Causes of death in hospitalized intravenous drug abusers

The authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital. There were 127 who died from diseases unrelated to intravenous drug abuse, and in 41% of these, chronic alcoholism was implicated. Deaths from overdose syndromes and drug-related organ pathology comprised only 11% of all cases. The mean age at death was 39 years. There was a male/female ratio of 3.6:1. Half of all patients died from infection--72 from acquired immunodeficiency syndrome (AIDS) alone. These findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that AIDS and chronic alcoholism are significant problems. Emphasis should be placed upon detecting "hidden" intravenous drug deaths to provide more accurate statistical information.     

Work,fertility, and the status of women in Mexico

Among the major transformations affecting Mexican women in recent decades were their growing participation in the labor market and the fertility decline that began in the 1970s with widespread access to contraception. Data from 3 major Mexican fertility surveys, employment surveys, and censuses are used to analyze changes in female employment and their determinants during the years of economic recession in the 1980s. The main characteristics of the Mexican fertility decline are described, and the relationship between fertility and female employment before and during the economic recession is scrutinized for different social sectors. Suggestions for research on the affects of these changes on the social condition of Mexican women are then presented. The proportions of Mexican women over 12 years old who declared themselves economically active increased from 16% in 1970 to 21% in 1979 and 32% in 1987. Until the 1970s the majority of employed women were young and single or childless. But a clear increase occurred between 1976-87 in the economic participation of older women in union. Economic participation of low income and less educated women increased as they sought work or created their own in response to deteriorating living conditions during the recession. Young women with intermediate or higher educational levels did not increase their relative presence in the labor market in the same period. The marked increase in economic participation of less educated women in union with small children was accompanied by a significant increase in manual occupations. Between 1982-87, the proportion of women aged 20-49 in nonsalaried manual occupations rose from 7.6% to 18.5%. Mexico's fertility decline has been well documented. The total fertility rate declined from 6.3 in 1973 to 3.8 in 1986, while the percentage of women in union using a contraceptive method increased from 30.2 in 1976 to 52.7 in 1987. Fertility differentials have been declining but are still considerable. The inhibitory influence of children on female labor force participation in Mexico is clear, but in the years of economic recession the most notable increase in female workers was in women with 3 or more children of whom the youngest was under 3. It appears that the influence of children on women's employment depends on the socioeconomic status of the woman as well as on the dynamism or sluggishness of the labor market. Research is needed on the significance of changes in fertility and female employment for women's status in Mexico. Several recent works have presented results of microsocial analyses of the ways in which women experience changes in their lives resulting from fertility and employment decisions. A methodological strategy for studying these changes and their influence on women's status should focus on comparisons between different generations and birth cohorts, different types of employment, and different socioeconomic statuses. Both macrosocial and microsocial forms of analysis are needed to provide a full picture.     

Moral atrophy in the welfare state

The welfare state is often accused of being counterproductive: as the scope of public responsibility expands, private morality (especially altruism and benevolence) atrophies. This essay surveys psychological findings for evidence, which turns out to be broadly consistent with either of two models of moral development, each bearing distinct policy implications. The model of morally keeping in practice that is implicit in the term moral atrophy suggests the need for frequent opportunities to exercise moral skills, which would seem inconsistent with the welfare state. Alternatively, the model of moral character-building favoured by both philosophers and ordinary discourse would require only occasional reminders of one's moral principles. On this model, benevolence could usefully supplement the welfare state.     

The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.