The levers of influence

Physicians often determine the demand for health care services, as well as control the clinical processes aimed at improving health outcomes at the individual and population level. Given their important role in enhancing health status and improving the health care delivery system, it is critical that physician executives master the tools necessary to positively influence physician behavior. But changing behavior is far more complex than "doing it or not doing it." The Nike slogan "just do it" is motivating, but over-simplified. The roots of human change include: consciousness-raising, emotional arousal, commitment, helping relationships, self-reevaluation, reward, and environmental control. A model to effectively influence behavior is presented and includes setting clear expectations, measuring and monitoring performance, providing feedback, and rewarding and recognizing improvement. If all else fails, try discipline. This five-step approach is based on the science of human behavior and working with physicians in diverse settings, ranging from academic medical centers to small practices.     

Negative impact of sexual abuse on adult male gender: Issues and strategies of intervention

Although male sexual abuse has co-existed with female sexual abuse, the professional literature has paid minimal attention to the impact of sexual abuse of male children to their adult adaptation. This paper concentrates on the negative impact of sexual abuse on the adult male's gender identity. Examples of eight male clients' responses to sexual abuse in their adult life and the therapeutic framework utilized to work with them are discussed in the paper.This paper was originally presented at the ICAPP conference, 1993.He teaches advanced clinical practice, Human Behavior and AIDS ELECTIVE. He maintains a private practice specializing in Gay men, persons with HIV virus.     

Pollution disclosures,pollution performance and economic performance

This study examines the association between pollution disclosures and pollution performance and between pollution disclosures and economic performance for firms in highly polluting industries. An index of pollution disclosures is developed and correlated with indices of pollution performance and economic performance. The results confirm earlier findings that there is no association between pollution disclosures and pollution performance. As far as the association between economic performance and pollution disclosures is concerned, the results show that the subgroup of large firms with poor economic performance provides the most detailed pollution information. For smaller firms there is no association between economic performance and pollution disclosures.     

Book Review

Book reviewed in this article:
Daniel P. M oynihan , Maximum Feasible Misunderstanding: Community Action in the War on Poverty. N.Y.: Free Press, 1969. xxi, 218 pp. $5.95.     

Freedom of choice and diversity of options: Some difficulties

This paper explores the possibility for a (non-preference-based) freedom ranking of opportunity sets that is sensitive to the diversity of the options. It turns out that how distances between sets and alternatives are measured is crucial to the derivation of such a ranking. Several proposals are examined, each of which is shown to lead to impossibility results. Earlier versions of this paper were presented at conferences in Kortrijk, Osnabrück, Oisterwijk, Caen and Pavia. I thank the participants at these conferences for their comments. I would also like to thank Steven Hartkamp, Theo Kuipers, Clemens Puppe and especially Kotaro Suzumura for their helpful comments. Furthermore, I am very grateful to Somdeb Lahiri for pointing out a mistake in a previous version of this paper.     

Musculoskeletal symptom survey among cement and concrete workers

Work in construction is associated with a high risk for musculoskeletal disorders and injuries. The symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the cement and concrete workers and identify the most problematic work-related activities and job factors that might have contributed to the occurrence of these disorders. Findings revealed that a large proportion of the laborers (77%) experienced at least one musculoskeletal disorder in the last year. Low back pain was reported as the most frequently experienced symptom (66%). 'Working while in pain' the concrete workers perceived as the major problem in the trade. Other problematic work-related activities included 'bending or twisting the back', 'work in hot, cold or wet conditions', and 'handling heavy objects'. Most of the laborers (82%) requested on-the-job safety training. Survey results combined with the outcomes of focus groups discussions and work site observations were used in the design of a training program aimed at the prevention of musculoskeletal morbidity in the trade. The program incorporated ergonomics principles, hazard recognition, safe work practices, problem solving and personal protection in the training curriculum for membership of the trade.