The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

SOURCES OF INFLUENCE AND TOPIC AREAS IN FAMILY THERAPY: TRENDS IN THREE MAJOR JOURNALS

Following Gurman (1981), this study reports on authors and topics of interest in prominent marriage and family therapy journals from 1980 through 1995. Fifteen of the 25 institutions that produced the greatest number of authors prior to 1978 continued to be among the top 25 between 1980 and 1995, and the 25 leading institutions produced 29.5% of articles from 1980 to 1995. Most authors held positions in university settings and taught in programs with a marriage and family therapy focus. Clinical issues were the most common focus of articles (61%), and one-third of all articles were research reports.     

Randbemerkungen zum Ambiente des Kongresses

Ohne Zusammenfassung     

The differential use of metaphor in psychotherapy

Metaphor is seen to play a significant role in psychoanalytic theory and technique. While acknowledging this view, this paper examines the differences in which individuals of varying developmental profiles, experience, comprehend and use metaphor in the context of psychotherapy. Differences in the capacity to play, adaptively regress, regulate affect, maintain ego boundaries, and symbolize, are found to affect capacities to employ those figures of speech in words or phrases literally denoting one type of object or idea but used in place of others by suggesting likenesses or analogies. A rationale for differential use of interventions involving metaphor is offered.     

Controlling type 1 error rate for sequential,bioequivalence studies with crossover designs

Sample size reestimation in a crossover, bioequivalence study can be a useful adaptive design tool, particularly when the intrasubject variability of the drug formulation under investigation is not well understood. When sample size reestimation is done based on an interim estimate of the intrasubject variability and bioequivalence is tested using the pooled estimate of intrasubject variability, type 1 error inflation will occur. Type 1 error inflation is caused by the pooled estimate being a biased estimator of the intrasubject variability. The type 1 error inflation and bias of the pooled estimator of variability are well characterized in the setting of a two‐arm, parallel study. The purpose of this work is to extend this characterization to the setting of a crossover, bioequivalence study with sample size reestimation and to propose an estimator of the intrasubject variability that will prevent type 1 error inflation.     

The story of Lucy: lessons learned,lessons taught

ABSTRACT

This article provides an extended case example highlighting the value of a supportive approach to practice, in addition to the importance of holding a psychodynamic developmental frame of reference. Concepts of repetition compulsion, the holding environment, and object constancy are applied to the clinical material. The case is underscored for its value as a teaching tool.     

Elderly migration: For sun and money

Discussions about elderly migration and its implications for growth planning tend to neglect the role of economic forces. Our view is that cost-of-living variations among states give elderly households on fixed incomes an incentive to move that closely resembles the effects of wage opportunities on workers who migrate. To test this view, we employ a state-by-state index of cost of living for a retired couple to explore its impact on migration choices of the elderly. The effects of cost of living on migration are investigated in terms of the probability that an elderly person will move out-of-state during a five-year period and the probability that a given state will be chosen as destination once a decision has been made to migrate. The influences of cost of living at both origin and destination are strongly confirmed.     

Elderly migration: For sun and money

Discussions about elderly migration and its implications for growth planning tend to neglect the role of economic forces. Our view is that cost-of-living variations among states give elderly households on fixed incomes an incentive to move that closely resembles the effects of wage opportunities on workers who migrate. To test this view, we employ a state-by-state index of cost of living for a retired couple to explore its impact on migration choices of the elderly. The effects of cost of living on migration are investigated in terms of the probability that an elderly person will move out-of-state during a five-year period and the probability that a given state will be chosen as destination once a decision has been made to migrate. The influences of cost of living at both origin and destination are strongly confirmed.