bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kaiser-Permanente: A Model American Health Maintenance Organization
Authors: Carnoy Judith , Koo Linda 
Published: May 2005

The Kaiser-Permanente medical care program, a prepaid group practice that has been operating in California for over 30 years, is one of the most successful Health Maintenance Organizations (HMOs) in the United States. Kaiser's membership in California, Portland, Hawaii, Denver, and Cleveland exceeds 2.5 million. The main success that HMOs can claim is cost reduction. Kaiser can provide a package of services at lower cost than identical services would cost in “mainstream” medicine. The way in which an HMO reduces cost is by lowering the use of services by its members. Kaiser members spend half as many days in the hospital as a similar population of Blue Cross/Blue Shield subscribers. But Kaiser also tends to lower the availability of services that are not presently performed in excess. Ambulatory care is not easily accessible-large numbers of patients complain of waiting several weeks for appointments, of receiving rushed impersonal treatment, and of being unable to find and keep a personal physician. Thus Kaiser cost reduction goes hand-in-hand with a general inaccessibility of services. The reason for this is the working of the profit motive. Whether for-profit or technically “nonprofit,” private corporations have always committed themselves to maximizing their income, reducing their expenditures, and using the surplus for expansion. The profit incentive leads private HMOs to limit services by hiring an inadequate number of physicians and other personnel so that patients will be discouraged from seeking care. In this way, expenses go down and surplus goes up. This is a revision of an article, “Kaiser Plan,” that appeared in the Health-PAC Bulletin, No. 55, pp. 1-18, November 1973.
Clinical Dilemmas Due to the Lack of Inpatient Mother-Baby Units
Authors: Wisner Katherine L. , Jennings Kay D. , Conley Barbara 
Published: May 2005

Objective: Epidemiologic studies have demonstrated the dramatic increase in the rates of new episodes of psychiatric illness in postpartum women. Mother-Baby joint admission inpatient units serve the needs of women with psychiatric illness related to childbearing in other countries. Such units have been rare experiments in the United States. This article explores the clinical dilemmas that clinicians who treat postpartum women face when mother-baby units are not available. Barriers to the implementation of these units are also discussed. Methods: A survey of mothers admitted to general adult units was performed to study their satisfaction with the experience. The authors also discuss their extensive clinical experience in the treatment of women with postpartum disorders and provide examples of the clinical dilemmas which occur because of mother-only admissions. Results: Clinical dilemmas were: separation from infants causes mothers to refuse admission, undermines breastfeeding, complicates the diagnostic evaluation, precludes participation of the infant in dyadic psychotherapy, produces longer lengths of hospital stay, and places the responsibility of caring for the baby on the spouse and extended family. Post-discharge readjustment to caring for the baby can contribute to maternal relapse. Conclusions: Although admission to Mother-Baby units offers significant advantages to mothers and families, firm data to support the cost-effectiveness of these units is not available and is a major barrier to implementation.
Psychogenic Erectile Dysfunction
Authors: Bodie Joshua A. , Beeman William W. , Monga Manoj 
Published: May 2005

Objective:To educate healthcare professionals on the historical aspects, clinical diagnosis, and current treatment methods of psychogenic erectile dysfunction.Method:A topic review of current literature was performed. Chief sources included primarily mainstream journals in the fields of urology, psychiatry/psychology, impotence/erectile dysfunction, epidemiology, and internal medicine. MEDLINE and PsycINFO databases were utilized.Data extraction:Data from clinical studies, trials, and review articles concerned primarily with psychological aspects of the arousal (erectile function) phase of the male sexual response cycle were collected, analyzed, and summarized in this review article.Results:There has been a shift in how erectile dysfunction has been perceived and treated over the past 30 years. With the current focus now on the very prevalent organic causes of ED, psychological factors are increasingly overlooked, though they remain important to the treatment of the patient as a whole. This article provides a complete, concise review of the interplay between psychological components and erectile function, reviews the work-up and diagnosis of psychogenic ED, and discusses treatment methods.Conclusions:Erectile dysfunction is a prevalent problem that can affect, and can be affected by, psychosocial aspects of a man's life. Medical or pharmacological interventions are often appropriate to treat ED, but the psychosocial aspects should not be ignored. It has become easier for practitioners to put aside patients' psychosocial and interpersonal concerns regarding sexual health. Clinicians provide the best possible treatment if they recognize that erectile dysfunction is a complex, multifactorial disorder, and treat accordingly.
The Neuropsychiatry of Multiple Sclerosis
Authors: Mendez Mario F. 
Published: May 2005

Objective: This article examines the cognitive and psychiatric features of multiple sclerosis. MS can manifest as a neuropsychiatric disturbance even in the absence of physical disabilities. Method: Two MS patients with predominant behavioral symptoms are described, and the literature is reviewed. Results: The first patient had an interhemispheric disconnection syndrome, and the second patient had cognitive fatigue and depression. Other patients have slowed information processing speed, memory retrieval difficulty, frontal-executive dysfunction, and visuospatial difficulty. Conclusions: MS results in specific cognitive deficits and mood disorders. These two patients had organic mental disorders from cerebral demyelination particularly affecting the corpus callosum. Other patients have neuropsychiatric symptoms from extensive demyelination of prefrontal-subcortical circuits. Evaluation and management strategies are discussed.
Nuclear Power Risks: Challenge to the Credibility of Science
Authors: Welch Bruce L. 
Published: May 2005

For a quarter of a century the Federal Government and the nuclear industry have deliberately deceived the American public about the risks of nuclear power. Facts have been systematically withheld, distorted, and obscured, and calculations have been deliberately biased in order to present nuclear power in an unrealistically favorable light.Most persistent and flagrant have been: (a) attempts to “normalize” public perception of nuclear accident casualties with those of more familiar accidents by emphasizing only acute fatalities and ignoring or downplaying the major effects of nuclear accidents, namely, health impairment and death years delayed; and (b) the cloaking of the objectively undocumentable faith of the atomic energy establishment that a nuclear accident is extremely unlikely in a smokescreen of invalid, pseudo-quantitative statistical probabilities in order to convince the public that the chance of an accident is negligible. Prime examples of these abuses are found in the Rasmussen report on nuclear reactor safety and in its representation to the public.The deceptive practices used in promoting nuclear power have seriously shaken public faith in government, technology, and science. The scientific community has a special responsibility to minimize such future political abuses of science. For those who were responsible for the deliberate breeches of public trust which resulted in this loss of faith, mere professional disdain will not suffice. They should be punished to the fullest extent of the law.
The Psychiatrist as Teacher in Primary Care Residency Training: The First Year
Authors: Lazerson Alan M. 
Published: May 2005

Increasing development of postgraduate primary care training programs to meet manpower needs is supported by flexibility in the Boards of Internal Medicine and Pediatrics to include experience in psychiatry; with this change, liaison psychiatrists will become progressively more involved and closely integrated into such training. This report outlines the first year experience of a psychiatrist in one innovative three year program in pediatrics and medicine, and describes some common problems and issues, along with teaching goals and some developing methodologies. Although the number of trainees in this first year cohort is small, preliminary results reported by a feedback component of an independent evaluation team attached to the program suggest that the interns are receptive to the psychiatric input and that they consider the initial contribution by psychiatry to have as much usefulness to their training in primary care as the more traditional pediatric and medical components.
Psychological Distress and Cognitive Impairment in Neurological In-Patients: Its Prevalence and its Recognition by Residents
Authors: Zlot Stefan I. 
Published: May 2005

Objective: This pilot study investigated the prevalence of psychological distress and cognitive impairment in neurological in-patients by means of three widely accepted questionnaires. We examined residents' recognition of corresponding disturbances. Method: We interviewed fifty-five consecutively admitted in-patients of a neurological unit with the MMSE, GHQ-28 and BDI. We asked the neurological residents whether they found cognitive impairment or psychological disturbances in their patients and to indicate the extent of those abnormalities. Results: Fifteen percent of patients showed cognitive impairment, but as many as one-third showed psychological problems warranting further work-up. Recognition of such by residents as well as specification of psychiatric diagnoses and important psychosocial factors in the final reports was poor. Conclusion: Psychological problems are common in neurologic in-patients. They are insufficiently recognized by residents and usually not taken into consideration in patient-care. We suggest the improvement of neurologic training to include appropriate interview techniques, providing the integration of biological, psychological and social factors in diagnosis and therapy.
Workplace Health and Safety: Report from Canada
Authors: Sass Robert 
Published: May 2005

This article represents a critical analysis of the major policy responses to workplace health and safety in Canada. It examines the deficiencies inherent in the legislative development of Joint Health and Safety Committees in most Canadian jurisdictions, the limitations regarding standard-setting of worker exposure to contaminants, and disincentive for employers to positively improve the workplace because of Workers Compensation legislation. Collective bargaining agreements in Canada have had only limited positive effects, while the ultimate legal sanction of criminal prosecution by the regulatory agencies has weakened enforcement and compliance of existing regulations. There has never been a successful criminal prosecution of an employer in Canada, even for multiple deaths. The article suggests the following four reasons for this “underdevelopment” of occupational health and safety in Canada: (1) the concealment of the dimension of the incidence of industrial disease based on Workers Compensation Board statistics; (2) the application of an incorrect theory of causation of both industrial disease and injury by both managers and government administrators of occupational health and safety programs; (3) the resistance of both senior and middle managers against increased worker participation in both work organization and job design questions; and (4) the general “moral underdevelopment,” rather than ignorance, of managers in favoring economic considerations or values at the expense of worker health and safety. In light of the magnitude of the problem and the deficiencies of existing policy approaches, the author proposes the need for greater workplace democratization of production and industry as a necessary and sufficient reform of workplace health and safety.
Health Care: An International Comparison of Perceived Morbidity, Health Services Resources, and Use
Authors: White Kerr L. , Anderson Donald O. , Bice Thomas W. , Kalimo Esko , Schach Elisabeth 
Published: May 2005

Selected summary findings from the World Health Organization/International Collaborative Study of Medical Care Utilization are presented, based on data collected during a twelve-month period in 1968–1969 in twelve study areas in seven countries in the Americas and Europe. A household interview survey of almost 48,000 persons, representing a total population of about 15 million, elicited information on demographic characteristics, on perceptions of illness, its severity and character, and on attitudes toward and use of major components of health services. Information was also collected on the prevailing health care systems and resources available to the study population, as well as on socioeconomic characteristics of the study areas. Standardized rates for those defined as “healthy” and “functionally healthy” are quite similar across the twelve study areas, as are the rates for persons who reported being sick within two weeks. Rates for the volume of sick days within two weeks vary widely, and levels of chronicity with disability are much higher in the four continental European study areas. Rates for volume of physician contacts within two weeks vary considerably across study areas, but rates for persons with contacts are more stable, although for persons with perceived morbidity of high severity, the corresponding rates are lower in the four continental European study areas. By contrast, the rates for persons with an administrative reason for their most recent physical examination within twelve months are substantially higher in the latter. Where unmet need for a physician contact is greatest, the volume of hospital nights used is also greatest; a direct relationship between these two measures is evident without regard to the ratio of hospital beds available to the population. Wide differences are observed between the extremes of the measures of need, resources, and use employed in the study, raising questions about the ways in which resources are organized to provide services and about the effectiveness and efficiency of these services.
Social Issues: Science, Technology and Public Policy
Authors: Tipple Bruce E. , Switzer Kenneth A. 
Published: May 2005

With the support of a grant from the National Science Foundation, the Social Science Education Consortium of Boulder, Colorado, is developing and field testing ten role-play learning activities designed to enhance students' understanding of public policy issues involving science and technology. The activities are designed for use in secondary-level (grades 10–12) natural science and social science courses. This three-year project, entitled Creative Role-Playing Experiences in Science and Technology (CREST), is based on the belief that citizens require both an understanding of issues and decision-making skills in order to reach responsible public policy decisions. This article presents a detailed rationale for the development of the project materials, outlines the phases of project development, and briefly discusses the content of one exemplar activity.
Lives, Liberty, and Seat Belts in Britain: Lessons for the United States
Authors: Leichter Howard 
Published: May 2005

By the end of this decade virtually all fifty U.S. state legislatures will have debated, and many will have adopted, mandatory seat belt legislation. While the debate in the United States has just begun, one can anticipate and preview the issues, arguments, and results by examining the British debate over, and experience with, a mandatory seat belt law. From this cross-national perspective, this article examines the practical, philosophical, and preventive health care dimensions and implications of this debate. Based upon personal interviews and the Parliamentary record, the author traces the background of the issue, and the major arguments for and against mandating seat belt use. Particular emphasis is placed upon the libertarian objections to such legislation, and how some British Conservatives were able to reconcile their philosophical beliefs with public safety needs. The article concludes by suggesting some lessons which U.S. proponents of mandatory seat belt legislation might learn from the British experience.
A Comparison of the Psychosocial Aspects of AIDS and Cancer-Related Bereavement
Authors: Kelly Brian , Raphael Beverley , Statham Dixie , Ross Michael , Eastwood Heather , McLean Susan , O'Loughlin Bill , Brittain Kim 
Published: May 2005

Objective: This study compares the psychological symptoms and bereavement distress of individuals bereaved by AIDS with a group bereaved by a cancer death, and addresses the question of whether an AIDS death is associated with a higher rate of adverse psychosocial factors that may increase risk of psychological morbidity in the bereaved individuals. Method: AIDS ( n = 28) and cancer ( n = 30) bereaved individuals (all within 3 months of the bereavement) completed measures of psychological morbidity and measures addressing a range of other adverse factors, e.g., number of losses, levels of social support and stigma. Results: The cancer and AIDS bereaved were essentially similar on all psychological symptom measures. The AIDS group reported lower levels of social support in response to the bereavement than cancer bereaved individuals; a greater number of bereavements, were more likely to conceal the cause of death from significant others including their own family and perceived, in some instances, a greater level of rejection from others. The AIDS group reported higher levels of social support from friends than from family. Conclusions: At three months following bereavement, AIDS and cancer bereaved were similar in levels of distress. While this may change with the progress of grief over time, it suggests essentially similar early bereavement responses. Those bereaved by AIDS reported a range of other adverse factors such as a greater number of losses, lower social support, stigma, and less open disclosure of the cause of death.
Leprosy Control by a People's Program: “A New Concept in Technology Transfer”
Authors: Antia Noshir H. 
Published: May 2005

Leprosy is a major health hazard in tropical countries as it also is in China. All programs for the control of this disease have been based on the cheap, effective, and low-toxicity antileprosy drug Dapsone (DDS), available since the early 1950s. The emphasis has been on early detection and regularity of treatment, which has to be maintained for several years, if not a lifetime. Despite the availability of what might be rightly termed the “magic bullet,” World Health Organization (WHO) figures demonstrate that leprosy has not been controlled in most countries and is generally on the increase. Blame has been ascribed to the patients for hiding the disease and for irregularity of treatment. Emphasis has now shifted to high-technology research to evolve more expensive and much more difficult multidrug regimens and an antileprosy vaccine. China, isolated from the rest of the world and using only simple DDS therapy, but ensuring its use through its barefoot doctor approach, has shown a reduction of leprosy cases from 500,000 to 100,000 in the past three decades. The author suggests that the world, including WHO, should learn from the experience of China rather than try to impose its own low effective and more expensive high-technology approach on this country.
Mental Health Treatment Preferences of Older and Younger Primary Care Patients
Authors: Wetherell Julie Loebach , Kaplan Robert M. , Kallenberg Gene , Dresselhaus Timothy R. , Sieber William J. , Lang Ariel J. 
Published: May 2005

Objective: To compare mental health treatment history and preferences in older and younger primary care patients. Method: We surveyed 77 older (60+) and 312 younger adult primary care patients from four outpatient medical clinics about their mental health treatment history and preferences. Results: Older adults were less likely than younger adults to report a history of mental health treatment (29% vs. 51%) or to be currently receiving treatment (11% vs. 23%). They were also less likely to indicate that they currently desire help with emotional problems (25% vs. 50%). Older adults were more likely to hold a belief in self-reliance that could limit their willingness to accept treatment for mental health problems, although they were less likely than younger adults to identify other barriers to treatment. Older adults reported that they were less likely to attend programs in primary care targeting mental health issues (counseling, stress management) than younger adults, although they were as willing as younger adults to attend programs targeting physical health issues (healthy living class, fitness program). Age remained a significant predictor of mental health treatment history and preferences even after controlling for other demographic variables. Conclusion: These results suggest that older adults in the primary care setting may be less willing to accept mental health services than younger adults. Results further suggest that perceived barriers may differ for older and younger patients, which may indicate the need for age-specific educational messages and services targeted to older adults in primary care.
Race in Epidemiology
Authors: Stolley Paul D. 
Published: May 2005

The Journal has opened its pages to an important debate, taking place primarily in the United States, on the scientific merits of including race as a category in vital statistics. To begin this debate, we present a guest article by Professor Paul Stolley, chairman of the Department of Epidemiology and Preventive Medicine at the University of Maryland School of Medicine, a well-known authority on this subject. Responses by other leading experts in this area will be published in an upcoming issue of the Journal. The category of “race” as applied to the human species has no generally agreed upon definition and has been completely discredited by most geneticists and anthropologists. Yet racial categories are still used in epidemiological and social research, and are to be included in the 2000 U.S. Census. Because the history and life experiences of blacks and whites in the United States have been so radically different, social and economic variables have become mixed up and confused with genetic determinants. Attempts to redress historical oppression and discrimination have tended to perpetuate racial categories. It is time for a serious reexamination of the use of categories based on race.
Individualized Instructional Systems Used by Xerox
Authors: Burgwardt Frederick C. 
Published: May 2005

The use of individualized instruction has been emerging as a training and development technique at Xerox over the past two years. We have accepted the challenge to: 1) identify appropriate instructional techniques; and 2) reduce costs by devising a delivery system by which programs prepared under a “single point” design/development concept can be distributed to users at various geographical locations. Individualized instruction offers unique benefits. Well received by Xerox employees, it is a viable approach to continuing education in an industrial environment. It is now used to train personnel in a broad range of job families including secretaries-clerks, technicians, and engineers and scientists.