Coverage, technology assessment, and the courts

Coverage decisions by third-party payers are relying more and more heavily on the conclusions of technology assessment programs about the safety and effectiveness of technologies applied in specific clinical situations. Assessment programs vary markedly in the sophistication and rigor of their methodology. Payers differ as to how such assessment information is integrated into their decision-making processes. Finally, coverage decisions about a specific technology can vary widely across the country.     

The challenge of world health

2 development specialists have expounded on the demands world health has placed on public health. Striking declines in infant and child mortality occurred with the advent of biomedical and technical interventions in developing countries after World War II. At the same time, these interventions promoted longer lives by curing and/or treating chronic diseases in developed countries. In the 1970s, however, it was apparent that the hospital based, curative approach could not meet health needs and was very costly. In developed countries, biomedical and social sciences showed that chronic diseases did not occur due to modernization but from unhealthy behaviors, diet, and lifestyle. In fact, in 1975, the US Centers for Disease Control announced that unhealthy lifestyles contributed to 50% of all deaths while the medical system was responsible for only 11%. The US and other developed countries then began to promote healthy lifestyles, and in the 1980s, considerable improvements in health occurred, especially among adults. Developing countries which depended on the Western medical model did not experience health gains in the 1970s. Yet developing countries where health systems concentrated on carrying essential services to all people and promoted basic hygiene and sound dietary practices continued to achieve considerable health gains. In 1978, WHO an UNICEF hosted the International Conference on Primary Health Care in Alma Ata, the Soviet Union to hold these developing countries with community based health systems as models of primary health care (PHC). The 1980s witnessed the spread of PHC especially in the form of child survival which focused on oral rehydration therapy and breast feeding. The biomedical and social sciences are needed to move this health policy and program strategy forward. Governments must see to policies that promote healthy people. Political will is needed to make human welfare a high priority.     

Migration,race and ethnicity, 1960-1980

"This article compares racial and ethnic patterns in interstate and interregional migration in the years 1960 to 1980.... This research looks at geographical assimilation--the extent to which patterns of migration and regional distribution of minority groups resemble those of whites. Attention is directed to United States-born Asian Americans, blacks, Hispanics, Native Americans and whites, and attempts to answer the following questions: 1) To what extent do the patterns of interstate migration of these groups resemble one another? 2) To what extent do the regional distributions and patterns of net regional migration of these groups resemble one another?" This is a revised version of a paper originally presented at the 1988 Annual Meeting of the Population Association of America (see Population Index, Vol. 54, No. 3, Fall 1988, p. 495).     

Assaultive behavior. Does provocation begin in the front office?

1. Provocation is an important risk predictor because these issues can be recognized, assessed, and appropriate interventions can be implemented to reduce the associated risks. It is only by the reduction of such "non-fixed" risk factors that any reduction of assaults can be accomplished. 2. Involuntary admission, patients with dementia or organic brain disorder, physical or verbal limits, staff attitude, denial of the possibility of assaults, and the educational level and clinical experience of the staff may help provoke an assaultive episode. 3. An important step is assessing the assault to identify provocation due to certain medical causes, and to document the extent of degeneration in patients with dementia or organic brain disorder. Medical intervention would be indicated and would appropriately address the causes of some violent episodes.     

Temporal dimensions of the fertility transition: an age-period-cohort analysis of frontier fertility

"This paper evaluates age, period, and cohort effects on marital fertility during onset of the Utah fertility transition (1880-1900). Computerized genealogies are used to derive age-period-cohort fertility rates for 49,842 once-married couples. Age, period and cohort effects on marital fertility are then estimated using Johnson's (1985) relational model. Declining marital fertility in Utah is shown to be explained by both lower fertility levels across periods and increasing age-specific limitation across cohorts. Direct cohort effects on fertility are insignificant. These results are consistent with prior research, and the view that fertility levels were adaptive (in part through birth spacing across ages) to immediate contexts of childbearing while age-specific fertility truncation increased across cohorts (in part through the more general diffusion of contraceptive innovations)."     

Telling lies in everyday life: Motivational and organizational consequences of sequential preferences

This study of a collection of self-observed lies told in everyday interactions indicated that all informants lied; that lying was, generally, an easy and spontaneous activity; and that our varied informants told lies in much the same manner and for the same reasons. The analysis of the general features of the interactions in which lies were embedded showed that many lies are the consequence of a preference system that promotes acceptance and hides rejection in the sequential organization of interaction. The lies found in pre-acceptance and pre-rejection sequences indicate that both parties contrive for acceptance. The negative cases of lies told in rejection of deprecating assessments suggest a broader theoretical template that encompasses the lies told for acceptance as a subset of the interactional preference for social solidarity. In contrast to the view that telling lies undermines social cohesion by interfering with trust, this study indicates that many lies are told to affirm affiliation.     

Tearoom trade: A research update

Conclusion Like many studies of covert deviance, this paper is based upon a captive sample of persons who have come to the attention of law enforcement agencies. The existence of Laud Humphreys' research, however, makes possible a comparison of police generated data with data obtained through observations and interviews with unapprehended offenders. Because police observations were so detailed, a rare opportunity to replicate a qualitative study presented itself. This research largely substantiates the picture drawn by Humphreys in his classic study,Tearoom Trade: Impersonal Sex in Public Places. Consistent with his observations, most tearoom participants (a) communicate through non-verbal gestures and seldom speak, (b) do not associate outside the tearoom or attempt to learn one another's identity or exchange biographical information, (c) do not use force or coercion or attempt to involve youths or children, (d) are primarily heterosexual and married, (e) depart separately with the insertor leaving first, (f) commit their sex acts out of sight of the entrance and accidental exposure, (g) do not undress or engage in anal sex, (h) break off sexual contact when someone enters the washroom, (i) rarely approach straight men, (j) read and write sexually explicit homosexual graffiti, and (k) linger inside and outside the washroom for someone to appear. In addition, (1) fellatio is generally not reciprocated and fellators are usually older men; (m) most offenders are neat in appearance; (n) some engage in series and simultaneous encounters; (o) encounters are brief, usually not exceeding twenty minutes; and (p) few have criminal records with the exception of those previously convicted of similar offenses.The behavior of players reveals remarkable consistency over time, from community to community, and across national boundaries. Many men, the majority of them married and primarily heterosexual, continue to visit out-of-the-way public washrooms in search of fast, impersonal, and exciting sex despite the risk to family, friends, job, and reputation. Although shopping malls have usurped public parks as the favorite locale of tearoom participants, the basic rules of the game and profile of the players—as Humphreys contends—remain the same over time and place.     

Neutralizing marginally deviant behavior: Bingo players and superstition

Bingo is one of the most popular and most accepted forms of gambling in the United States today. Yet, despite its popularity, many bingo players are not completely comfortable with the moral rightness of their actions. This participant observation and interview study spanning a 5 year period shows how bingo players use superstitious strategies, such as feelings, hunches and psi, attitudes, and luck to neutralize their marginally deviant behaviors.     

Smart money

Rick was an ambitious entrepreneur beginning the first of several businesses at age 16. He amassed a fortune by age 35. Between the ages of 42 and 50, his gambling rampage liquidated his assets, he lost his business and license to practice in his field, and he ended up in debt of over $1 million. Today at age 53 he is starting a new career in counseling and working with compulsive gamblers.