Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.     

A preliminary study on findings of psychopathy and affective disorders in adult sex offenders

The construct of psychopathy has often been considered mutually exclusive to the presence of genuine depressive or anxiety symptomotology. This article addresses the hypothesized reasons for this dichotomous relationship. In this study, 68 civilly committed adult male sex offenders were evaluated using a variety of psychological measures to determine if psychopathic individuals in this group would demonstrate clinically significant affective symptoms. Results indicate that the men in this sample endorsed high rates of psychopathy on the PCL-R, with 42% of these expressing concurrent symptoms of depression and 26% manifesting symptoms of an anxiety disorder. Relationships between affective symptoms and PCL-R factor scores and qualitative differences between these constructs in child molesters and rapists are also discussed.     

The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

Occupational safety and health in Poland in the 1990s: A regulatory system adapting to societal transformation

The societal transformation underway in Poland createda fundamental challenge to the occupational health and safety system, as the ideological and administrative principles on which it was founded vanished along with the communist-dominated regime. This paper examines the regulatory reform in Poland during the 1990s: its structural elements, implementation record and future prospects. Drawing on five case studies of privatized firms, a mailed questionnaire, and policy and institutional analysis, we find that Poland had considerable success in developing an effective regulatory system for managing occupational health hazards in privatized sector while also achieving considerable socioeconomic progress. The fundamental legitimacy of the regulators and regulatory process, the availability of information about firms and regulatory intents, and the capacity for case-specific decision making, are among the key explanatory factors. The case-specific implementation in Poland is consistent with models advocated by several authors in relation to other industrialized European economies (termed variously as negotiated compliance, tit-for-tat, cooperation-deterrence), despite a uniquely Polish context related to the continuing legacy of the communist era. The study also shows how in Poland a good fit between regulatory institutions and policies on the one hand, and their social context on the other hand, contributes to the effectiveness of the regulatory system.