpiece” whereas others slip into oblivion. Computer content analyses can help us achieve this goal, first, by isolating connections between the differential aesthetic success of diverse works and their content attributes, and, second, by identifying the compositional, biographical, and historical correlates of those content analytical predictors. After reviewing the key findings with respect to the thousands of musical pieces defining the classical repertoire, this investigation strategy is applied to 105 compositions (containing 593 themes) by Beethoven. Two distinct measures of artistic impact, compositional popularity and aesthetic significance, were shown to be associated—often in a curvilinear fashion—with four content characteristics: melodic originality and variation and metric originality and variation. Some of these attributes are linked to such circumstances as the work's key, the instrumentation, and the number of movements, Beethoven's age and concurrent level of productivity, stress, and health, and the presence of international war in Europe. Hence, an objective, computer analysis can enhance our understanding of the aesthetic and creative processes behind a single creator's artistic reputation.
Adjustment to Loss among Adolescents
Authors: Servaty Heather L. , Hayslip Bert
Published: May 2005

The purpose of the present investigation was to explore the adjustment of adolescents who had experienced the death of a parent relative to those who had experienced parental divorce. A 3 (type of loss: parental death, parental divorce, and control) × 3 (age: early, middle, late) × 2 (gender) Multivariate analysis of covariance with socioeconomic status and social desirability as covariates was performed on the subscales of the Hopkins Symptom Checklist (HSCL). Main effects for type of loss indicated that the parental death and divorce groups, although not differing from each other, scored significantly higher than the control group on the HSCL subscales of Somatization, Obsessive-Compulsive, and Depression. In contrast, only the parental death group scored significantly higher on the HSCL Interpersonal Sensitivity subscale which measures uneasiness and negative expectations regarding personal communications as well as interpersonal inadequacy and inferiority. These results indicate that parental death and divorce losses impair the intrapersonal adjustment of adolescents. In addition, findings suggest that parental death is unique in that it disturbs perceptions of interpersonal relationships, a fact which may result in isolation and rob adolescents of needed support at a time when relationships with others (e.g., peers, parents, teachers) are critical to adjustment, well-being, and identity development.
Imagined Interaction, Conversational Sensitivity and Communication Competence
Authors: Honeycutt James M. , Zagacki Kenneth S. , Edwards Renee
Published: May 2005

This research explores the relationship between imagined interaction dimensions [1], conversational sensitivity dimensions [2], and communication competence [3]. Results of a study reveal features of imagined interaction predicting both conversational sensitivity and self-reported communication competence. Mental experiences of communication (i.e., imagined interaction) are thought to activate sensitivity to conversations and to provide knowledge structures for competent interaction. A path analysis revealed the mediating role of overall conversational sensitivity leading to communication competence.
They Don't Care: Unemployed Physicians in the Nordic Countries
Authors: Riska Elianne
Published: May 2005

Recent sociological research on the medical profession has been concerned with the profession's power and autonomy. So far, little research has focused on the total loss of the market value of a large number of physicians, that is, on the increasing rate of unemployment among physicians in some European countries. The author describes the extent of physician oversupply in the Nordic countries and examines the reasons for and implications of the growing unemployment among physicians.
Marijuana and Ethanol: Effects on Sleep
Authors: Zarcone Vincent P.
Published: May 2005

Both marijuana and alcohol have effects on sleep which can be clinically important if either drug is used heavily. A number of polygraphic studies of both drugs' effect on sleep demonstrate that both are rapid eye movement (REM) sleep suppressors and that both effect the REM sleep deprivation response for days after the acute effects have ceased. Marijuana also increases slow wave sleep compared to alcohol which decreases it. The studies reviewed indicate that marijuana, like alcohol, has persisting effects on neuronal activity and presumably on its underlying neurochemical regulation. Also, the studies suggest that caution should be employed in advising the public about the use of marijuana.
Evaluating the Effectiveness of Student Assistance Programs in Pennsylvania
Authors: Fertman Carl I. , Fichter Cele , Schlesinger Jo , Tarasevich Susan , Wald Holly , Zhang Xiaoyan
Published: May 2005

This article presents data from an evaluation of the Pennsylvania Student Assistance Program (SAP). Focusing on both program process and effectiveness, the evaluation was conducted to determine the overall efficacy of SAPs in Pennsylvania and, more specifically, how SAP is currently being implemented. Five data collection strategies were employed: statewide surveys of SAP team members and county administrators, focus groups, site visits, and the Pennsylvania Department of Education SAP Database. A total of 1204 individual team members from 154 school buildings completed the team member survey. Fifty-three county administrators completed the county administrator survey. Focus groups were comprised of SAP coordinators, school board personnel and community agency staff. Site visits were conducted at five schools. The findings of the evaluation indicate that SAP in Pennsylvania is being implemented as designed. Recommended is the development of benchmarks and indicators that focus on the best SAP practices and the extent to which various indicators of the effectiveness of SAP are occurring at appropriate levels.
Medical Interests and the Public Interest: A Comparison of West Germany and the United States
Authors: Altenstetter Christa
Published: May 2005

In Germany, the influence of providers of medical services has long been subordinated to that of government and public policy making bodies. Public involvement in the health field is the result of a social commitment to a right to health care made a century ago and most widely manifests itself today in national health insurance for about 87 per cent of the population. Other restraints on the providers are the influence of trade unions, business management, political parties, and officials of the federal and state governments. Due to a built-in concern for the consumer, and its more integrated and coordinated organizational structure, the German health system attempts to benefit the recipient at least as well as the provider of health services.

Until recently, the health scene in the United States has been characterized by a lack of positive government action. While this is consistent with the United States' traditional concern for pluralism and individualism, the result has been to vest a predominant policy making role to the private enterprise providers of medical services. The medical community in the U.S. has had a long and successful political career through its lobbying activities. Entry to the medical profession, physical facilities, and standards have all been controlled by the physicians themselves. Current trends and concerns for the consumer, however, have both identified and challenged deficiencies in performance under the influence of self-regulating providers.
Delusional Parasitosis: A Clinical Profile
Authors: Bhatia Manjeet S. , Jagawat Tushar , Choudhary Sandeep
Published: May 2005

Objective:

Delusional parasitosis is a form of monohypochondriacal psychosis, a condition sometimes encountered in psychiatric or primary care practice. The outcome of this condition is not well known.

Method:

In the present study, a series of fifty-two consecutive cases of delusional parasitosis is reported.

Results:

A majority of cases (92%) had insidious onset. The duration of symptoms in all but two cases was six months or more. Twenty-six cases presented with a delusion of infestation by insects over the body and twenty-three cases with a delusion of insects crawling over the scalp. Three cases had associated diabetes mellitus, five cases had leprosy, five cases dementia, four cases had depression, and three cases presented with trichotillomania. Pimozide was used in forty-six cases, amitriptyline and fluoxetine in three cases each. Twenty-eight cases (54%) showed complete remission while receiving pharmacotherapy, eighteen cases showed partial improvement, and six cases did not respond to treatment.

Conclusion:

Further studies are warranted to study the treatment and outcome of this important psychiatric disorder.
Profile of Medical Education in Latin America
Authors: García J. C.
Published: May 2005

Preliminary results of a study on medical education in Latin America carried out by the Department of Human Resources Development of the Pan American Health Organization are given in this article. Each of the Latin American schools of medicine existing at the end of 1967 and at the beginning of 1968 was visited by a researcher for approximately seven days. During this period specially prepared questionnaires were completed.

An analysis of the data reveals the presence of three types of imbalances: (1) imbalance between the system of secondary education and that of medical education, (2) internal imbalance between the system of higher education and medical education, and (3) imbalance between the system of health services and that of medical education.

The study of the data compiled may serve as a basis for the proposal of activities leading to harmonious development of the health manpower sector.
A Personal Construct Approach to the Conjugally Bereaved Woman
Authors: Woodfield Robert L. , Viney Linda L.
Published: May 2005

Kelly's theory of personal constructs has been applied to generate an explanation of the normal processes of grief and mourning, using widowhood as an example. The psychological states characteristic of widowhood–shock and numbness, stress, anger, anxiety, guilt, sadness, despair, hostility, idealization, depression, and psychological reorganization–are viewed as manifestations of changes in parts of the widow's personal construct system. These changes involve the processes of personal construct dislocation and adaptation. Dislocation refers to the real or apparent failure of the widow's construct system to embrace the new events associated with her husband's death. Adaptation involves two processes, assimilation and accommodation. This proposal of concurrent processes of personal construct dislocation and adaptation differs from the phase-oriented approaches to bereavement. It also encourages the widow's active coping with her bereavement reaction.
A New Look at Infinitives in Business and Technical Writing
Authors: Myers Marshall
Published: May 2005

This article begins by arguing that the infinitive phrase has not been taken seriously in writing because writers have been too concerned with Bishop Robert Lowth's proscription against the split infinitive. However, careful examination of three types of technical prose (instructions, annual reports, and “junk mail”) reveals that more than one sentence in four contains an infinitive phrase. The article then argues that two linguistic theories do not adequately explain the overwhelming presence of infinitives in the three types of prose. The reason for the presence of infinitives seems to be that they fulfill several rhetorical purposes, including vigor, symmetry, emphasis, variety, economy, and depersonalization. Implications for writing and teaching are also discussed.
The Impact of Public Health Programs on Economic Development
Authors: Kühner A.
Published: May 2005

This paper is based on an attempt to describe the economic effects of a health program and to measure these effects. Multiple and complex factors make it difficult to determine the economic value of health investments. This problem of measurement may be solved by considering that any improvement of health means an increase and any deterioration of health indicates a decrease in the working capacities of the labor force. This paper suggests that death and disease cause losses of working time and gross domestic product (GDP). The example presented relates to malaria and to the effects of the malaria eradication program in Thailand. For the computation of economic losses due to malaria mortality and morbidity, a model was constructed in which the main variables are combined. The computations show the GDP lost year by year by the agricultural laborers who die or are sick as a result of malaria. The losses of GDP are calculated over a period of 12 years. Their downward trend is attributed to the impact (benefits) of the malaria eradication program. A separate series of computations (Table 2) indicates the economic losses of GDP that would be expected in the absence of a malaria eradication program.
Psychosocial and Economic Study of Families with β Thalassemic Children in Northern Jordan
Authors: Sadiq May F. G. , Rimawi Hala S. , Haddad Linda G.
Published: May 2005

Some aspects of β thalassemia major in Jordan were defined. The study included interviews with 77 out of 81 families with multi-transfused β thalassemia children. The interviewed families had a total of 107 affected children. In this study, we assessed the knowledge and attitudes of the affected families toward family planning, the complications of the disease, and the screening of the heterozygote condition before marriage. The majority of these families were properly informed about the disease at the time of the interview but 75 percent of them had not heard about it before having their first affected child. The immense national cost of medical care and the tremendous psychosocial burdens on the patients and their families indicate the urgent need for clinical promotion through patient educational programs and counseling for these families, and justify the establishment of systematic programs for the prevention of β thalassemia in Jordan.
Persuasive Techniques Used in Fundraising Messages
Authors: Spears Lee A.
Published: May 2005

Based on an analysis of 63 fundraising packages representing 46 nonprofit organizations, as well as research in trade journals and other secondary sources, this study discusses a variety of persuasive techniques used in fundraising messages to accomplish their missions. The fundraising package consists of the carrier envelope, the fundraising letter, the reply form, the reply envelope, and optional enclosures such as brochures, small gifts for the reader, and surveys to complete. These parts work together to perform the following tasks: 1) persuade recipients to open the envelope and read the letter; 2) convince readers a serious but not unsolvable problem exists; 3) make readers want to help solve the problem; 4) convince readers they can help by giving to the appealing organization; 5) tell readers what the organization needs them to do; and 6) make it easy to comply.
Narragansett Basin Argillite: Lithology, Chronology, and Prehistoric Tool Manufacture
Authors: Strauss Alan E.
Published: May 2005

This article examines the use of one low-grade raw material, Narragansett Basin argillite, by prehistoric peoples in southeastern New England. Petrographic sections analyzed by Dr. Dan Murray (Geologist, University of Rhode Island) have provided a detailed account of the lithology of this material. Rock formation processes and lithic sources are also discussed. Artifact analysis has provided data pertaining to the prehistoric periods when Narragansett Basin argillite was most often used by prehistoric populations in Rhode Island and southeastern Massachusetts. An examination of tool manufacturing techniques has brought to light striking similarities between argillite and quartz Small Stemmed points further supporting the hypothesis of an in situ development of the Small Stemmed Point tradition in New England.
Six Keys to Better Technical Writing
Authors: Brett Carlton E.
Published: May 2005

Six ideas for improving technical writing are presented, with illustrative material. Briefly they are: (1) arrangement, attention to logical sequence of ideas; (2) perspicuity, the removal of temptations to interpretation; (3) placement, where the words go for maximum intelligibility; (4) fortuity, the avoidance of pitfalls in writing, particularly accidental humor; (5) economy, the control of repetition and avoidance of the obvious; and (6) transition, the effect of proper connections among ideas how to get from here to there.
Convergent Validity, Situational Stability and Meaningfulness of the Threat Index
Authors: Neimeyer Robert A. , Dingemans Peter M. A. J. , Epting Franz R.
Published: May 2005

A pair of related experiments examined the psychometric properties on the Threat Index (TI), a theoretically based scale for the assessment of threat of death. An extremity scoring revealed that both structured interview and paper-and-pencil versions of the TI were more meaningful to respondents than was a similar instrument utilizing semantic differential dimensions. The TI displayed generally low convergence with Lester's Fear of Death Scale, Tempter's Death Anxiety Scale, and the State-Trait Anxiety Inventory. Although the TI demonstrated some capacity to discriminate groups of respondents on the basis of personal characteristics (e.g., religious affiliation), scores on the instrument did not increase as a function of an anxiety-producing experimental manipulation. The high reliability of the TI suggested its functioning as an index of stable conceptual orientation toward death.
The Politics of Employment-Based Insurance in the United States
Authors: Staples Clifford L.
Published: May 2005

Analyses of the corporatization of U.S. health care typically focus on the political struggle between corporations and traditional health care providers, e.g., physicians. A neglected area of study is the struggle between corporations and their employees over the employment-based health insurance system. Yet, since this system is currently the primary mechanism for financing health care in the United States, an analysis of its historical development is critical to any understanding of the corporatization of U.S. health care. It is argued here that the employment-based health insurance system was a part of a political compromise between capital and labor that emerged after World War II. In exchange for control over production and increased worker productivity, corporations agreed to provide workers with steady wage increases and an expanded system of fringe benefits, or “corporate welfare.” But, by the late 1970s, rising health care costs created a corporate health care financing crisis that has prompted corporations to cut back employee health insurance coverage. The relative inability of workers to resist such cutbacks reveals the extent to which, by linking health care to wage labor, the “corporate welfare” system has made the U.S. working class more vulnerable to corporate power.
A Randomised Comparison of Two Forms of a Brief, Group, Psychoeducational Program for Cancer Patients: Weekly Sessions versus a “Weekend Intensive”
Authors: Cunningham Alastair J. , Edmonds Claire V. I. , Jenkins Gwen , Lockwood Gina A.
Published: May 2005

There is considerable evidence that brief group psychoeducational programs for cancer patients, offering support and some training in coping skills, may have lasting beneficial effects on mood and quality of life.

Objective:

to compare two different formats of a brief, group psychoeducational program for cancer patients; a standard format of six weekly two-hour sessions or a “weekend intensive,” involving the same content and contact time compressed into two days.

Method:

Cancer patients were randomly assigned to either the standard weekly intervention ( n = 77) or the weekend program ( n = 79). Two assessment measures were used: Profile of Mood States (POMS) and Functional Living Index for Cancer (FLIC). Assessments were made before and after each intervention and at a nineteen-week follow-up.

Results:

While the two formats were found to be equivalent in their overall effects on mood and quality of life, there were some differences. There was a sudden, large improvement in mood by the end of the weekend version of the course (2-day time point) but this did not persist, and by the six-week point and again at nineteen-weeks, mood improvement was the same for both groups. Quality of life improvement seemed to be marginally greater with the six-weekly sessions (reaching statistical significance at the 6-week point).

Conclusions:

The two formats produced similar improvements in both mood and quality of life. We discuss the need for further studies to find optimal ways of presenting such help for different patient groups.
Gender and Computer Use in an Academic Institution: Report from a Longitudinal Study
Authors: Mitra Ananda , Lenzmeier Stefne , Steffensmeier Timothy , Avon Rachel , Qu Nancy , Hazen Mike
Published: May 2005

This article explores the nature of the relationships between gender, categories of computer use, and attitudes toward computers in a computer enriched environment where all students were provided with network access and laptop computers over a four-year period. The results indicate that women were less positive about computers than men, and the use level of computers by women were less frequent than for men. This change in the relationship is a throwback to the earlier days of computing when research had indicated that men were more positively disposed toward computers than women.
Human Rights and Population Growth—A Feminist Perspective
Authors: Marsden Lorna R.
Published: May 2005

The question of the relationship between human rights and population growth is examined from the perspective of the rights and status of women. A brief review of the literature indicates that no necessary connection between an improvement in the status of women and a reduction of fertility has yet been discovered. The most promising investigations are found in culturally and regionally specific studies. The involvement of women in birth control and population growth is classified, and the concerns of feminists identified. The partial contradiction between the goals of feminism and the control of population, and the relatively unresearched aspects of reproduction are made explicit. The paper concludes that the voice of women should be heard in the worldwide population debate and in the national action plans for contraception, not just as representatives of government, the academy, or the professions, but as women-the people most intimately affected by the present population policies.
Enhancing Online Education Using Collaboration Solutions
Authors: Ge Shuzhi Sam , Tok Meng Yong
Published: May 2005

With the advances in Internet technologies, online education is fast gaining ground as an extension to traditional education. Webcast allows lectures conducted on campus to be viewed by students located at remote sites by streaming the audio and video content over Internet Protocol (IP) networks. However when used alone, webcast does not provide the form of user-to-user interaction that is so important in education. This article presents a collaboration system that can be used to facilitate interaction among users in a live webcast environment. The collaboration system supports real-time communication in both text and audio modes. To allow discussions to be carried out in an orderly manner, a virtual hand-raising scheme is implemented to put more control in the hands of the instructor. Using a topic browser, students can access content of previous discussions and use them as reference sources for any new question they may wish to raise. To allow offline viewing, the discussion content are automatically saved to the local computer at the end of each collaboration session.
Historic Sites Archaeology on the Western American Frontier: Theoretical Perspectives and Research Problems
Authors: Hardesty Donald L.
Published: May 2005

Historic sites archaeology in the western United States is booming but continues to be conducted ad hoc. The demands of assessing significance for cultural resource management purposes suggests that integrative research problems must be identified. One set of such problems emerge from the frontier concept. The use of synecological models from general ecology is proposed as a new framework within which to better understand frontier phenomena. As an illustration, one aspect of Frederick Jackson Turner's “frontier thesis” — the homogenization of frontier behavior — is examined in this light and related to historic sites research. In addition patterns of frontier colonization are studied with models of island biogeography developed by the late Robert MacArthur and E. O. Wilson.
The Sensitivity and Specificity of the Center for Epidemiologic Studies Depression Scale in Screening for Post-Stroke Depression
Authors: Parikh Rajesh M. , Eden Dianne T. , Price Thomas R. , Robinson Robert G.
Published: May 2005

The present study examines the sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for post-stroke depression. Eighty stroke patients were evaluated by a research nurse over a two-year period using the CES-D and also by a trained psychiatrist using a standardized interview for affective, cognitive, physical and social functioning. CES-D scores correlated significantly with DSM-III diagnoses of depression in-hospital and at three months, six months, and one year follow-up but not at two years follow-up, reflecting the natural course of these depressions, as well as the predictive validity of the CES-D. Furthermore, at a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.
The Influence of English Language and Spanish Language Captions on Foreign Language Listening/Reading Comprehension
Authors: Markham Paul , Peter Lizette
Published: May 2005

The purpose of this study was to investigate the effects of using Spanish captions, English captions, or no captions with a Spanish language soundtrack on intermediate university-level Spanish as a Foreign Language students' listening/reading comprehension. A total of 213 intermediate (fourth semester) students participated as intact groups in the study. The passage material consisted of a DVD episode (seven minutes) presenting information concerning preparation for the Apollo 13 NASA space exploration mission. The students viewed only one of three passage treatment conditions: Spanish captions, English captions, or no captions. The Spanish language dependent measure consisted of a 20-item multiple-choice listening comprehension test. The statistically significant results revealed that the English captions group performed at a considerably higher level than the Spanish captions group which in turn performed at a substantially higher level than the no captions group on the listening test. The article concludes with a discussion of the pedagogical implications of using multilingual captions in a variety of ways to enhance second language listening and reading comprehension.
Beyond Our Means: Patterns of Variability of Physiological Traits
Authors: Himmelstein David U. , Levins Richard , Woolhandler Steffie
Published: May 2005

Epidemiologists usually employ measures of variability of physiological traits such as blood pressure and cholesterol only to determine confidence intervals or statistical significance. For evolutionary biologists population variability per se has proven of interest. This article explores the applicability of this perspective to the analysis of human physiology, using data from the Framingham Heart Disease Study and the National Health and Nutrition Examination Surveys. The nonrandom patterns of variability observed suggest that examination of the degree and pattern of heterogeneity within a population may provide information not evident from the analysis of mean values.
An Equitable Way to Pay for Universal Coverage
Authors: Rasell Edith
Published: May 2005

This article describes a way to finance universal health care coverage that preserves much of the current financing system and replaces funds obtained from regressive sources with revenue from more progressive ones. New funding would be needed for 24 percent of health expenditures and would be raised through an increase in the federal personal income tax. Premiums are eliminated since their cost is the same to everyone regardless of income. Cost sharing and out-of-pocket spending for medically necessary services are also abolished. In a more equitably financed system, employers would pay a new payroll tax that raised the same amount of money they currently spend for employee health insurance premiums; this would require a payroll tax of about 7 percent. Revenue from an increase in federal personal income taxes would replace household out-of-pocket expenditures for medically necessary services and payments for insurance premiums. For the average, middle-income family, the tax increase would total $731 in 1998. In exchange for the tax increase, no American or American employer would need to buy health insurance or face out-of-pocket charges for any medically indicated health care.
Self-Reported Depressive Symptoms following Treatment with Corticosteroids and Sedative-Hypnotics
Authors: Patten Scott B. , Williams Jeanne V.A. , Love Edgar J.
Published: May 2005

Objective:

To evaluate associations between exposure to corticosteroids or sedative-hypnotic medications and incident self-reported depressive symptoms in medical inpatients.

Method:

The study utilized a prospective cohort design, focusing on acute depressive symptoms developing soon after medication exposure. The incidence of self-reported depressive symptoms was evaluated using a modified version of the Center for Epidemiological Studies Depression Rating Scale (CES-D). The incidence of depressive symptoms in subjects newly exposed to corticosteroids and sedative-hypnotics was compared to that of a nonexposed comparison cohort.

Results:

The incidence of self-reported depressive symptoms was elevated in subjects newly exposed to corticosteroids (Risk Ratio = 3.10), although the association did not attain statistical significance ( p = .07). The risk ratio for sedative-hypnotic exposure was 4.18, a statistically significant finding ( p = .02). As expected, incident self-reported depressive symptoms were also associated with several psychosocial variables. However, the data did not suggest that the observed associations between drug exposures and depressive symptoms were due to confounding by psychosocial or illness-related variables.

Conclusions:

Depressive symptoms among medical inpatients have a biopsychosocial etiology. Corticosteroids and sedative-hypnotics are biological risk factors for depressive symptoms in this population.
Body Image in Chronic Illness—A Reconceptualization
Authors: Vamos Marina
Published: May 2005

Objective:

Was to construct a classification system of the body image specifically relevant to patient experience of chronic physical disorder.

Method:

To review both previous writings on body image and also data on psychosocial factors relevant to a variety of chronic illnesses. From this were derived four component parts of body image: comfort, competence, appearance and predictability. These are discussed in general and disease-specific terms.

Results:

Using this format, a classification system is offered. This is intended to be simple enough for routine clinical use and yet to offer some insight into body experience. An example is given.

Conclusion:

Separating out the aspects of body image relevant to physical illness provides a clinically useful classification system. Further work is needed to determine its applicability as a research tool.
Inequality as a Basis for the U.S. Emergence from the Great Stagnation
Authors: Chernomas Robert
Published: May 2005

A significant body of evidence suggests that capitalism entered an economic crisis phase in the late 1960s due to a fall in the rate of profit. With falling profits, corporations are compelled to find means of reducing costs by lowering wages and taxes and/or raising productivity. Attacks on the welfare state (in the form of the war on deficits and debts), unions, and government in general resulted in falling wages, longer hours of work, and increased poverty. Only in 1997, despite years of exaggeration about its macroeconomic recovery, did the United States finally have a true boom year, like something from the Golden Age of the 1950s or early 1960s: GDP, investment, productivity, employment, and even wages grew by reasonable historical standards. This article is an account of how this tentative recovery was accomplished—in part, by the state and corporate sectors' ability to generate inequality over the past quarter century—and how these changes in the macroeconomy changed the context for health and the health sector.
Recent Excavations at the Williamson Site: A Quarry-Related Paleoindian/Early Archaic Site in Dinwiddie County, Virginia
Authors: Hill Phillip J.
Published: May 2005

The Williamson Site (44DW1) was recently re-examined after a seventeen-year cessation of its investigation. Williamson is a well known, highly investigated, quarry-related Paleoindian/Early Archaic site located in Dinwiddie County, Virginia. Situated at the northern end of the site is a hillside and creek where primary and secondary sources of cryptocrystalline material are thought to exist. Past investigations have demonstrated that the hillside contains undisturbed artifact deposits dating to the Paleoindian Period (ca. 9,200–8,000 B.C.). The hillside is also where recent excavations were completed. This article presents some of the results of this recent examination.
Where is the Popular Mandate? A Reply to Conventional Wisdom
Authors: Navarro Vicente
Published: May 2005

Current federal policies include substantial cuts in government expenditures for health programs and for care of the poor, elderly, and handicapped, and the weakening of government regulations in health and medical care. These policies are presented by many political, academic, and medical leaders as responding to a popular mandate both to cut government expenditures in all non-military areas and to diminish government intervention in health care and medicine. Also, it is assumed that the tax revolt that occurred in the late seventies further triggered the need for tax cuts and cuts in all social expenditures, including health and educational expenditures. The evidence of North American people's wants, wishes, and desires—measured by leading polls—leads to opposite conclusions, however. In the period 1977–1982, there has been continuous popular support of government programs for health and education; for care of the elderly, poor, and handicapped; and for strengthening government regulations in health care and medicine. During these years, there has been a popular mandate not to decrease but, rather, to increase such interventions. Thus, the current policies cannot be presented as responding to a popular mandate. In fact, the mandate is for policies precisely opposite to the ones which are being implemented by the Reagan Administration.
Predictors of Driving While Intoxicated (DWI) among American Indians in the Northwest
Authors: James William H. , Hutchison Beth , Moore David D. , Smith Albert J.
Published: May 2005

This study compares DWI arrest records for American Indians to those of the general population in Washington State. Within the period January 1987 through December 1987, 1,067 American Indians were arrested for DWI. This sample was compared for age, gender, and occupational status to 28,130 total DWI arrestees during the same period. The data indicate that American Indians were the most over-represented population as they were two-and-one-half times as likely to be arrested for DWI, compared to overall DWI arrest population. The population of American Indians arrested for DWI was three times as likely to be unemployed as compared to the resident labor force of all American Indians. This research supports the conclusion that DWI arrests may be viewed as a symptom of alcohol misuse, abuse, or chemical dependency for American Indians, and that a DWI prevention approach should include education, prevention, intervention, treatment, aftercare, and law enforcement efforts that are sensitive to tribal diversity.
Health Worker Awareness of Cultural Health Attitudes and Practices in Rural Colombia
Authors: MacDonald Jane
Published: May 2005

Health workers' awareness and understanding of clients' attitudes and practices regarding “health” is an important but insufficiently studied factor in planning health promotion programs. A group of thirty-seven rural Colombian campesino (peasant) women were interviewed to determine their health beliefs and practices. Following interviews and observation, the health workers (doctors, nurses, and nursing assistants) who worked with these women and their families, were interviewed regarding their perceptions and awareness of the campesinos' health attitudes and practices. The results show that the women had both western and “popular” (traditional) health practices. The health workers' awareness of their clients' beliefs and practices varied greatly and was influenced by various factors including: professional level, type of illness, local conditions, and experience. In general, however, the health workers were largely unaware of the more subtle health attitudes and practices—those attitudes which may strongly influence health seeking and health maintenance behavior. Concerted efforts must be made to determine the health beliefs and practices of a client or community in order for health promotion programs to be successful.
Yugoslavia's Autonomous Health Institutions
Authors: Popović B. , Škribić M. , Kohn R.
Published: May 2005

Health care in Yugoslavia is provided through a partnership of federal, republic, and local health authorities in collaboration with health insurance funds, sociopolitical and work associations, as well as other associations which represent either the providers or users of health services, or those who shape the development of health policy. The concept of cooperation culminates in a high degree of autonomy for individual health institutions, with self-management characterizing the general pattern of Yugoslav health care delivery. Self-management entails legal, administrative, and fiscal autonomy of the institution, both in its relations with other agencies and within the institution itself, with high levels of self-management within individual departments and sections. Given this diminished role of classical hierarchical organization, the health institution operates with a minimum of legal restraints in responding to the special social interests concerned with health matters. To deal with the institution's external role on the one hand, and its internal cohesion on the other, two organs have been created to serve these respective functions: the council and the management board. Self-management requires planning for several distinct levels: the individual health institution, the local community, and the entire republic. Health services development planning requires cooperation of all pertinent organizations in achieving a “social agreement” on the objectives and priorities of the health services, the resources required, and the specific plans for construction and renovation of health facilities. The principles of the “social agreement” encourage the interest as well as the broad support of citizens and their representatives in the development, implementation, and financing of health protection plans.
Questions and Answers about Medicare
Authors: Bodenheimer Thomas
Published: May 2005

A premium support (voucher) proposal for Medicare will be introduced into the U.S. Congress in 1999. To explain this proposal to the public, the National Coalition to Protect, Improve, and Expand Medicare has published a report entitled “Rebuilding Medicare for the 21st Century.” The lead author of the report here presents some questions and answers on the main topics under discussion.
How the United States Exports Managed Care to Developing Countries
Authors: Waitzkin Howard , Iriart Celia
Published: May 2005

As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism—which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States.
General Practice in Canada
Authors: McWhinney I. R.
Published: May 2005

Medical practice in Canada is in a stage of rapid change. All provinces now have government insurance schemes which pay for hospital care and physician services. Health care is being reorganized in several provinces. The pattern evolving is a three–tier system, with health centers for primary care, district hospitals for inpatient care, and regional hospitals—usually teaching hospitals—for highly specialized services. A regional administrative structure is being developed. Although many variations exist the general practitioner (family physician) is still the major source of primary care. Current trends indicate that in the future the family physician will continue to be the usual source of primary and continuing health care. General practitioners in Canada normally have hospital admission privileges. Although the role of the general practitioner in hospital is changing, there is no indication that the general practitioner will cease to play a part in hospital care. Nurses are beginning to play a more important role in primary health care. Most Canadian medical schools now have departments or divisions of family medicine. The College of Family Physicians has played a major part in establishing postgraduate training for family practice.
Social and Economic Disparities under Canadian Health Care
Authors: Badgley Robin F.
Published: May 2005

Central to the objectives of Canadian national health insurance were the principles that health is a basic right that should be open to all and that all Canadians, regardless of their ability to pay, would be provided with publicly financed comprehensive hospital and medical services. During the two decades that this program has been in place, substantial gains have been realized in making insured services more accessible to all Canadians, in the reduction of regional mortality disparities, and in a leveling out of earlier sharp differences in the supply of health resources across Canada. These changes have not been matched by any significant realignment of the health status of Canadians relative to their economic circumstances, nor as yet by the full removal of economic constraints affecting accessibility to health services. The Canadian experience raises the fundamental concern of whether a reasonable level of equity can be achieved in nations having distinctive regional priorities, a federal structure linking people of different cultural identities, and where a sharp gradient of economic opportunities is entrenched.