Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Injuries of the large arteries of the brain and vital reactions. An electron microscopy study

In 90 forensic autopsies (Craniocerebral injury, gunshot, stabbing, blow, strangulation, etc.), semithin sections of great arteries were prepared from around 770 Epon blocks and checked for vital reactions at the mural and intimal ruptures. In 21 cases in which death had occurred immediately or soon after the trauma, with three exceptions, there was a subsequent electron microscopic investigation. In all six mural ruptures and in five of ten intimal ruptures, thrombocyte aggregates were found at the rupture margins. In five intimal ruptures, the possibility of the occurrence of preparations injuries had to be considered. In five cases, the results of the histological study were negative. The success rate is limited in principle in such a screening test since there are technical difficulties in preparing serial sections on long vessels. Death was rapid and the thrombocytes were observed to adhere to the injured wall sites immediately after the trauma. The "thrombocyte sign" is thus of substantial importance as the earliest local vital reaction. In two control cases (strangulation), thrombocyte aggregates were found at intimal ruptures of the basilar artery, which were regarded as the results of stretching via the vertebral arteries during attacks to the neck. The healing processes of intimal ruptures and traumatic medial necrosis in incomplete ruptures occurring later in life are discussed. Even if a cadaver is a few days old, the histological findings at the level of the thrombocytes can be evaluated.     

Juror decision making in the capital penalty trial

Two factors thought to influence jurors' penalty decisions in capital trials—the nature of the crime committed and the defense's portrayal of the convicted offender's character—were examined. Mock jurors were death-qualified and exposed to one of twelve simulated penalty trials. Each trial was comprised of one of three capital crimes and one of four defense strategies. Jurors were least punitive in robbery-murder conditions and most punitive in multiple murder conditions. A conceptual argument against capital punishment was the most effective defense; a mental illness defense was the least effective. Penalty decisions were mediated by three attributional variables: (a) juror perceptions of the defendant's volition, (b) juror perceptions of the defendant's future dangerousness, and (c) juror perceptions of the relative competency of the opposing attorneys.This article is based on the author's dissertation which received an Honorable Mention in the 1985 SPSSI Dissertation Prize competition. The research was made possible by grants from the University of California, Santa Cruz and Division 41 of the American Psychological Association. The author is indebted to Craig Haney, Elliot Aronson, and Dane Archer for their valuable suggestions and support.     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

The evolution of employment in Mexico: 1895-1980

Employment figures from the Mexican national census are the basis for this analysis of employment changes in Mexico between 1895-1980. The work identifies longterm trends in the volume and composition of employment and distinguishes 3 main periods in the evolution of employment. The first period, from 1895-1930, marked the end of a stage of development lasting until about 1907 in which sufficient internal stability was achieved to support Mexico's entrance into the world market. Export of agricultural products and metals was the principal focus of economic growth. Construction of roads and railroads was a central element of progress. But economic and social problems manifested in regional disparities, concentration of wealth, conflicts between economic sectors, low pay for agricultural workers, and fierce social and political control characterized the period and culminated in the Mexican Revolution. After the first decade of the 20th century the ability of the economy to absorb new workers began to decline, and the falling of crude activity rates was not reversed until the 1940s. During the 1920s, total employment increased less than 6%, reflecting a net increase of 403,000 male workers and a decrease of 110,000 female workers. The second major period of employment from 1930-1970 saw the change from an economy based on export of primary products to one based on manufacturing for the internal market. There were 2 subperiods, a stage of transition from 1930-50, the economy registered marked fluctuations, but by the 1940s the consolidation of state power and important reforms permitting expansion of the internal market were factors in an accelerated growth of employment relative to the preceding intercensal period. Despite considerable increases in agricultural employment, the relative share of the agricultural sector in total employment was beginning a decline. Employment registered the highest growth rates of the century in the 1940s and exceeded population growth. The increased employment was explained by accelerated growth and accumulation in manufacturing along with increases in commerce, services, construction, and agriculture. From 1950-70, industrial development was consolidated, and there was a generalized expansion in employment in manufacturing as well as in the secondary and tertiary sectors. The economy was less able to absorb new labor, primarily because the agricultural sector had reached the limits of expansion in both the commercial and peasant sector by 1965, at just the time that population growth was most rapid. During the 1970s, manufacturing employment grew less rapidly because of modernization, almost exclusive orientation to the internal market which limited expansion, and scarcity of funds for importing capital goods. A new model of growth will be needed if Mexico is to escape its present stagnation, and a significant share of economic activity will need to be oriented to export. Until this process is consolidated, the national economy is unlikely to show signs of sustained recuperation.