Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Immigration reform in France and the United States: reflections and documentation

This paper analyzes similarities and dissimilarities in French and American efforts to come to grip with irregular migration. The symbolic importance of immigration reform is argued to be a key political concern in both nations, although the politics of immigration reform has assumed a more partisan flavor in France, particularly since the municipal elections of 1983. In France, the theme of control and security, associated with the notion of preventing "automatic" immigration which would endanger the cohesion of French society, was widely utilized for political ends prior to and after May 10, 1981 (the date of Francois Mitterand's investiture). The American government, on the other hand, is confronted with the unenviable task of obtaining a legislative consensus on legalization and employer sanctions through an approach seeking to harmonize and integrate the demands articulated by various groups: employers, unions, and alien and ethnic interest groups (principally Hispanic groups divided into a hierarchy along a recently arrived/established cleavage). The American situation most sharply differs from the French case in terms of the absence of a right/left political cleavage. The real effects of clandestine immigration are to be found at the local level. In France, as in the US, the ability of local actors to exert pressure raises the fear that legalization and sanctions will change little, except in terms of symbolic legitimacy.     

Eye-contact as a chance product of individual looking: Implications for the intimacy model of argyle and dean

From time to time during social encounters, people look at one another in the region of the eyes, and sometimes their eyes meet to make eye-contact. According to Argyle and Dean (1965), eye-contact in dyadic encounters signals the intimacy of the interaction and is controlled largely by the competing approach and avoidance forces that motivate the pair. In the present paper, new analyses are reported of three published experiments that were designed originally to test aspects of the intimacy model and it is shown that the duration of eye-contact is no more than a chance product of how long the two subjects look individually. Looking and not eye-contact, it is argued, should be the basis for models of visual interaction, and the intimacy model is ill-founded conceptually; the role of emotion in gaze has been overstressed at the expense of the concept of information; and the most important aspect of vision is in any case not looking and eye-contact but visual access to the whole person. The more cueless the encounter—that is, the fewer the social cues from vision and all the other senses combined—the greater the psychological distance; and the greater the psychological distance, the more task-oriented and depersonalized the content of what people say and, in turn, the less spontaneous their style of speech and the less likely a debate to end in compromise.Research for this article was sponsored by the Social Science Research Council of Great Britain.     

The influence of child spacing on child survival

Summary This study evaluates the strength of the influence of spacing on child survival. Data related to a traditional culture (Punjab) in which almost all children are breast-fed up to the age of 17 months. An initial pregnancy history survey, subsequent four years updating through continuous monitoring of vital events and a second cross-sectional pregnancy history survey at the mid-point provided a file containing information on pregnancies and survival of children of 5,018 women. The analysis first looks at the correlation between the lengths of the preceding and subsequent intervals of index children, then examines whether this correlation was related to the repeated pattern of child death or survival. Next, the influence of the duration of the preceding interval on the survival of the index child in general and after accounting for the fate of the preceding child were considered. Then the influence of the length of the subsequent interval on the survival of the index child after conception and after the birth of the next child were studied. Lastly, regression analyses with preceding and subsequent intervals as independent variables and age-specific survival or death as the dependent variable were performed.     

Setting health priorities: a review of concepts and approaches

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.     

Optimal Times to Contact Sample Households

Finding a suitable respondent at home is an essential and expensivecomponent of a household survey. This article reports on theresults of a study of the probabilities of finding someone aged14 or older at home and discusses the application of such datato survey design and budgeting.     

Social forecasting: An integral part of corporate planning?

The increasing need for business to monitor the social dimensions of its environment and, hopefully make some forecasts of future trends has met with some constructive response from academics and consultants although not as yet on a very liberal scale. The published literature does not indicate to what extent companies in general attemp social forecasting and, where they do, the degree of integration which exists within their corporate planning systems. The authors, therefore, decided to survey a sample of British organizations to see if they could shed some light on these issues and thereby add some information to the excellent accounts of individual cases of social forecasting in, they suspect, the more advanced and atypical companies. The survey suggests a general picture of: awareness of the value of social forecasting; fairly widespread ignorance of the techniques which do exist, primitive though these may largely be; successful integration of social forecasting into the corporate planning systems of a substantial number of organizations but not in the majority.     

Further research in theories of population being carried out]

The 2nd Chinese Scientific Symposium on Theories of Population was held in Chengdu, Sichuan, on December 7-13, 1979. The symposium was jointly sponsored by the Department of Family Planning of the Chinese Central Government, Chinese Academy of Sociology, Sichuan Provincial Revolutionary Committee (SPRC), and the Institute of Population Theories of the Chinese People's University (IPT). There were 255 attendants, representing 60 academic institutions, 14 scientific research organizations and 31 provincial, municipal, and autonomous regional departments of family planning. The main theme of the meeting was "Population Problems and Their Solutions Facing the Four Modernizations in China." 147 papers were read at the meeting. The meeting opened with a welcoming speech by Comrade Liu Haiquan, Vice-Chairman of SPRC, who pointed out the challenge Chinese family planners would face in advocating the 1 child family policy. Long speeches were made by Comrade Chen Dao who stressed the training of workers for Chinese population research and by Comrade Du Xinyuan (secretary of SPRC) who summarized results on recent family planning efforts in Sichuan. During the meeting, based on their contents, the papers were divided into 7 groups for separate discussions: 1) population development in the socialistic society, 2) relationship between population and economic developments and between population control and the 4 modernizations in China, 3) possible population problems in China, their nature, etiology and methods of solution, 4) population policies and family planning in China, 5) trends in population development and population planning in China, 6) problems of population distribution in China, and 7) development of population theories in China during the past 30 years. The meeting discussions were summarized by Comrade Liu Zheng of IPT who noted that there were 84 more attendants and 110 more papers in this meeting than the first held in 1978.