Physician licensure: a new approach to examining the role of professional interests

For years, economists have debated the extent to which organized medicine has benefited from medical licensing restrictions. This debate has been hampered by the lack of a viable alternative hypothesis. This paper provides an alternative hypothesis and suggests an empirical test which focuses on the relationship between licensure restrictions and the level of consumption of physician services across states. The evidence suggests that in the mid-1960s the interests of organized medicine dominated those of consumers in influencing the medical regulatory supply process.     

Parental visiting and family reunification: could inclusive practice make a difference?

This study examines whether inclusive practice, or parental involvement in foster children's lives while in placement, is correlated with more frequent visiting and a greater likelihood of reunification. This hypothesis was tested among a random sample of 230 twelve- and thirteen-year-olds placed in traditional family foster care. Results suggest that mothers who visit their child and are involved in case reviews and child care activities visit more frequently than mothers who visit in settings such as agency offices and have no other types of involvement. In addition, visiting frequency is highly predictive of reunification. These associations were not explained by maternal substance abuse, mental illness, or the child's placement history.     

Near and Far

In this paper we distinguish between two measures of contact between children and their non-residential fathers: whether or not the children have seen their father in the previous year, and how many weeks the children stayed with their father. The distinction between the two is important because there are many aspects of a parent-child relationship, some of which may be met during shorter contacts, and others which may be nurtured during an extended visit at the father's house. Using data from the 1987-88 National Survey of Families and Households we find that having a legal agreement regarding joint custody is positively related to the number of weeks that a child stays with his/her father. Children are more likely to see their fathers if there is a legal child support agreement and the father pays child support, which indicates that paying child support and seeing the child are complementary activities. This pattern is reversed for the number of weeks the child stays with the father, which gives support to the hypothesis that non-residential fathers substitute one activity for another. This research highlights the need for careful consideration of different measurements of contact between non-residential parents and children in order to understand more fully the dynamics of families following divorce.     

Race,Rural Residence,and Wildland Visitation: Examining the Influence of Sociocultural Meaning1

Abstract Previous studies have shown that African Americans have less favorable impressions about wildlands and recreate on wildland areas less frequently than do whites. However, most of these investigations have been conducted on non-rural populations. Rural perceptions of wildlands and visitation to such areas have received relatively little attention. In this exploratory study, we propose that race operates on wildland recreation visitation through the different meanings rural blacks and whites attribute to wildlands. We examine this hypothesis with a structural model which specifies wildland meaning as an intervening factor between race and visitation. Single equation results show blacks visit wildlands less, and have less favorable definitions of wildlands, compared to whites. However, when wildland meaning is included in the structural model, racial differences become insignificant. This suggests that the meanings different racial groups attach to wildlands help explain visitation. Both sex and age are also significant predictors of both wildland meaning and visitation.     

Specific Cases,Techniques and Approaches; Narrative Behaviour Therapy? Integration in Practice1

This is a clinically‐oriented paper which seeks to describe the integration of narrative and cognitive‐behavioural approaches in working with children and adolescents. It is suggested that a CBT model can be augmented by typical narrative manoeuvres. For example, it is often helpful to relieve children as quickly as possible of the ‘problem‐saturated story’ with which they and their parents enter therapy. The narrative approach of ‘externalising the problem’ can achieve this within the first session, and helps the family to a) find a good working relationship with the therapist, b) clarify goals, and c) embrace the possibility of change. The use of CBT and narrative therapy in conjunction is illustrated by a case study of obsessive compulsive disorder in a young adolescent girl.     

The presence of the absent father: how lone mothers with sons construct and animate the absent father through narratives

This article builds upon results from an empirical study of nine cases where single mothers and their teenage sons have reflected on the relationship to the absent father and on his significance for the family. The results have led us to reflect further on how the construction of a father figure is shaped. The cases are selected from ongoing interventions from the social services. The child's age at the start of the father's absence varied from birth to seven years old or more. Through analysis of the different cases of mother–son dyad, their narratives and their joint construction of a father figure, the dyad transforms into a triad with the presence of the absent father. Also discussed is the question of which underlying conditions contribute to the need for a joint construction of the father. Further, doubt is cast on the one-sided gender perspective that presupposes young men's need for an adult man as a model of masculinity. The analysis is related to Swedish legislation, emphasising the importance of ascribed biological parenthood, meaning that fathers’ right to joint custody and to visit the child have been strengthened. Along with the biological relationship, the welfare state also regulates the content of fatherhood, i.e. a state-controlled fatherhood.     

Sexual assault and alcohol use: exploring the self-medication hypothesis

Though a link between sexual victimization and alcohol use has been well documented, the mechanisms underlying this relationship remain unclear. The current study used path analysis to examine the role of self-reported levels of psychological distress and the function of alcohol use as indirect pathways between adult sexual assault and alcohol use. Participants were 318 undergraduate female victims and nonvictims of adult sexual assault. Results showed that a history of sexual assault was associated with increased psychological distress, which in turn contributed to alcohol use via negative reinforcement. Taken together, these findings provided support for the hypothesis that women who have been sexually assaulted consume alcohol, in part, to self-medicate. The implications for future research are discussed.     

The repeal of the land acts: the challenge of land reform policies in South Africa

This paper analyses South Africa’s land reform policies post-1994 against the backdrop of the apartheid government’s manoeuvres through the repeal of the notorious Land Acts in 1991. The paper concludes that the democratic government could have avoided the challenges of ineffective land reform by taking into consideration land dispossession prior to 1913.     

Dimensions of service satisfaction with clinic visits in a group practice HMO : The service cycle model

In a study of patient satisfaction for a group practice HMO, a clinic visit satisfaction survey questionnaire, based on the service cycle, was analyzed. The study investigated clinic visits, in which patients (n = 1680) rated the entire cycle of service during the visit, for applicability of the service cycle model. Four dimensions of a visit were extracted: provider interaction, access, ancillaries, and exit. While the provider interaction, access, and ancillaries dimensions had been identified in other similar research, the exit dimension was a new and unique factor that combines pharmacy and cashier functions. These dimensions corresponded very well to the chronology of a visit and gave support to the service cycle model as a construct. The presence of the four dimensions possibly implied that encounters within the dimensions could be colocated. All four factor scales were significant predictors of visit satisfaction (p < .01) in regression analysis.     

Functional capacity evaluation: An essential component of South African occupational therapy work practice services

South African occupational therapists have been involved in the delivery of work practice services since the inception of the profession in this country. Initial development in this area of practice appeared slow but following the acceptance of South Africa's first democratic Constitution in 1996, many opportunities for service delivery were facilitated by the implementation of disability equity legislation. One of the key services offered by practitioners is Functional Capacity Evaluation (FCE). Although the outcomes of FCE are many, the process in essentially the same. This entails: referral, the initial interview, evaluation of performance components and ADL, vocational evaluation, obtaining collateral and the closure interview, the work visit, hypothesis testing and reporting. This article reports on the Functional Capacity Evaluation process as followed by South African occupational therapists in various contexts.     

Family narratives and migration dynamics: Barbadians to Britain

The global dimension of migration, played out in international labour markets and mediated by the manoeuvres of the host polities, engages with a home‐based social and cultural history which furnishes Caribbean migrants with their own agenda, in which family plays a key role. The use of transgenerational life‐stories to explore family dynamics and family narratives can contribute to an understanding of the history and culture of migration and the process by which such a culture is transmitted and transformed across generations. This article takes three case studies of Barbadian migrant families from a larger quota sample.     

Does income inequality harm health? New cross-national evidence

The provocative hypothesis that income inequality harms population health has sparked a large body of research, some of which has reported strong associations between income inequality and population health. Cross-national evidence is frequently cited in support of this important hypothesis, but the hypothesis remains controversial, and the cross-national work has been criticized for several methodological shortcomings. This study replicates previous work using a larger sample (692 observations from 115 countries over the 1947-1996 period), a wider range of statistical controls, and fixed-effects models that address heterogeneity bias. The relationship between health and inequality shrinks when controls are included. In fixed-effects models that capture unmeasured heterogeneity, the association between income inequality and health disappears. The null findings hold for two measures of income inequality: the Gini coefficient and the share of income received by the poorest quintile of the population. Analysis of a sample of wealthy countries also fails to support the hypothesis.     

Auditing Nonphysician Providers' Visits through a Computer-Assisted System

Abstract

The Medical Department is using a computer-assisted system for auditing care provided by mid-level practitioners. Standards of care and corresponding checklist forms have been developed for six common ambulatory problem areas. These include: Respiratory complaints, headache, gastrointestinal disorders, urinary tract infections, male genitourinary problems, and minor trauma. The standards for the diagnostic process and treatment of each complaint were developed by a working group of physicians and mid-level practitioners. Providers complete a checklist form for each patient presenting with problems covered by the protocol. The checklist serves as the medical record for the visit. Checklist data is entered into a computer which audits the visit record against protocol standards. The computer identifies records containing discrepancies in the appropriateness of diagnosis, treatment plan, and physician consultation. The computer output is not the end of the audit process. It identifies encounter records which need further review. Because a discrepancy from the programmed standards does not necessarily reflect faulty medical judgement or care, these records are referred weekly to a physician-nurse audit team. The computerized system allows the auditors to focus their efforts on problems which may make a significant difference in patient care.

As a result, the Medical Department's audit process is both more comprehensive and more thorough than it was prior to the inception of this program. Since April 1, 1977, more than 15,000 encounters have been audited through this system.     

The effects of physical activity and sedentary behavior on cognitive health in older adults

Physical activity has been shown to be positively associated with cognitive health, but the mechanisms underlying the benefits of physical activity on cognitive health are unclear. The present study simultaneously examined two hypotheses using structural equation modeling (SEM). The depression-reduction hypothesis states that depression suppresses cognitive ability and that physical activity alleviates dysphoric mood and thereby improves cognitive ability. The social-stimulation hypothesis posits that social contact, which is often facilitated by socially laden physical activities, improves cognitive functioning by stimulating the nervous system. Sedentary behavior in the absence of physical activity is expected to exert an inverse relationship on cognitive health through each of these hypotheses. Community-dwelling elders (N = 158) were administered a variety of measures of cognition, depression, social support, and physical activity. SEM techniques provided partial support for the social-stimulation hypothesis and depression-reduction hypothesis. Implications for treating depression and improving cognitive functioning are discussed.     

Catching a wave: auto‐ethnographic notes on love and war in Hawaii

This is an autoethnographic account of a research visit to Hawaii in the spring and summer of 2003. The substantive research, of which conventional reports have been published, was an exploratory study of implementing new information technology in a large US health care provider organisation. However, the fieldwork opened a door onto the wider culture of Hawaii, as different from our English culture as from that of northern California, our temporary home. This is my attempt to record that experience in the context of our year abroad.     

Interpersonal Compatibility and Student-Faculty Evaluations: The Effects of Need Complementarity in the Classroom

Abstract

Previous studies have examined student characteristics or teacher characteristics as sources of variation in student-faculty evaluations. However, little attention has been given to the ways in which interpersonal needs of student and teacher may jointly contribute to such evaluations. This study investigated the hypothesis that complementarity of student-teacher needs for control and affection would be related to positive evaluations of teachers. Eight teachers and 265 students completed the FIROB Scales; student-faculty evaluation forms were later administered to the students. The hypothesized relationship for affection needs was not obtained; however, complementarity of control needs was significantly related to positive teacher evaluations. The results suggest that noncomplementary relationships tend to lead to negative teacher evaluations when the teacher expresses a high need to control others.     

Racism, IQ and Down's Syndrome

There is a consistent difference of some 15 IQ points between the test means of American black and white citizens, and there has been a fierce debate as to whether this can be best accounted for by black intellectual inferiority or by such environmental factors as prejudice and discrimination. However, even supporters of the environmental hypothesis have neglected to apply it to the population-people with Down's Syndrome - to which it is most clearly applicable, and this failure of imagination indicates the boundaries of discourse in the field of intellectual disability. The complex relationship between racism and prejudice against people with Disability is illustrated by Dr Down's use of the term 'mongolism'. Down's characterisation of people with intellectual impairment as equivalent both to children and to people of different races fits the need for a working explanation of intellectual impairment. The characterisation is none the less worthless, and we need new frames to shape our observations.     

The home situation and the homosexual

This article is concerned with the home situation of the homosexual, as a part of the process which develops homosexuality. An exploratory study was conducted in San Francisco on a sample of the homosexual population. Three hypotheses were examined: there is a positive relationship between the incidence of homosexuality and the unhappy childhood of the homosexual at home; there is a positive relationship between the confusion in sexual role‐playing in early ages, and homosexual behavior; and there is a positive relationship between the presence of homosexual family members and the development of new homosexuals. The data were collected in recorded interviews. Fingings tended to suport the first hypothesis, but did not support the second and third hypothesis.     

The significance of ‘the visit’ in an English category-B prison: views from prisoners,prisoners’ families and prison staff

A number of claims have been made regarding the importance of prisoners staying in touch with their family through prison visits, firstly from a humanitarian perspective of enabling family members to see each other, but also regarding the impact of maintaining family ties for successful rehabilitation, reintegration into society and reduced re-offending. This growing evidence base has resulted in increased support by the Prison Service for encouraging the family unit to remain intact during a prisoner’s incarceration. Despite its importance however, there has been a distinct lack of research examining the dynamics of families visiting relatives in prison. This paper explores perceptions of the same event – the visit – from the families’, prisoners’ and prison staffs' viewpoints in a category-B local prison in England. Qualitative data was collected with 30 prisoners’ families, 16 prisoners and 14 prison staff, as part of a broader evaluation of the visitors’ centre. The findings suggest that the three parties frame their perspective of visiting very differently. Prisoners’ families often see visits as an emotional minefield fraught with practical difficulties. Prisoners can view the visit as the highlight of their time in prison and often have many complaints about how visits are handled. Finally, prison staff see visits as potential security breaches and a major organisational operation. The paper addresses the current gap in our understanding of the prison visit and has implications for the Prison Service and wider social policy.