Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Fit and Skill in Employee Selection: Insights from a Study of Headhunters

We draw upon evidence from a qualitative study of headhunters to provide insights into the character and importance of candidate fit and skill for the selection of a broad range of white-collar employees. Headhunters suggest that the fit of a job candidate is assessed at two levels, one corresponding with a general compatibility with organization-level norms, culture, and strategy, the other corresponding more closely with traits and characteristics of the person or persons with whom the job candidate actually interviews. Skill—a factor which is largely neglected by those who tout the importance of fit—also plays an important and independent role in employee selection. Stalls that influence the selection of employees from a pool of candidates tend to be highly specific if not idiosyncratic, and take the form of what headhunters call hot buttons. We conclude by discussing the conceptualization, causes, and implications of fit; we also consider how the importance of fit and hot buttons challenges the explanatory logic of standard accounts of labor-market success.     

Severely Traumatized Siblings: A Treatment Strategy

Siblings who have suffered severe trauma and disrupted attachment relate to one another in ways that interfere with individual development, the chance to benefit from connections with adults, the establishment of healthy sibling relationships, and the working through of traumatic experiences. The authors use case examples to illustrate four distinct sibling patterns: absent, adult lockout, half and half, and trauma shield. The authors highlight the importance of recognizing these types and then varying the therapist's treatment stance to pursue five goals. These include suspending problematic sibling relationships to create room for bonding with caring adults, transferring attachment behaviors and impulses to a receptive adult, resuming healthy individual development, forming more adaptive sibling connections, and expressing shared traumatic content.     

Euthanasia and persistent vegetative state individuals: the role and moral status of autonomy

This paper offers a philosophical consideration and evaluation of several different criteria of moral standing, and discusses their implications for persistent vegetative state (PVS) individuals who were once competent. It is argued that the only criterion PVS individuals meet is that of being human, which is not the best test of moral standing. Accordingly it is, in principle, morally acceptable to perform passive or active euthanasia on PVS individuals or to use their bodies for research or for organ harvest. Nevertheless, the autonomous choices made by the persons the PVS individuals used to be can still impose moral obligations. Indeed, it is argued that the capacity for autonomy is a particularly appealing criterion of moral standing, and that the implications of this standard for PVS individuals confirm that appeal.     

Mandatory seat belt laws in the states. A study of fatal and severe occupant injuries

This study examines the impact of mandatory seat belt laws on fatal and incapacitating injury rates in the states. Annual data for all 50 states for the period 1975-1991 are used. Pooled time series analysis is employed. The general conclusion that emerges from this analysis is that seat belt laws significantly impact state fatal injury rates. Primary enforcement and all-seat coverage provisions appear to be particularly effective in reducing fatality rates.     

The implementation of the healthy cities project in developing countries: lessons from Chittagong

The Chittagong Healthy City Project was carried out in late 1994 in Chittagong, Bangladesh. This paper presents findings of an evaluation of the project based upon internationally generated process indicators related to the institutional aspects of the project. The following issues are discussed with regard to project implementation: the institutional organization of local authorities, institutions' conceptual understanding of the project, formal insertion of the project into public authorities' activities, institutional leadership of the project, central-local relations, the lack of interministerial coordination, the project's office, international projects, and community organization. Giving consideration to these issues may help program planners detect problems in forthcoming projects prior to their implementation.     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

Ways of thinking about the long-term care of the baby-boom cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

Statistics in epidemiology: the case-control study

This article presents a general review of the major trends in the conceptualization, development, and success of case-control methods for the study of disease causation and prevention. "Recent work on nested case-control, case-cohort, and two-stage case control designs demonstrates the continuing impact of statistical thinking on epidemiology. The influence of R. A. Fisher's work on these developments is mentioned wherever possible. His objections to the drawing of causal conclusions from observational data on cigarette smoking and lung cancer are used to introduce the problems of measurement error and confounding bias."