Raymond L. Goldsteen

Examining the Relationship between Health Locus of Control and the Use of Medical Care Services

Health locus of control, the extent to which one believes he or she can affect his or her health status, usually is viewed as one of the factors that predisposes individuals to use medical services. However, some social theorists outside the area of utilization studies suggest that locus of control beliefs also are consequences of health-related behaviors and events such as utilization. The authors address this issue by investigating the relationship between health locus of control and utilization of medical services in a sample of 298 elderly community-dwellers surveyed at three points in time. They found that health locus of control was affected by serious medical care encounters and that, for two dimensions of health locus of control, there was a reciprocal relationship between control beliefs and utilization.

Health status, the health events of significant others, and health locus of control

Abstract As people age, they increasingly observe death and illness among those they know well and care about. We asked two questions concerning this phenomenon: (I) Does observing illness and death among close friends and relatives influence the older person s sense of control over his or her own health?; and (2) Is this impact, if any, dependent on the individuals own health status? Thus, two models were tested, one for main effects and one for interaction between the health events of significant others and the individuals health status. Data were collected at two points in time from 346 older men and women residing in the Chicago metropolitan area. The results of the investigation support the hypothesis that observing death, illness, and injury among close friends and relatives influences an individuals health locus of control orientation and that this relationship is contingent upon the individuals health status.

BEHAVIORAL AND MENTAL HEALTH EFFECTS OF THE THREE MILE ISLAND ACCIDENT ON NUCLEAR WORKERS: A PRELIMINARY REPORT

This study of nuclear workers was conducted by the Task Force on Behavioral Effects of the President’s Commission on the Accident at Three Mile Island (TMI). The study was one of four that the task force had conducted to examine effects on “the mental health of the public and the workers directly involved in the accident at TMI-2.”’ Determining the behavioral responses of nuclear workers under stress during the accident was of particular interest. Examining the potential impacts of the TMI accident on nuclear workers involved considering a wide variety of factors. To begin with, disaster research [e.g., References 2-41 clearly demonstrates the power of disaster situations to cause symptoms of psychological distress among high proportions of affected populations.’ Hence, the disaster literature provided one theoretical base for the research. It was also necessary, however, to consider the special status of nuclear workers in this situation. Since the nuclear workers were permanent members of the organization that experienced the accident, they had both a psychological and an economic stake in its outcome. And, to varying degrees, these workers were directly involved in the incident and had responsibility for controlling the plant and bringing it to a safe condition. Consequently, organizational behavior literature on key dimensions of employee reactions under stress [e.g., perceived workplace hazards, job-related stress, and job security] served as the second major conceptual base of the study. In short, nuclear workers were involved in the accident situation both as members of the general population and, more directly, as employees of TMI. Therefore, it was essential to examine key aspects of likely worker experiences from both perspectives.

Institutions With Accredited Residencies in New York State With an Interest in Developing New Residencies or Expanding Existing Ones

Purpose In view of the looming physician shortage, especially in primary care specialties, there have been calls for increasing graduate medical education (GME). However, the capacity for increases of GME in institutions accredited by the Accreditation Council for Graduate Medical Education (ACGME) has not been determined. Method In 2009, the authors surveyed the 48 designated institutional officials supervising ACGME-accredited residencies in New York State that were eligible for their study, to determine interest in and capacity for development of new core residencies and expansion of existing ones if additional funds were made available at current Medicare rates. Results Thirty-six (75%) responded; 39% would add new programs and 47% would expand current programs with additional funding. The major interest in adding new programs was in emergency medicine (35%). Notably, only 11% would add family medicine. The major interest in program expansion was internal medicine (48%), urology (42%), diagnostic radiology (35%), obstetrics–gynecology (26%), and emergency medicine (25%). Conclusions Fewer than 50% of current training institutions are interested in or have the capacity for expansion of core residencies. The interest in establishing or expanding primary care is especially problematic. Because 70% of internal medicine residents become subspecialists, additional funds for GME at current rates would largely encourage the training of additional hospital-based and hospital-intensive specialists, with little impact on those who would practice adult primary care medicine. Significantly increasing the physician training for adult primary care medicine will require more substantial institutional incentives.

Trust and Its Relationship to Psychological Distress: The Case of Three Mile Island

In this paper, we report on a study of the relationship between trust and psychological distress in a community near Three Mile Island (TMI). Trust is defined as the expectation that others will honor agreements, either implicit or explicit. Evaluation of a path model indicated that mistrust of authorities associated with the accident was directly related to perceptions of danger and harm to health and indirectly related to distress through these perceptions.

Introduction to public health

This is the only survey of the US public health system to combine the perspectives of academicians and public health professionals. Replete with illuminating case studies, the text describes basic public health activities and services including the organization of our public health system, administrative and management concerns, financing, use of technology, and workforce and reform issues. The text explores and analyzes those aspects of the public health system that have successfully achieved their goals and those that have not. It addresses careers in public health and the educational requirements and skills needed to attain them, including new accreditation and certification programs. New public health initiatives are discussed including evidence-based practices, along with such critical issues as health disparities, emergency preparedness, and health care technology. The text covers the cost, financing, and outcomes of the US public health system and includes extensive references, statistics, and tables from current health reports (i.e. the CDC Healthy People 2010 objectives and IOM Report Future of Public Health). Key Features: Provides a comprehensive overview of the US public health system for public health, nursing, medical, and pharmacology students Combines the academic and practical experience of leaders in public health Includes plentiful case studies offering real-world examples Reflects the latest public health certification requirements and standards including the CHP exam Addresses critical issues such as health disparities, emergency preparedness, health care technology, and evidence-based practice

Antigovernment sentiment and support for universal access to care: are they incompatible?

OBJECTIVES Attitudes toward universal access to medical care were examined to determine whether support for it among people opposed to government involvement in health care was modified by three proxy measures of self-interest: being uninsured, in poor health, or a high user of medical care. METHODS Data on support for universal access, attitudes toward government involvement in health care, and the indicators of self-interest were obtained from a representative sample of adult Oklahomans (n = 1547) surveyed between October 1992 and December 1994. Forced-order multiple regression with interaction terms was the data analysis technique. RESULTS People opposed to government involvement in health care were found to be less likely to favor universal access to medical care, but poor health, lack of insurance, and high usage of medical care moderated this effect. CONCLUSIONS The findings support the view that antigovernment sentiment need not foreclose the public option for health policymakers. Other considerations such as self-interest may modify the effect of unfavorable attitudes toward government.

Jonas' introduction to the U.S. health care system

I. Introduction II. The Settings for Health Care III. The People Who Provide Health Care IV. Financing the Health Care System V. Health Insurance: From Prepaid Group Medical Practice to Managed Care VI. Health Care System Oversight & Policy VII. Health Care System Performance VIII. Health Care Reform IX. Health Care System Trends: Their Drivers and Consequences

Desirable life events and physician utilization among older American men and women

Abstract In this article we report on a study which examined the relationship between desirable life events and outpatient physician utilization. We tested two models: (1) a model which assumed that desirable events are associated with a change in utilization, and the relationship is linear; and (2) a model which assumed that desirable events are associated non-linearly with physician utilization. Data were collected at two points in time from 346 older men and women residing in the Chicago metropolitan area. We conceptualized our models in terms of Andersen s behavioral model of medical care utilization. Our analyses suggest that experiencing desirable events resulted in a non-uniform reduction in number of physician visits. People who experienced three desirable events did not benefit as much as those who experienced one or two. We suggest that the effect of desirable events on utilization was due to the impact of desirable events on psychological well-being, and thus, on perception of health status. Furthermore, we discuss the findings in relationship to social support, its costs and benefits.

The engine or the caboose: health policy in developing countries

A discussion of health policy in developing countries is presented. It argues that developing countries must adopt a progressive approach to health policy which rejects the two-tiered system of public and private health care. However, it also points out that ideology is not sufficient to maintain support. A progressive health system must utilize administrative and social and behavioral sciences to achieve effectiveness and efficiency in health care delivery. It cannot ignore these goals any more than a private health care system can.