“Comorbidity” of behavioral, emotional, and cognitive problems in adolescence

The purpose of this study was to examine in a sample of 11,516 secondary school students the extent to which different behavioral, emotional and cognitive problems (a) reflected one or more underlying common factors; (b) actually cooccurred; and (c) were single problems. Principal Component Analyses were performed and percentagewise techniques were used. PCA demonstrated that one or more general syndromes could not by far account for all of the variance of the variables. The results suggest the existence of adolescent subgroups with divergent comorbidity patterns: those who primarily report one single symptom; those who report concurrent symptoms either exclusively in the category of behavioral problems or exclusively in the category of emotional and cognitive problems; and those who report concurrent symptoms in both categories. This distinction between different subgroups has important theoretical, diagnostic, and treatment implications.     

Book reviews

Ash Amin and John Tomaney (eds), Behind the Myth of European Union: Prospects for Cohesion (Routledge, London, 1995), 334 pp., ISBN 0–415–13078–6 (pb)

Stephen Gundle and Simon Parker (eds), The New Italian Republic: Front the Fall of the Berlin Wall to Berlusconi (Routledge, London, 1996), 334 pp., ISBN 0–415–12161–2 (hb), 0–415–12162 (pb)

Donald Sassoon, One Hundred Years of Socialism: The West European Left in the Twentieth Century (I. B. Tauris, London, 1996), 965 pp., ISBN 1–85043–879‐X

Geoff Mulgan, Connexity: How to Live in a Connected World (Chatto & Windus, London, 1997), 280 pp., ISBN 0–7011–6396–8     

A review of recent developments affecting COBRA rights

Due to the high cost of health care claims and COBRA's status as remedial legislation, COBRA has generated a significant amount of litigation in recent years. While the early COBRA decisions tended to broaden the law in order to provide a remedy to an otherwise uninsured qualified beneficiary, the recent trend in the case law has been to limit the expansion of COBRA rights based on a narrower construction of the statute. Even so, COBRA still represents a legal minefield for employers. As a result, a careful employer will minimize its exposure by monitoring changes in the law and its interpretation and making appropriate modifications to its COBRA documentation and administration. This article discusses some of the more significant recent changes in the law affecting qualified beneficiaries' COBRA rights--and therefore, employers' exposure.     

Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.