Panhypopituitarism in a young drug abuser

An intoxicated young man returned home from a drinking party and collapsed and died in his mother's presence. Three weeks earlier, he had been released from prison, having served a sentence for possession and sale of "street drugs". At the time of his release, he and his friends had gathered together for a celebration at which drugs were used. At the autopsy table, there was initial evidence of an intrasellar hemorrhage of recent onset with ablation of the adenohypophysis. At first the prosectors considered the case to be one of drug-induced pituitary "apoplexy". However, there was subsequent autopsy evidence of chronic panhypopituitarism. The intrasellar lesion proved to be a Rathke-cleft cyst of dysontogenetic origin, probably unrelated to drug abuse. This case is presented as an example of the increasing complexities encountered by the forensic pathologist in a world of increasing numbers of available toxic substances.     

Health care labor relations law--understanding the issues

The 1974 amendments to the Labor Management Relations Act have created new problems of statutory interpretation in the rapidly evolving area of health care labor law. By including nonprofit hospitals under the auspices of the Act, the amendments have opened up a new area for unionization and have given rise to questions concerning the types of bargaining units that are appropriate in health care facilities. In the following article, the authors discuss these questions and other current issues in health care labor relations law. The issues include the determination of relevant bargaining units, the status of state nursing associations as labor organizations, and the ten-day strike notice requirement of the Labor Management Relations Act.     

Evaluating the effectiveness of a court sponsored abuser treatment program

The literature on abuser treatment programs reveals the following problems: (1) the dominance of shelter-related abuser programs, (2) little understanding of the effectiveness of such programs, and (3) low recruitment and high attrition rates in shelter-related programs. This study attempts to deal with some of these difficulties by an evaluation of a court mandated abuser treatment program. The sample used in this study includes a treatment group of 120 court-referred abusers and a control group of 101 nonreferred abusers. The research was designed to deal with problems such as differential participation in the treatment sessions and self-selection bias. Results indicated that the relationship between treatment attendance and recidivism was not linear. Only those defendants who attended 75% of the treatment sessions or more have decreased recidivism; others showed no impact. Some policy implications are also discussed.     

Articles found in the possession of a methamphetamine abuser

A plastic syringe containing bloody fluid, 2 ampules of 20% glucose, an ampule containing diphenhydramine hydrochloride and calcium bromide, powder in a plastic bag and powder wrapped in paper were among the articles found in the possession of a 42-year-old male methamphetamine abuser, who had been taken to a mental hospital owing to his hallucinations.Examination of the patient revealed several recent needle punctures on the left forearm. The concentration of methamphetamine and its metabolite, amphetamine, in blood collected 1 day following the last intake was 76 nmol/100 g. Analysis of the powder and of the contents of the syringe revealed methamphetamine hydrochloride at a concentration of 99.0–99.5% and 7.4%, respectively. Neither glucose nor diphenhydramine were detected in the contents of the syringe.It would seem that the patient abused methamphetamine hydrochloride by intravenous injection after dissolving it in city water or distilled water.     

Health policy and the politics of research in the United States

During the past decade research has been more important to the health policy-making process in the United States than at any time in the past. This article describes and assesses three competing normative models for research on health affairs: economizing, social conflict, and collective welfare. The three models provide a context for the history of research bearing on health policy in the past half century, with particular pertinence to the years since 1980. The article concludes with a discussion of some of the consequences of the new legitimacy of research.     

关于知识产权促进医药创新的政策思考

为建立创新型国家这一奋斗目标,根据我国尤其是医药领域自主创新及其知识产权保护的现状,探讨利用知识产权促进创新的政策调整的目的、原则及必要性,并对医药领域创新类别及相应政策调整提出若干具体设想。     

Market-oriented health care reforms and policy learning in the Netherlands

In this article we analyze the evolution of market-oriented health care reforms in the Netherlands. We argue that these reforms can be characterized as policy learning within and between competing policy programs. Policy learning denotes the process by which policy makers and stakeholders deliberately adjust the goals, rules, and techniques of a given policy in response to past experiences and new information. We discern three distinctive periods. During the first period (1988-1994), the prevailing corporatist and etatist policy programs were seriously challenged by the proponents of a new market-oriented program. But when it came to political decision making and implementation, the market-oriented program soon lost its impetus because it was technically too complex and could not provide short-term solutions to meet the urgent need for cost containment. During the second period (1994-2000), the etatist program regained its previously dominant position. In parallel to a strengthening of supply and price controls, however, the government also persevered in creating the technical and institutional preconditions for regulated competition. Moreover, public discontent over waiting lists and the call for more autonomy by individual providers and insurers strengthened the alliance in favor of regulated competition. This led to the revival of the market-oriented program in a 2001 reform plan. We conclude that the odds of these new post-2001 reforms succeeding are substantially higher than in the first period due to the technical and institutional adjustments that have taken place in the past decade.     

Research, policy, and the National Health Service

The National Health Service is a system designed to bring about a rational use and distribution of resources yet which largely ignores the contribution of the research community. With a relatively closed health policy arena, there are few customers for policy-oriented research. With responsibility for funding research concentrated at the center and responsibility for delivering services at the periphery, the research community finds itself in limbo. In comparison to both the U.S. and Canada, Britain therefore offers an example of research both underfinanced and undervalued. However, research has made some significant contributions in areas where there has been a perceived use for its findings to support service developments. And the changes now being introduced in Britain's NHS are likely to create a new market for research as the system adopts some North American ideas and becomes less consensual and more pluralistic.