Despite evidence indicating that public health services are the most effective means of improving the population's health status, health care services receive the bulk of funding and political support. The recent passage of the Affordable Care Act, which focused on improving access to health care services through insurance reform, reflects the primacy of health care over public health. Although policymakers typically conceptualize health care and public health as two distinct systems, gains in health status are most effectively and cost-efficiently achieved (...) through their integration into a single health system. The Act does little to compel integration; however, there are numerous opportunities to encourage the coordination of public health and health care in the Act's implementation. (shrink)

Heath care and public health are typically conceptualized as separate, albeit overlapping, systems. Health care’s goal is the improvement of individual patient outcomes through the provision of medical services. In contrast, public health is devoted to improving health outcomes in the population as a whole through health promotion and disease prevention. Health care services receive the bulk of funding and political support, while public health is chronically starved of resources. In order to reduce morbidity and mortality, policymakers must shift their (...) attention to public health services and to the improved integration of health care and public health. In other words, health care and public health should be treated as two parts of a single integrated health system. Furthermore, in order to maximize improvements in health status, policymakers must consider the impact of all governmental policies on health. (shrink)

One day in the year 1274, Giuntino Jacobi appeared at the church of Santo Stefano in Quarrata. According to the notarial contract in the register of Ildebrandino d'Accatto, Giuntino was already seething with rage when he arrived at the sanctuary. When he then tried to force his way into the church, the presbyter Donato refused him access by slamming the door in his face. There is little doubt that Donato felt threatened, as he very quickly set about raising the hue (...) and cry by sounding the church bell and calling out for help. Meanwhile Giuntino, in a gesture portending Khrushchev's more famous one, took off his shoe and began pounding on the church door until a group of local men arrived and carted him away. Donato lost no time in denouncing the shoe-thumping Giuntino to the court of the podestà. When Giuntino absented himself from court, he was fined 200 fiorini piccoli, declared contumacious, and by order of the General Council banished from the commune of Florence and its territories. Thanks to the institution of the peace agreement, this story has an unexpected ending. Six months later, Donato and Giuntino stood before a notary and three witnesses in the church of Sant'Angelo di Quarrata and reconciled their differences. Their dispute was settled with the kiss of peace. The written witness—the peace agreement—was duly registered in the notarial protocol of Ildebrandino d'Accatto. (shrink)

The scarcity of human organs requires the transplant community to make difficult allocation decisions. This process begins at individual medical centers, where transplant teams decide which patients to place on the transplant waiting list. Each transplant center utilizes its own listing criteria to determine if a patient is eligible for transplantation. These criteria have historically considered preexisting affective and psychotic disorders to be relative or absolute contraindications to transplantation. While attitudes within the field appear to be moving away from this (...) practice, there is no data to confirm that eligibility criteria have changed. There are no nationwide guidelines detailing the manner in which affective and psychotic disorders should impact transplant eligibility. Individual transplant centers thus form their own transplant eligibility criteria, resulting in significant inter-institution variability. Data from the 1990s indicates that the majority of transplant programs considered certain psychiatric illnesses, such as active schizophrenia, to be absolute contraindications to transplantation. A review of literature reveals that no comprehensive data has been collected on the topic since that time. Furthermore, the limited data available about current practices suggests that psychiatric illness continues to be viewed as a contraindication to transplantation at some transplant centers. In light of this finding, we review psychiatric literature that examines the impact of affective and psychotic disorders on transplant outcomes and conclude that the presence of these disorders is not an accurate predictor of transplant success. We then discuss the requirements of justice as they relate to the creation of a just organ allocation system. We conclude that transplant eligibility criteria that exclude patients with affective and psychotic disorders on the basis of their psychiatric diagnosis alone are unjust. Just listing criteria must incorporate only those factors that have a causative effect on posttransplant morbidity and mortality. Justice also demands that we eliminate current inter-institution practice variations in favor of national transplant eligibility criteria. Given the limited data available about current practices, we call for an updated study investigating the manner in which affect and psychotic disorders impact transplant eligibility determinations. (shrink)

Infant facial characteristics may affect discriminative parental solicitude because they convey information about the health of the offspring. We examined the effect of Fetal Alcohol Syndrome (FAS) infant facial characteristics on hypothetical adoption preferences, ratings of attractiveness, and ratings of health. As expected, potential parents were more likely to adopt “normal” infants, and they rated the FAS infants as less attractive and less healthy. Cuteness/attractiveness was the best predictor of adoption likelihood.

This article examines five different Medical-Legal Partnerships associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best (...) practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the “L” has been lacking and is overdue. (shrink)

Persons registered to vote in Seattle, Washington for the November, 1986 general election and a September, 1987 primary election were randomly assigned to treatments in two telephoneconducted experiments that sought to increase voter tumout. The experiments applied and extended a "self-prophecy” technique, in which respondents are asked simply to predict whether or not they will perform a target action. In the present studies, voting registrants were asked to predict whether or not they would vote in an election that was less (...) than 48 hours away. This technique, which previously increased turnout in a small study done during the 1984 U.S. Presidential election, was again effective among moderate prior-turnout voters in the second of the present much larger experiments. The failure of the effect in Experiment 1 was plausibly a ceiling effect due to very high turnout for a U.S. Senate contest in the 1986 election. Successful applications of the self· prophecy technique are facilitated by social desirability of the target action (which leads subjects to predict that they will perform it). However, social desirability of the target behavior is not a sufficient condition for the effect, as indicated by an unexpected nonoccurrence of the effect among low prior-tumout voters in Experiment 2. (shrink)

The main goal of this study was to identify factors motivating pragmatic transfer in advanced learners of English. Based on a cross-cultural comparison of requesting behavior between Koreans and Americans, this study determined the impact of individual subjective motives on pragmatic language choice. Two different groups of subjects participated in this study: 30 Korean participants and 30 American college students. Data were collected by using a Discourse Completion Task. Korean participants provided the data for Korean and English versions of DCT. (...) Semi-structured interviews were also conducted with 13 Korean ESL learners who showed the most and least amount of pragmatic transfer. Findings showed evidence of pragmatic transfer in the request responses given by Korean ESL learners in their requestive strategies, level of directness, and perspectives of head acts. The interview data revealed that Korean students were conscious of differing rules for making requests. Learners’ judgment of L2 pragmatic norms, perception of their own language, and their attitudes of the target language influence language use. Furthermore, findings showed that purpose of learning English, different types of motivation, and the length of intended residence contribute to the extent of pragmatic transfer. (shrink)

Physicians play a critical role in preventing and treating firearm injury, although the scope of that role remains contentious and lacks systematic definition. This piece aims to utilize the fundamental principles of medical ethics to present a framework for physician involvement in firearm violence. Physicians' agency relationship with their patients creates ethical obligations grounded on three principles of medical ethics — patient autonomy, beneficence, and nonmaleficence. Taken together, they suggest that physicians ought to engage in clinical screening and treatment related (...) to firearm violence. The principle of beneficence also applies more generally, but more weakly, to relations between physicians and society, creating nonobligatory moral ideals. Balanced against physicians' primary obligations to patient agency relationships, general beneficence suggests that physicians may engage in public advocacy to address gun violence, although they are not ethically obligated to do so. A fourth foundational principle — justice — requires that clinicians attempt to ensure that the benefits and burdens of healthcare are distributed fairly. (shrink)

Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended (...) to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies. (shrink)

This research merges literature from organizational behavior and marketing to garner insight into how organizations can maximize the benefits of Corporate Social Responsibility for enhanced CSR and organizational engagement of employees. Across two field experiments, the authors demonstrate that the effectiveness of employee co-creation activities in increasing employees’ positive CSR perceptions is moderated by self-construal. In particular, the positive effect of co-creation on CSR perceptions emerges only for employees with a salient interdependent self-construal. Moreover, the results demonstrate that increased positive (...) CSR perceptions then predict increased CSR engagement and organizational engagement. The research thus highlights the need to consider self-construal when trying to utilize co-creation to predict CSR engagement and organizational engagement, via CSR perceptions. (shrink)

The question addressed here is whether evidence concerning defendants' past criminal records should be introduced at their trials because such evidence reveals their character and thus reveals whether they are the kinds of persons likely to have committed the crimes with which they are currently charged. I strongly caution against the introduction of such evidence for a number of reasons. First, the link between defendants' past criminal records and claims about their standing dispositions to think and act is tenuous, at (...) best. Second, noncharacter, or trace, evidence should have primacy in determining the guilt or innocence of defendants. Third, character evidence will vary in its freshness and specificity. Other things being equal, only relatively fresh and specific character evidence has probative value. Moreover, such evidence will have greater probative value in criminal cases where the issue before the court is whether a crime has been committed than in cases where the issue is whether it was the defendant who committed the crime. Finally, we might be more sanguine about the introduction of fresh and specific character evidence under conditions likely to work against its misuse or misinterpretation. However, the relevant conditions may not often be satisfied in the real world of criminal trials and defendants. (shrink)

Language provides rich social information about its speakers. For instance, adults and children make inferences about a speaker's social identity, geographic origins, and group membership based on her language and accent. Although infants prefer speakers of familiar languages, little is known about the developmental origins of humans’ sensitivity to language as marker of social identity. We investigated whether 9-month-olds use the language a person speaks as an indicator of that person's likely social relationships. Infants were familiarized with videos of two (...) people who spoke the same or different languages, and then viewed test videos of those two individuals affiliating or disengaging. Results suggest that infants expected two people who spoke the same language to be more likely to affiliate than two people who spoke different languages. Thus, infants view language as a meaningful social marker and use language to make inferences about third-party social relationships. (shrink)