ESTIMATING THE NUMBER OF VISITS TO THE DOCTOR

The frequency of doctor consultations has direct consequences for health care budgets, yet little statistical analysis of the determinants of doctor visits has been reported. We consider the distribution of the number of visits to the doctor and, in particular, we model its dependence on a number of demographic factors. Examination of the Australian 1995 National Health Survey data reveals that generalized linear Poisson or negative binomial models are inadequate for modelling the mean as a function of covariates, because of excessive zero counts, and a mean‐variance relationship that varies enormously over covariate values. A negative binomial model is used, with parameter values estimated in subgroups according to the discrete combinations of the covariate values. Smoothing splines are then used to smooth and interpolate the parameter values. In effect the mean and the shape parameters are each modelled as (different) functions of gender, age and geographical factors. The estimated regressions for the mean have simple and intuitive interpretations. However, the dependence of the (negative binomial) shape parameter on the covariates is more difficult to interpret and is subject to influence by extreme observations. We illustrate the use of the model by estimating the distribution of the number of doctor consultations in the Statistical Local Area of Ryde, based on population numbers from the 1996 census.     

Psychiatric Rehospitalization of Children and Adolescents: Implications for Social Work Intervention

This study explored factors associated with the psychiatric rehospitalization of children and adolescents. A retrospective archival review was conducted on 403 children and adolescents admitted into an inpatient psychiatric hospital. Results indicated that 16% were readmitted in the same year. Children and adolescents who had a prior history of psychiatric rehospitalization, lived in a residential treatment facility, and had a diagnosis of oppositional/defiant or conduct disorder were more likely to be rehospitalized. Psychosocial factors must be considered in predicting and preventing psychiatric rehospitalization. Clinical social workers should include therapeutic foster care as an option for aftercare placements of youth exhibiting externalizing behaviors and/or with a history of multiple restrictive care placements.     

Comparing Intake Concerns and Goals With Career Counseling Concerns

The authors investigated the relationship among clients' intake concerns, intake goals, and career counseling concerns. Results indicated that intake goals focused primarily on resolving D. E. Super's (1957) exploration stage tasks, but concerns included education‐related issues and ego dystonic emotions related to work. Intake concerns and goals were not related to the content of career counseling. Implications are discussed.     

Bovine Spongiform Encephalopathy Maternal Cohort Study—Exploratory Analysis

The bovine spongiform encephalopathy (BSE) maternal cohort study supports a role both for direct maternal transmission and for inherited genetic susceptibilty to the BSE agent. Additional data from the main BSE database do not resolve whether the risk of direct maternal transmission of BSE from dam to calf is concentrated in the interval within 5 months before the onset of BSE in the dam, as data from the BSE maternal cohort study suggest. The reason for this is that we cannot rely, as our analysis requires, on the survival of calves or traceability of the dam being independent of the interval from the birth of a calf to onset of BSE in the dam. Accordingly, for the present, we place most weight on evidence from the BSE maternal cohort study. Direct maternal transmission of the BSE agent from dam to calf has not been ruled out; vertical transmission of the new variant Creutzfeldt–Jakob disease (NVCJD) from mother with NVCJD to baby is therefore also possible. Actions to quantify, and minimize, the transmission risk, if any, from a mother with NVCJD to her baby, or to delivery teams, should be taken without delay.     

Efficient solutions to bargaining problems with uncertain disagreement points

We consider a cooperative model of bargaining where the location of the disagreement point may be uncertain. Based on the maximin criterion, we formulate an ex ante efficiency condition and characterize the class of bargaining solutions satisfying this axiom. These solutions are generalizations of the monotone path solutions. Adding individual rationality yields a subclass of these solutions. By employing maximin efficiency and an invariance property that implies individual rationality, a new axiomatization of the monotone path solutions is obtained. Furthermore, we examine the consequences of employing efficiency axioms based on alternative decision criteria. Received: 17 March 2000/Accepted: 15 January 2001     

Differentiation Levels of College Students: Effects on Vocational Identity and Career Decision Making

This study assessed the effects of differentiation levels on the career development of college students. Participants were 231 college students who completed the Differentiation of Self Inventory (Skowron & Friedlander, 1998 ), My Vocational Situation (Holland, Daiger, & Power, 1980 ), the Career Decision Profile (CDP; Jones & Lohmann, 1998 ), and demographic questions. The results supported the hypotheses that higher levels of the various components of differentiation would predict higher levels of vocational identity and fewer difficulties with career decision making. In particular, lower levels of emotional cutoff and emotional reactivity and higher levels of “I position” predicted higher levels of vocational identity and career decision making. Results suggest a more complicated picture for fusion, with higher levels being predictive of lower levels of decisiveness but not significantly related to vocational identity. Implications of the results for career counselors are provided.