An appraisal of organizational response to fiscally constraining regulation: the case of hospitals and DRGs

Results from analysis of 227,771 discharge abstracts from 68 short-term, acute-care hospitals and from interviews with a stratified random selection of 24 of the 68 chief executives of these hospitals demonstrate that institutions perceive implementation of DRGs as fiscally constraining, especially in light of other resource-constraining conditions (an increase in unemployment resulting in fewer people with hospitalization insurance, in addition to severe cuts in Medicaid rolls and budget). Hospitals responded to DRGs by decreasing the use of affected resources or services available to the hospitalized Medicare patient. In order to survive a more economically stringent marketplace, hospitals no longer protected the traditional core within the Medicare inpatient market. They opted instead to change practices and products at the unregulated margins of the DRG system.     

The marihuana perception inventory: stage 3--the parent sample

This article reports the third step in the development of a perceptual inventory of factors associated with marihuana use. Identification of those factors, along with an analysis of demographic characteristics is designed to facilitate the formulation of drug education programs. This third phase was an administration of the inventory to sixty-parents who were also members of a community anti-drug group. Their beliefs are strong, as evidenced by their active association with the group. Factors analysis revealed a five-factor solution that utilized all thirty-four items of the inventory. Scales were again labeled Parental Limitations, Societal Issues, Inherent Predispositions, Rebelliousness, and Maturational Difficulties. Since there was a shift between parents and youths in specific items that made up the scales, it appears that drug educators will need to take parents' perceptions into account when designing programs.     

Clinical observations on interferences of early father absence in the achievement of femininity

In clinical work, we have observed that the loss of the father through divorce has a significant effect on the young girl's developing sense of feminity. This paper briefly reviews the research findings from sex-role development theory and psychoanalytic theory, and presents clinical discussions of latency aged girls whose parents divorced during their daughter's early and oedipal years. The most common defensive or coping patterns seen in these child patients during latency are identified, with clinical material presented to illustrate both the existence of these patterns and implications for treatment.     

Siblings of handicapped children

There is a strong suggestion that the siblings of handicapped children are at risk psychologically. Factors which contribute to this risk, aspects of the sibling relationship, and the siblings' issues, concerns and feelings are discussed so that professionals may have a framework within which to assess and evaluate these children's needs. Case examples are given.     

Knowledge about AIDS and reported risk behaviors among black college students

This study surveyed 975 undergraduates attending a large East Coast university during the spring semester of the 1987/88 academic year. A convenience sample of predominantly black students (94%) participated. Overall, knowledge of basic AIDS-related facts was satisfactory. Raw scores on the 25-item knowledge scale ranged from 7 to 25, with a mean of 20.5 (82%) and a mode of 22 (88%). Selected questions on how HIV is not transmitted, however, posed some problems for respondents. Less than 30% of respondents knew that the AIDs virus was not transmitted by insects; less than 80% knew that AIDS was not transmitted on toilet seats, through blood donations, kissing, and coughing. The survey also asked students whether they had ever engaged in certain behaviors that put them at risk of HIV infection. Approximately 17% of respondents had experienced anal intercourse, 6.5% reported use of heroin, 32.6% reported having had multiple sex partners, and 16% had been treated for a sexually transmitted disease. Students who reported engaging in high-risk behaviors had statistically significant lower mean knowledge scores than those who reported not engaging in those same high-risk behaviors. Results of the study support the need to increase efforts to deliver AIDS information specifically targeted to individuals who may be engaged in high-risk behaviors. Special health education programs must be designed to focus attention on risk behaviors (ie, unprotected anal intercourse) instead of risk groups (ie, homosexual and bisexual males).