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The article examines abstracts of papers submitted but not included in the program of the annual meeting of the American Public Health Association, Medical Care Section, 1962. Some of these are "Experiences and Activities at a Medical Computing Center," by L.D. Cady, M.A. Woodbury, and L.J. Tich and "An Internist's Experiences With Medical Care of Welfare Patients in Proprietary Nursing Homes," by Sidney M. Greenberg. The first abstract focuses on the center that is cooperating with investigators in the area of mathematical and theoretical analysis and statistical data handling and analysis, information coding, keypunching and storage of medical data for further study and retrieval. The second abstract contains observations of the medical, nursing, and administrative practices in four nursing homes as made by an internist responsible for the medical Scare of welfare patients in these homes. In evaluating these activities the recognition and meeting of the patient's total needs was utilized as the criterion of quality of performance.

This is the second of two papers which involve a "triangulation" on medical performance in an effort to test the proposition that organizational stratification is related to hospital care. The triangulation consists of the measurement of performance from the subjective, reputational, and objective points of view. The present paper presents evidence based upon the objective medical records. The evidence is organized around a conception of the hospital as an institution performing seven key functions. Criterion measures related to these seven functions are examined, and it is shown that units which differ in their degree of stratification also differ in their performance with respect to a number of these criteria (e.g., the length of patient stay, and the use of the consultation process). Taken together, the two papers show that when performance is independently measured in three fundamental ways, there is a basic congruence which supports the proposition that the degree of stratification of organizational units is related to variations in task performance. [ABSTRACT FROM AUTHOR]

To be meaningful social indicators must be components of some social systems model so that changes in the values of these social statistics over time tell us something about the functioning of the social system. A necessary next step in developing social indicators is constructing models involving interrelated sets of social indicators in each major institutional area of society. This paper reports an initial effort to derive a set of social indicators for the area of health care. A structural equation model has been constructed fox the health care system serving the state of New Mexico. The model includes a network that specifies the causal relationships hypothesized as existing among a set of social, demo graphic, and economic variables related to the availability and use of health services and to health status; a set of structural equations that indicate the direct effect of variables in the model on each endogenous variable; a set of reduced form equations that indicate the combined direct and indirect effect of each predetermined variable on each endogenous variable included in the model. The model can be used to provide monitoring information pertaining to the effect of a change in a particular variable on all other variables comprising the health care system. Also it provides explanatory information regarding the differences in the availability of health care services, their use, and the health-status of the population in various counties. Finally, predictions of the effects of alternative health care policies that would affect the supply, the organization of care, or patterns of use of health services can be made based on the model. [ABSTRACT FROM AUTHOR]

This paper develops hypotheses regarding the impact of select organizational factors on the distribution of service among applicants to health or welfare agencies. It is hypothesized that agencies with more control over exchange with their environments, i.e. more "boundary control," will under conditions of surplus applicants choose to serve smaller and more homogeneous applicant populations. Also, applicants will tend through referral and rejection processes to flow from agencies with high boundary control to agencies with low boundary control. The extensiveness of agency domains is hypothesized to be directly related to both the size of the applicant populations and the number of applicants serviced. Finally, the size of "domain discrepancy" is seen as directly related to the proportion of applicants rejected and referred. The necessity to relate other organizational characteristics to referral and rejection patterns is stressed. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

Much research has been done in the past fifteen years on the effects of medical education, viewed as professional socialization. Although the significance of social origins, viewed as early sources of socialization, is recognized, there has been little empirical research on the effects of specific background characteristics on specific attitudes, behavior, and careers of professionals. This paper examines the effects of practicing physicians' socioeconomic and religious background on their concern with success values and on their political ideology, including their attitudes toward government participation in medical care. [ABSTRACT FROM AUTHOR]

This paper takes note of the convergence of both research and opinion supporting the assertion that perceived symptoms and ability to pay are the major determinants of health services utilization. Four reservations pertaining to this body of evidence are offered and research supporting the role of cultural factors in determining the utilization of services is cited. Several cultural barriers to the full utilization of services are discussed. [ABSTRACT FROM AUTHOR]

Increasing professionalization of the occupational structure and increasing pressures for organizational innovations of various types suggest the importance of understanding the factors influencing variability in the responses of professionals to organizational innovation efforts. This paper reports the results of a study designed to explore this issue in the context of the health care system. Variability in the responses of practicing physicians to an organizational innovation is examined in light of a number of hypotheses derived from the literature on adoption of innovation. The findings support five of the sit hypotheses tested, and suggest that receptivity to organizational innovation in professionally dominated systems is influenced by factors similar to those in other systems. [ABSTRACT FROM AUTHOR]

In this paper a behavioral model consisting of sociodemographic, economic, ecological, need, and social psychological variables is developed and used to account for differential patterns of health and illness behavior among members of a pre paid medical group. Data from a sample of students who were enrolled in a university health plan were used to estimate parameters of structural equation models for males and females. The model suggests that social-psychological factors, such as symptom sensitivity and students' appraisal of the services provided, affect the extent to which they seek outside medical care. While medical need and insurance coverage both directly affect the choice of health services, sociodemographic and ecological factors appear largely to affect utilization indirectly through their effect on intervening social-psychological variables. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various research papers published in the June 1961 issue of "Journal of Health and Human Behavior." One of the abstract discusses the relationship between and intrapsychic processes. Another abstract presents a study which attempts to ascertain, and account for, the presence of significant differences in knowledge of attitudes toward mental disease between a sample of high school boys and one from a boys' reformatory. The purpose of one of the papers on hospital-patient relationships is to clarify the precise nature of the relationship between mental hospitals and patients and to compare and contrast it with the relationship between medical hospitals and patients. Another paper on mental hospitals presents information about four types of "pathway" organizations which seek to assist in the transitional period between the discharge of a mental patient from a hospital and his re-entry into community life. The four general types considered are day hospitals, halfway houses, sheltered workshops, and ex-patient organizations.

In the course of a study of the medical profession in Soviet society undertaken as part of a larger project on the Soviet Social System by the Russian Research Center, it was decided to tap former Soviet citizens' attitudes as patients toward the Soviet system of medical care and the Soviet physician. Refugees were asked to fill in a medical questionnaire in Russian. Two-thirds of these were administered in Munich and the rest, in New York. There can be no question but that the use of refugees as informants presents methodological problems. Disaffected people are hardly the type to give the West an objective picture of Soviet society. Moreover, there is often a suspicion that refugees tend to flatter Western inquirers by telling them what they think will please them, rather than the truth about the Soviet system. The present paper is limited to delineating certain meaningful patterns within the sample at hand. Finally, as will be seen below, if it is assumed that the refugee sample was strongly and consistently biased against the Soviet Union and its institutions, or that it consistently tended to flatter the U.S. and its institutions. then this assumption is certainly not borne out by the evidence.

This paper investigates the relationship between attributes of thirty-two innovative health services and their level of implementation in a national sample of hospitals and health departments. It was found that services implemented in hospitals are primarily characterized by high payoff, a low rate of cost recovery, and low social approval. For health department services perceived primarily as having high divisibility, a high association with the preventive orientation of the department, and a relatively low payoff had a high level of implementation. The respective attribute patterns accounted for 58 per cent of the variance in the implementation of health services in hospitals and 50 per cent of the variance in health departments. [ABSTRACT FROM AUTHOR]

This paper analyzes the relationships among participants' organizational affiliation, the nature of their representation, and the orientation of their attitudes within the decision making process of eight Model Cities health programs. The data were collected by means of content analysis of the Model Cities documents and personal interviews with the participants. Formal representatives of provider organizations are the most likely to have an orientation that can be predicted by their organizational affiliation. Informal representatives of provider organizations tend to act in terms of their own self perceptions and attitudes, which might be consumer or provider oriented. Representatives of consumer organizations are consistently consumer oriented in their perceived roles and attitudes regardless of the nature of their representation. The findings are discussed in terms of their implications for the selection of representatives in a community decision making process. [ABSTRACT FROM AUTHOR]

When do people see a doctor? At one extreme, blatant pathology and extreme pain will, with few exceptions, bring one to a doctor in those societies where doctors are available (with the possible exception of mental illness). At the other extreme, a small portion of the visits are accounted for by a preventive health orientation, where no symptoms have been perceived. But, as Zola points out (1966, 1968), "we find that the vast bulk [of a physician's load] is concerned with quite minor disorders." There is, on the other hand, he notes, a great body of data which show that there is much illness, defined as such both clinically and subjectively, which is not brought to the attention of the physician. What Zola is saying, then, is that the potential for entry into patienthood is extraordinarily widespread and continuous. One can be ill, clinically speaking, without going to the doctor; or one can go to the doctor, either without any particular change in one's clinical condition or even without any particular justification from the point of view of the physician. If variations among individuals, social subgroups, or societies in visiting rates cannot be explained, within limits, by variations in clinically-determinable morbidity, what are the factors that can predict such variations? It is the purpose of this paper to present a model which, though derived from the case of Israel, should be applicable to other societies as well. [ABSTRACT FROM AUTHOR]

This paper examine the influence of variations in outpatient clinic control structure on physician' perception of conflict in there teaching and three community hospital pediatric clinics. In previous work, professional control has been equated with autonomy, or freedom from hierarchical direction. Defining controls as freedom to direct clinic policies and staff, the authors found:(1) higher levels of both physician and total staff control in community than in teaching hospital clinics; (2) higher levels of control associated with indepented with lower levels of coflict;(3) no relationship between physician autonomy and either the independent or dependent variables. It is suggested that control facilitates the staff coodination that is essential to patient care in ambulatory clinics, and that community hospital clinics provede a more favorable environment for the exercise of control by clinic staff. [ABSTRACT FROM AUTHOR]

This paper examines the timing of a patient's release from a state mental hospital and the relationship to his family's desires for discharge or further hospitalization. Family wishes concerning release are found highly related to length of hospitalization, whether or not the patient is seen professionally as dangerous, highly psychiatrically impaired, or in need of further hospitalization. Psychiatrists for a variety of reasons, it is argued, weigh family desires very heavily when making release decisions, making family wishes a significant factor in the length of a patient's hospitalization. [ABSTRACT FROM AUTHOR]

Bureaucracy is frequently viewed as being detrimental to certain aspects of professionalism. This paper examines the relationship between bureaucratic structure and degree of professional autonomy within the client-professional relationship. Perceived autonomy of physicians in three types of bureaucratic settings—non-bureaucratic, moderately bureaucratic, and highly bureaucratic—are compared. The data reveal that those associated with the moderately bureaucratic setting are most likely, and those in the highly bureaucratic setting are least likely, to perceive themselves as autonomous. These findings suggest that there is an optimal level of bureaucratic organization with respect to professional autonomy within the clientprofessional relationship. [ABSTRACT FROM AUTHOR]

This paper presents some findings from a sample survey dealing with bases of choice between Blue Cross-Blue Shield Comprehensive Plan and Community Health Association group practice plan by auto workers in the Detroit Metropolitan Area. Two independent probability samples were drawn to represent the choice groups, and different sampling rates were utilized to equalize sample sizes for group comparisons. Analysis focuses on such factors as selectivity in the type of people who are drawn to group practice; differences in desire for extension of coverage: and association of choice with frequency and intensity of perceived features of health plans. A major conclusion of the study is that most persons selected their plan on the basis of pragmatic and specific rather than ideological and general criteria. [ABSTRACT FROM AUTHOR]

This paper examines changes the structure of the medical profession in Finland. Using questionnaire data from 93 per cent of the total population of Finnish physicians, the consequences of these changes, both for the physicians and for the country as a whole, are discussed. [ABSTRACT FROM AUTHOR]

The American Sociological Association (ASA) co-operated with the American Association for the Advancement of Science in the annual meeting, December, 1961 by contributing two sessions on Medical Sociology to the Program of Section K-Social and Economic Sciences. The papers in this symposium were devoted to discussing some of the major problems that have emerged as foci of interest in the rapidly developing collaborative relationships between the social sciences and the health and medical professions. One dramatic indication of the phenomenal growth of these relationships is the fact that the recently established Section on Medical Sociology of the ASA now has over 700 registered members, the great majority of whom are engaged in research in one or another aspect of the health field. The administrative sciences are those disciplines that are useful in planning, organizing, and facilitating the provision of health and medical services, and Demerath identified six focal points in medical-care administration where strategic applications can be made of the research findings of these disciplines.

The article presents information on studies by researchers at the Princeton University regarding labor and industrial relations in 1974. An investigation on the effect of manpower training programs on trainee earnings is being conducted by Orley Ashenfelter. The manuscript "The Human Nature of Organizations," by J. Douglas Brown focuses on the basic principles of industrial relations policy. Richard Lester is preparing a manuscript on the impact of equal employment opportunity legislation on the faculty and administrators in universities. Herman Somers is involved in a study of Canadian national health insurance as part of a long-term study of foreign health care systems. Yoram Weiss is completing two papers on the effect of risk on educational and occupational choice.

Three types of hospitals that deliver short-term health care are discussed in terms of several different models of hospital behavior. The structure-specialization model emphasized hospital control structure as a determinant of goal emphasis, while the exchange model stressed the interdependencies between the organization and essential resource suppliers in its environment. In so far as the models differed, the exchange model was supported by aggregate data (obtained from the American Hospital Association). Additionally, a competence model emphasizing the possibility that certain hospital types may perform relatively well on several dimensions was partially confirmed. Suggestions are forwarded for future research along these lines. [ABSTRACT FROM AUTHOR]

The relative importance of the determinants of physician utilization was examined using data obtained from a community health survey of 2,168 households in five New York and Pennsylvania counties. Eighteen variables, including individual and organizational attributes, were selected to determine the causal ordering of these variables in predicting use of physicians' services. It was found that the need for care, average cost per visit, health insurance coverage, and age have strong direct effects on physician utilization. The other variables had either an indirect or a negligible influence. The path analysis employed in this study reveals the great potential contribution of sociological methods in health services research. [ABSTRACT FROM AUTHOR]

There is a significant lack of patient-centered studies in current socio-medical research, and also very little use made of experimental designs. As a departure from this trend, this paper presents the design and result s of a clinical experiment indica-. ting greater effectiveness of a patient-centered nursing approach used to administer a standard nursing procedure. [ABSTRACT FROM AUTHOR]

Previous theory and research in role conflict provided empirical tools and hypotheses regarding conflict resolution. A pencil-and-paper conflict situation was administered to workers in a mental hospital, a setting previously described as conflict- ridden. A positive association was found between mode of conflict resolution, ideology and worker's effectiveness as a hospital employee. [ABSTRACT FROM AUTHOR]

This paper examines the internal and external stresses which accompany the gradual shift of responsibility from local boards of health to a possible eventual domination by the state health department. Fifty seven members of boards of health in 14 communities in one county in Eastern Pennsylvania were interviewed on the present functions of the local boards of health. Our finding suggests that the local board of health is not simply an organization. It is symbolic of a way of life in a community and it represents many things-a part of town, individualism, self-rule. [ABSTRACT FROM AUTHOR]

In the health insurance movement, the provision of drugs has been one of the medical needs least well met. One prepaid medical care plan has pioneered in an effort to meet this need, and its precise experience is reported in this paper. [ABSTRACT FROM AUTHOR]

The article discusses the primary objective of the workmen's disability income system in the U.S. which is to provide a back up of the source of family income in cases where earnings are interrupted because of the employee's disability. The workmen's compensation is a program which offers benefits such as cash or medical care to victims of work-connected injuries. The injured employee may be paid in several ways such as public income-transfer programs or through private supplements like workmen's compensation, sick-leave pay or payments under a private insurance program. Although the workmen's compensation program was acclaimed to be an excellent way to deal with industrial injuries, it has been fired with controversy.

Whether there is a shortage of physicians is an issue which has been widely debated in recent years. Examining the economic position of physicians in relation to the rest of society, the author of this study finds that there has been a significant rise in the relative income of physicians, along with a search for less costly substitutes for their services, and concludes that a shortage does currently exist. [ABSTRACT FROM AUTHOR]

As this note is being written, a proposal to provide health insurance to retired workers under Social Security—the Forand bill—is being vigorously debated. Although health care for such workers involves some special considerations, the arguments of the proponents of this bill and the massive support being marshalled for its passage are symptomatic of general concern over voluntary health insurance. The dilemma threatening the survival of many of these voluntary programs is that costs tend to outstrip their ability to provide the quantity and quality of health care demanded by the groups they serve. In this discussion, the authors attempt to identify the major problems currently at issue in voluntary health insurance and to describe and appraise some administrative innovations that have been made in a few instances to control costs and improve the quality of medical and hospital care. [ABSTRACT FROM AUTHOR]

The article presents information about this special "Medical Care Issue," which presents reports of several specific programs that illustrate contributory streams in this larger movement of medical care organization. The variety in the movement derives from locality as well as content. One report in this issue comes from the Appalachian coalfields, where new forms of consumer-sponsored prepaid group medical practice are evolving. Another comes from the nation's capital, where a long established health insurance plan has added drugs to its benefits. Another comes from New York City, where organized "home care" has been explored, for the first time as a feature of hospitalization insurance. Another comes from Southern California, where efforts are being made to up-grade the quality of nursing homes. Another comes from a college town in Kentucky, where a great new medical center is being established. Two papers of generic orientation are then presented: one is on the economic characteristics of health services and how they differ from other services or commodities. The final paper offers a review of sociological research conducted on the organization of medical care over the years.

An examination of community mental health ideological variations among staff from a national sample of community mental health centers, their perceptions of their organization's position on a social service/medical continuum, and relationships between ideology and organizational structures indicated highest ideological adherence within rural areas, under agency/board structures, among social workers and psychologists and among those positioning their organizations closer to social than medical services. Theoretical and policy implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

A Guttman scale was constructed to measure attitudes of Yale University School of Medicine students and graduates toward possible changes in the organization and delivery of medical care in the United States. When analyzed by multiple regression, the best predictors of a respondent's score on this scale were his political ideology, the organization of his medical practice and whether or not he was still in medical school Type of specialty, father's political philosophy and whether or not a respondent was or planned to become an AMA member were strongly correlated with political ideology. Many other factors did not have independent correlations with attitudes when subjected to multiple regression analysis. The striking intraprofessional variations found in medical and political attitudes document the heterogeneity of American doctors. Any spokesmen for the medical profession should recognize that such heterogeneity exists. [ABSTRACT FROM AUTHOR]

Hypotheses explaining the link between SES and preventive health care were tested; and a preliminary predictive model for preventive health behaviour was developed. Variables relating to childhood socialization, social participation, work self-direction, work constraints, powerlessness-painfulness, and health knowledge were included as were several demographic variables. Separately, none of the explanatory variables greatly accounted for the influence of SES. combined, however, they accounted for about half of the variance of SES. Together, education, age, income, and social participation (in that order) were found to provide the most parsimonious set for predicting general preventive health behaviour. [ABSTRACT FROM AUTHOR]

This article discusses the administration and management of school and college health services. Various studies and researches have indicated the rapid rise of health services in schools. It is the most important role and responsibility of school health services to appraise and improve student health particularly on students': (1) eyesight; (2) hearing; (3) nutrition; (4) growth; (5) dental health; (6) mental and emotional health; and (7) other health concerns. Additionally, schools have instituted communicable disease control to prevent the spread of disease in the campus. Finally, areas of needed research have been pointed out in the hope that future investigations may bring solutions to some of unsolved school and college health problems.

The effects of seeking help for problems of disturbed behavior are examined to determine the extent to which attidudes toward an individual exhibiting symptoms of mental illness are predicated on knowledge of the particular help-source that the individual is consulting. The term "help-source" refers to the clergyman, the physician, the psychiatrist, and the mental hospital. A Graeco-Latin Square design, used with 300 respondents, provided a large amount of information from a relatively small number of observations. The findings indicate that individuals described as exhibiting identical behavior are increasingly rejected as they are described as utilizing no help, utilizing a clergyman, a physician, a psychiatrist, or a mental hospital. [ABSTRACT FROM AUTHOR]

The article studies the presence of arationality and ignorance in the prevention and treatment of an illness. Medical care is an especially fertile area for an examination of some of the critical variables related to arational behavior. A measure of arationality was made possible by asking each respondent to recall the manner in which she treated her child or children. Open-ended questions and check lists were also administered in order to elicit hypothetical responses. In an attempt to measure a general form of arationality, each respondent was asked to name persons other than medical doctors from whom she sought help or counsel in treating an illness. Those named, in order of frequency, are clergymen, pharmacists, nurses, and chiropractors. The evidence indicates that when the respondent did not perceive her child's illness as serious she tended to consult one or more of these other individuals. Evidence on the basis of an empirical investigation done in an American city supports those who argue that the use of arational behavior patterns recedes as modern civilization unfolds.

Alienation, defined as subjectively experienced powerlessness to control one's own work activities, is examined among the nursing force of a large mental hospital. It is found that alienation is intensified where authority relations are such as to limit the reciprocal influence of subordinates. This is reflected in situations where there is great positional disparity between superordinates and their subjects, where authority is exercised in a peremptory fashion and where authority figures are physically inaccessible. Career experiences within the hospital opportunity structure are also related to alienation; limited achievement and dissatisfaction with extrinsic work rewards are alienative conditions. Finally, personnel working in isolation and without outside social ties to fellow workers are more subject to intense alienation. [ABSTRACT FROM AUTHOR]

Among relatives of formerly hospitalized patients, attitudes toward the etiology of mental illness, the mental hospital, the normaley of former patients, and the responsibility of patients for their condition were assessed by means of short, structured scales. These attitudes were found to be associated with education, age, and verbal ability. There was no relationship, however, between these attitudes and social class, independent of education. The analysis suggests that "enlightened" attitudes toward mental illness can be more parsimoniously accounted for on the basis of differential verbal skills than on the basis of differences in "style of life." Attitudes of relatives were also found to be associated with the post hospital behavior of the patients. Difficulty may be anticipated in implementing procedures to modify the attitudes of patients' family members, for their attitudes appear to be "rooted" in a set of diverse elements that includes socialization as well as situational variables. [ABSTRACT FROM AUTHOR]

The image of an occupation is primarily defined for the prospective entrant by those of its activities which are known to the general public, either directly or through media of communication. Training for occupations typically is acquired with respect to "job families" and not for specific occupations. Vocational preparation and occupational choice are rarely made for a highly specific occupation: few people prepare themselves and make plans for becoming refrigerator repairmen, stock analysts, or public health officers; more likely they think of preparing for mechanical work, business, or medicine. Thus, a prospective entrant into the labor force usually is unfamiliar with the many possible fields open to him and has a vague or distorted view of those occupations with which he is relatively familiar. Specialization in medicine is a strategic area in which to study the crystallization of occupational choice. For professions prescribe definite courses of training: pre-professional, general professional, and specialized.

How satisfactory it may be for aged parents to live with their children depends in part upon the attitude of the younger generation toward their responsibility for the care of their elders. Children who did not want to accept the obligation, but who did so anyway, because of family tradition, community opinion, or legal requirement might carry out the role with such little grace or with such manifest ill will as to make the parents aware of not being wanted or as to lead to friction and major conflicts. The attitude of children toward taking care of aged parents also has implications for the law of support, for its administration, for public housing for old people, and for the medical care of mentally deficient or bedridden cases. These implications are particularly noteworthy if the assumption is made that there should be or eventually will be a definite relation between what the children want and what the law or its administration requires. If children do not believe they should extend home support to their aged parents, then, the question of what substitutes the State should provide, becomes pertinent.

A physician is the crucial factor in the organization and functioning of social institutions for health maintenance. The availability to the population of his skilled services, as well as his counsel and leadership in community organization, are antecedent to the achievement of desirable goals in the matters of health. While hospitals, clinical and other facilities are vitally important, it is needless to point out that they are secondary in importance to the professional personnel which mans them. With the maintenance of the public health assuming such major importance in the present national crisis, some knowledge of general trends in the distribution and characteristics of medical personnel in peace time should be of value. The distribution of physicians is shown to be inversely related to the fertility of the population; that is, the regions with the higher fertility ratios had the fewest doctors in proportion to the population, while the areas with lower fertility had relatively more doctors. The departure of physician from rural areas is undoubtedly related to economic factors. If medical care is to be regarded as of equal social importance to education, social action to make rural service more attractive to the professional personnel seems highly justified.

At the present stage in the study of mental causes it is relevant to explore the possibilities in measuring provisions for state care of mental patients and in setting up indices of the adequacy of this care. The problem of institutional adequacy has been generally considered an individual one in each state. Statements of relative provisions for care expressed in quantitative terms give a reasonable basis, however, for comparisons among states. The methods described of rating state hospital provisions and care is tentative. They constitute an exploratory approach to an objective alignment of the states and will serve as a point of departure for further studies which ultimately should be of use in determining to what extent provisions for care actually are related to differential rates of first admissions to state hospitals. The states rank about as would be expected on the basis of general knowledge concerning differential hospital care and other social factors. This fact together with the consistency found between the indices of personnel and of expenditures attests to their reliability. The indices used appear to have a logical basis for inclusion. Moreover, the data utilized were secured under uniform conditions, the schedules being filled in the 1922 survey by persons employed in the various institutions and in the 1933 survey by officials and employees of the hospitals or by the state departments in charge of the hospitals. The data cover all state hospitals, and combining all institutions within a given state results in a large enough number of patients to give relative stability to the results.

The adequacy of the notion that traditional cultural attitudes and beliefs of the internal migrants in Latin American cities explains much of their reluctance to make use of modern scientific medical care is empirically tested. A longitudinal study of health and medical care was done in San Pedro Sula, Honduras. in a low-income sector where 80 per cent of the residents were not born in the city. Data collection included migration and health questionnaires, retrospective life histories, clinical examinations, and participant observation. Findings reveal low access rates of the population to professional medical care institutions. No consistent relationships are found between migratory status and access to medical care once socioeconomic status is held constant. Positive selectivity, prior urban experience, and extensive kinship networks aided most migrants in the transition to urban life and norms of institutional participation. The Roemer model of a socially stratified medical care system in most of Latin America is corroborated in the case of San Pedro Sula. As a consequence, whether a person or family manifests "modern" medical care utilization behavior depends more on the urban opportunity structure than on attributed "traditional" cultural beliefs and attitudes. [ABSTRACT FROM AUTHOR]

A developmental pattern of child rearing was found to be associated with better health care practices by children than a disciplinary pattern of child rearing. The developmental methods included substantial use of reasons and information, rewards, and granting of autonomy. Based on these findings and a review of previous research, the higher level of health practices of children reared by developmental than of those reared by disciplinary methods is interpreted as an expression of the differential effectiveness of these contrasting child rearing approaches in developing the child's resources and capacities for coping and taking care of himself. [ABSTRACT FROM AUTHOR]

The rehabilitation system in the 1970's will be markedly different in its structure and activities from what it was in the past. The bases for this prediction are the current challenges to the traditional model of professional-client relationships; an increase in activity on the part of the client and his family in the rehabilitation process; a changing ideology and value system concerned with the right rather than the privilege of individuals to have good medical care and rehabilitation; and the high financial costs of institutional care of the disabled. A proposed solution is to develop for the rehabilitation system a "built-in environment." [ABSTRACT FROM AUTHOR]

Three investigations show that laymen presented with medical information recall best (a) what they are told first and (b) what they consider most important. The findings from volunteer subjects recalling fictitious information are confirmed with patients recalling real information. In the real-life situation, it was possible to manipulate recall of certain kinds of information by using the primacy and importance effects. [ABSTRACT FROM AUTHOR]

The development of a standardized instrument designed to measure the treatment environment of the mental hospital provided the basis for two separate works of Jay Jackson (1964, 1969). The present study is in part a partial re-analysis of this standardized instrument known as the "Characteristics of the Treatment Environment Scale" (CTE Scale). The analysis is based on a heterogeneous national sample of 18 state mental hospitals and results in the construction of a new instrument called the "Treatment Milieu Scales" (TMS). This present analysis includes shortening of the Jackson CTE instrument, the development of new factors, and a test of their predictive ability with respect to the therapeutic orientation of the treatment environment as measured by hospital effectiveness. These effectiveness measures include in-hospital indicators such as staff morale, quality of over-all care, psychiatric care, patient movement, and net release, as well as in-community measures including social adjustment, and medical (mental status) adjustment. Significant findings are obtained for the patient movement measures, while several partial correlations were found to be significant in all the other in-hospital measures except staff morale. The findings suggest the "humanistic" tradition of therapy is not necessarily the most appropriate when viewed from the perspective of in-community patient rehabilitation. [ABSTRACT FROM AUTHOR]

The rapid growth of the community mental health movement has evoked both praise and scorn. A major aim of many community mental health specialists is the reduction or elimination of mental illness through primary prevention. Crucial for primary prevention is the notion that mental illness is etiologically or sequentially associated with social conditions such as poverty and racism. An examination of the empirical evidence largely fails to support this notion. Instead, belief in the efficacy of primary prevention rests on ideological grounds. Some of the logical implications of these ideologies are examined and their significance for the future of community mental health programs are assessed. [ABSTRACT FROM AUTHOR]

In this study we have attempted to identify certain factors that would be helpful in differentiating between metropolitan and nonmetropolitan physicians. One objective of this differentiation was to explore the value of using social and geographical origins as predictive and differentiating factors affecting choice of location to establish one's profession. Another objective was to offer suggestions for recruitment programs, with the idea that more selective recruitment methods would have long-range benefits for areas most affected by the physician shortage. Based upon what we have found in comparing the two physician samples, our objectives have been partially achieved. [ABSTRACT FROM AUTHOR]