Theoretical perspectives for explaining infant mortality in the third world.

The authors analyze differentials in infant mortality rates in developing countries and attempt to go beyond the usual economic interpretations of these differences and identify some of the relevant social and political factors affecting infant mortality. In particular, they apply "a 'political economy of health' perspective to infant mortality and seek to account for discrepancies between economic progress and progress against infant mortality. [The paper] traces out a four-fold comparison--between countries with high/low economic development and countries with high/low infant mortality--for testing hypotheses in the political economy of health."

Adolescent pregnancy and severe heart defect. A risky combination.

Current concern about adolescent pregnancy is based largely on its negative impact on the social, developmental, and economic prospects of the mother and her infant. The issues of adolescent pregnancy are more complex when the mother has a severe heart defect. Our case illustrates the problems that can arise in the pressure of associated medical problems. Although the patient's behavior contributed substantially to a tragic outcome, we believe that greater professional awareness and sensitivity regarding the needs of such adolescent patients might have produced a more favorable outcome.

Adolescent vicissitudes and medical judgement: a case study.

Professional concern about the widespread occurrence of adolescent pregnancy is based upon its negative impact on the social, developmental, and economic prospects of the mother and her infant. The usual presumption is that the pregnant adolescent is in good health but suffers from socioeconomic and cultural disadvantages, which the pregnancy will exacerbate. The problems of the pregnant adolescent are more complex when she also has a severe medical handicap. We draw upon such a case to illuminate the issues which arise when medical problems interact with the vicissitudes of adolescence. Although it is clear that the patient's own behavior contributed substantially to the tragic outcome of this case, we believe that greater professional anticipation of the contingencies of adolescent development might have produced a more favorable result.

Health services and the political culture of Saudi Arabia.

Health services occupy a high priority in the development agenda of Saudi Arabia, Saudi culture--devotion to Islam, extended-family values, the segregated status of females and the Al Saud monarchic hegemony--is being formulated in an increasingly deliberate fashion, constituting a new 'political culture' which acts as a screen to insure that technological and human progress remain within acceptable bounds. There is a general disposition on the part of the Saudi populace to use modern health services as these become available, largely under governmental auspice. The role of the government in providing health care for pilgrims during the hajj to Mecca is of particular culture importance. Cultural sensitivities concerning male physicians and female patients will be minimized by the training of a substantial number of Saudi female physicians, whose efforts will be directed toward female patients. At present, most health care in the Kingdom is delivered by male expatriate physicians, as part of the general massive reliance upon expatriate workers: although the expatriates will eventually be replaced by Saudi physicians, this dependency, which is felt to threaten Saudi culture, will continue for a decade or more. Private medicine is rapidly increasing though not on the same scale as government medicine. The provision of government health services is a source of legitimation for the Al Saud regime. In general, health services appear to constitute a form of modernization which meets the test of cultural compatibility.

Renal medicine and renal patients at the Seventh I.K.A. Hospital of Athens.

Clinical nephrologists are generally aware that bringing chronic renal treatment to all patients who need it is both an economic and a medical challenge. On the medical side, there is the task of giving the most appropriate form of treatment to the individual patient and, so far as it lies within the power of the physician and his staff, of supporting and motivating the patient to maintain a reasonably satisfying and productive life despite the stress of illness and treatment. On the economic side, there are a number of issues concerning the generation of funds for treatment, the utilization of various categories of medical and nonmedical personnel, and the geographic deployment of treatment resources of varying levels of expertise and intensity. For example, the hospital facilities for diabetic dialysis patients who can anticipate periodic complications are more extensive than the more limited back-up facilities needed for well-stabilized "healthy" patients who are managing domiciliary dialysis. These questions have an international aspect, as the nephrology professionals and health administrators in many nations seek to expand their treatment programs for chronic treatment of renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Organizational effects on mentally retarded adults: a longitudinal analysis.

Normalization has gained wide acceptance as a goal that residential institutations for the mentally retarded should strive to achieve, but many organizations have been shown to have difficulty achieving the goal. Theories developed from the organizational contingency perspective suggest that organizations with bureaucratic structures will have particular difficulty accomplishing the nonroutine tasks associated with normalization. Our major purpose was to test the usefulness of such theories for the evaluation of mental retardation facilities by ascertaining whether a less bureaucratic organization for the mentally retarded would achieve greater success than a more bureaucratic organization. The closing of a large public hospital and the subsequent transfer of most of its residents to two new facilities (one of which was more bureaucratic than the other) allowed us to examine bureaucracy's effect on treatment. As predicated, the analysis showed that the less bureaucratic organization produced a greater average positive change in behavior than did the more bureaucratic organization. A number of clinical and demographic characteristics of the residents which could have influenced the observed changes in behavioral level were identified and controlled. They were not found to explain the differences between facilties. Other factors, which could not be controlled in this study, provide suggestions for future research.