The many faces of access: reasons for medically nonurgent emergency department visits

Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come to the ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions.     

The law and the public's health: a study of infectious disease law in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.     

Computer-Aided Instruction in Law: Theories, Techniques, and Trepidations

Legal education is only beginning to make use of the technological capabilities of computers as a medium for instructional design. In this article the authors show the applicability of computer-assisted instruction to law through programmed instructional techniques. They trace the two decades of development of computer-assisted instruction (CAI) in law, the use and misuse of the computer's capabilities, the impact of CAI on law student attitudes and performance, and the positive student endorsement. They carefully analyze the computer's capacity for use in memory drills, tutorial sessions, and simulation exercises. They do not offer an unrestricted endorsement of the computer's capabilities but hope for the continuing development of CAI in the legal education process.     

Latina Fortitude in the Face of Disadvantage: Exploring the Conditioning Effects of Ethnic Identity and Gendered Ethnic Identity on Latina Offending

Recent literature has investigated if socialization and identity protect against the criminogenic effects of strainful experiences for African Americans. Here Latinas are brought to the forefront. This study not only investigates if a positive ethnic identity increases fortitude against strainful events, but if its effects are further influenced by gender socialization. Results reveal ethnic identity increases resilience against the criminogenic effects of vicarious victimization and acculturation and gendered ethnic identity protects against direct victimization. This study reinforces the need for further investigation into cultural explanations for within group differences in criminogenic outcomes.