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PubMed1986

Feminist attitudes and mother-daughter relationships in adolescence.

In spite of the growing amount of research on women's issues, there are few empirical studies of mother-daughter relationships, and almost none on the effects of the major women's movement of our times on relationships between mothers and daughters. In this study of late adolescent daughters' perceptions of their relationships with their mothers, two alternative hypotheses are examined: (1) feminism, with its emphasis on bonding among women, strengthens relations between adolescent daughters and their mothers, or (2) feminism as a force of social change, both attitudinal and behavioral, weakens the adolescent daughter-mother relationship. Based on 102 questionnaires completed by university-age women in the winter of 1983, it was found that the majority of daughters who have a good relationship with their mothers see both themselves and their mothers as feminist. However, these daughters do not attribute their positive mother-daughter relationship explicitly to feminism. For the minority of daughters who claim to have a poor relationship with their mothers, they attribute the problems to feminism.

Adaptation, Psychological↗
PubMed1985

Generational boundary dissolution between mothers and their preschool children: a relationship systems approach.

A particular perspective on relationship systems served as the basis for this research. Postulates within this perspective include qualitative aspects of relationships are stable over time, and there are lawful relations among relationships within the same system. Previously, a concept of seductive mother-toddler relationships was initially validated. From the theory surrounding this concept, later forms of this pattern were conceived, and a hypothesis concerning complementary mother-daughter relationships was formulated. In the present research we showed first that the pattern of "seductiveness" was stable, though transformed, from 24 to 42 months. Second, the same mothers were not found to be seductive with male or female siblings. Third, mothers who showed the seductive pattern (almost always with boys) were, as predicted, hostile toward their daughters in a particular way ("derision"). 2 other scales used at 42 months ("nonresponsive intimacy" and "generational boundaries") were elevated for target mother-male dyads and not for mother-daughter pairs. In fact, mothers who were seductive with sons were rated significantly lower on the intimacy scale when seen with daughters than were control mothers. It is suggested that maternal relationships across siblings are coherent, however distinct, and that these connections derive from the totality of the mother's relationship history.

Adult↗
PubMed1985

Relationship of the parameters of body cholesterol metabolism with plasma levels of HDL cholesterol and the major HDL apoproteins.

The inverse relationship between plasma levels of high density lipoprotein (HDL) and coronary heart disease rates has suggested that HDL might influence body stores of cholesterol. Therefore, we have investigated potential relationships between the parameters of body cholesterol metabolism and the plasma levels of HDL cholesterol and the major HDL apoproteins. The study involved 55 human subjects who underwent long-term cholesterol turnover studies, as well as plasma lipoprotein and apolipoprotein assays. In order to maximize the likelihood of detecting existing relationships, the subjects were selected to span a wide range of plasma levels of lipids, lipoproteins, and apolipoproteins. Single univariate correlation analyses suggested weak but statistically significant inverse relationships of HDL cholesterol and apoA-I levels with the following model parameters: production rate (PR), the mass of rapidly exchanging body cholesterol (M1), the minimum estimate of the mass of slowly exchanging body cholesterol (M3min), and of the mass of total exchangeable body cholesterol (Mtotmin). These correlations, however, were quantitatively quite small (/r/ = 0.28-0.42) in comparison to the strength of the univariate relationships between body weight and PR (r = 0.76), M1 (r = 0.61), M3min (r = 0.58), and Mtotmin (r = 0.78). Correlations for apoA-II and apoE levels were even smaller than those for apoA-I and HDL cholesterol. In additional analyses using multivariate approaches, HDL cholesterol, apoA-I, apoA-II, and apoE levels were all found not to be independent determinants of the parameters of body cholesterol metabolism (/partial r/ less than 0.17, P greater than 0.3 in all cases). Thus the weak univariate correlations reflect relationships of HDL cholesterol and apoA-I levels with physiological variables, such as body size, which are primarily related to the model parameters. We conclude that plasma levels of HDL cholesterol and apoproteins A-I, A-II, and E are not quantitatively important independent determinants of the mass of slowly exchanging body cholesterol or of other parameters of long-term cholesterol turnover in humans. These studies give no support to the hypothesis that the inverse relationship between HDL cholesterol levels and coronary heart disease rates is mediated via an influence of HDL on body stores of cholesterol.

Aged↗
PubMed1993

[Instantaneous pressure-velocity relationship of the coronary flow, alternative to coronary reserve measurement: a feasibility study and reproducibility of the method].

Animal experimentation has shown that the instantaneous pressure-velocity of coronary blood flow in the hyperaemic phase has a linear relationship. The slope of this regression evaluates coronary reserve independently of haemodynamic variables and the X-intercept (zero flow pressure or Pf = 0) determines the intra-myocardial back pressure which could influence the regulation of coronary flow. The object of this study was to evaluate the instantaneous pressure-velocity relationship of coronary flow in clinical practice and to analyse the reproducibility of this parameter. Forty-nine patients were divided into two groups, depending on whether their coronary arteries were angiographically normal (n = 34) or atheromatous with stenosis > or = 35% of the reference diameter (n = 15). Recordings of coronary flow velocity were made with a Doppler transducer mounted on a 0.018 inch guide wire. The slope of the diastolic linear segment of the pressure-velocity relationship was determined at the peak of papaverine-induced vasodilation from 4 consecutive cycles by a regression analysis. The pressure value at 0 flow was obtained by extrapolation of the regression slope to the axis of aortic perfusion pressure. A good quality spectral recording allowing reliable analysis of the velocity profile was obtained in 88% of cases (44/49). The high values of the correlation coefficient observed with each measurement of the slope confirm the applicability of linear regression analysis to the pressure-velocity relationship. The slope of the pressure-velocity relationship was significantly lower in patients with coronary stenosis (1.7 +/- 0.7 cm/s/mmHg in normal vessels versus 0.7 +/- 0.3 cm/s/mmHg in stenotic arteries, p < 10(-4)), and, similarly, the pressure at zero flow was also reduced (36.9 +/- 16 mmHg versus 25.5 +/- 12 mmHg, p = 0.03). A statistically significant correlation was observed between the slope values and coronary flow reserve but no correlation was demonstrated between the slope and intraluminal surface area of angiographically normal coronary arteries or the slope and degree of stenosis of atheromatous vessels. The linear regression slope and the pressure at zero flow were lower when the pressure-velocity relationship was measured during long diastolic periods induced by the injection of adenosine. In addition, the curvilinear appearances of the pressure-velocity relationship observed during these long periods suggest that the linear regression model is not applicable throughout the whole range of pressures and velocities, especially for the lowest values.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1996

Expressions of the attachment relationship outside of the strange situation.

41 preterm infants and 38 full-term infants and their mothers were observed at home at 8 and 12 months of age and in the Strange Situation at 18 months in order to compare expressions of attachment relationships in these 2 settings. There was 84% concordance in the distinctions between secure and nonsecure classifications of the mother-infant relationship made at home at 12 months and in the Strange Situation. Classifications of avoidant relationships also displayed high concordance, but only 6 of the 15 dyads classified at home as ambivalent were classified in the same way in the Strange Situation. Mothers in secure relationships as assessed in the Strange Situation were rated as more sensitive at both 8 and 12 months than mothers in either avoidant or ambivalent relationships, whereas the sensitivity of mothers in these two nonsecure relationships did not differ significantly. Infants in secure relationships in the Strange Situation were characterized by more effective secure base behavior and more affective sharing and enjoyment of physical contact, and they were less fussy or difficult during the 12-month home observations.

Female↗
PubMed1997

Sexual relationships in married dementia sufferers.

OBJECTIVE: To determine the proportion of couples, one of whom suffers from dementia, continuing with a sexual relationship, their level of satisfaction with their sexual relationship and the associations of remaining sexually active. DESIGN: A survey of married couples enrolled in a prospective dementia study. SETTING: Psychiatric services and a memory clinic. SAMPLE: The partners of 47 married patients with mild to moderate dementia. MEASURES: The assessment included the GMS/HAS/SDS package, the Marital Intimacy Scale (with some additional questions regarding sexual relations), the CAMCOG, the Carers Stress Scale, the Cornell Depression Scale and the Burns Symptom Checklist. Dementia was diagnosed according to DSM-III-R, McKhann, McKeith, Hachinski and HAS AGECAT criteria. RESULTS: Forty partners completed the study. Nine (22.5%) continued to have a sexual relationship, all of whom were satisfied with the situation. Twelve (38.7%) of the carers who were not sexually active were dissatisfied with the absence of a sexual relationship. There was a trend for male carers to be more likely to be involved in a continuing sexual relationship. Dissatisfaction with the absence of a sexual relationship was significantly associated with a diagnosis of vascular dementia in the patient and showed a trend towards an association with younger patient age. CONCLUSIONS: Nearly a quarter of married dementia sufferers are involved in a continuing sexual relationship, emphasizing the importance of further research in this area.

Aged↗
PubMed1998

The relationship between mutual family relations and child psychopathology.

The associations of the mutual mother-child, father-child, and mother-father relationship and various patterns of family relations with child psychopathology were investigated in a sample of 137 families referred to outpatient mental health services. Assessment of the relative association of the different family dyads showed that both the mother-child and the mother-father relationship were related to child problem behaviour. However, whereas the mother-child relationship was consistently more related to externalising behaviour, the mother-father relationship was particularly related to internalising behaviour. Our findings gave clear support for the cumulative risk model: having more negatively qualified relationships was associated with more problem behaviour. Furthermore, our results suggested a protective influence of the parent-child relationship: having one or two positive parent-child relationships was associated with less problem behaviour. No support was found for the cross-generational coalition hypothesis. Implications for future research are discussed.

Adolescent↗
PubMed1997

An examination of the relationship between foot length, T1, T2, T3, T4, T5 (toe lengths), ankle circumference and calf circumference of Turkish University students aged between 17 and 25.

In this study, the relationship, between Foot Length, Toe Lengths, Ankle Circumference and Calf Circumference of the students aged 17-25 was examined. When looked at the correlation coefficients, a significant relationship between Foot Length, Ankle Circumference, Calf Circumference and T1, T2, T3, T4, T5 (Toe Lengths) was discovered (p < 0.05). However, from the statistical point of view the relationship between only Foot Length and Ankle Circumference in the Males was discovered to be bigger than the Females (p < 0.05). Whereas, the other measurement in both Males and Females were relatively close to each other. During the study it was discovered that while the relationship between Ankle Circumference and Calf Circumference in both sexes was statistically significant (p < 0.05), the relationship between Ankle Circumference and T1, T2, T3, T4 was also statistically significant, but this relationship in Males were bigger than that of Females (p < 0.05). When the regression analyse was carried out, it was observed that there was a linear relationship between Foot Length and T1-T5. This indicated that Turkish people has bigger Ankle & Calf Circumferences and Foot Length than Japanese people.

Adolescent↗
PubMed2026

Longitudinal Relations among Perceived Economic Stress, Teacher-Student Relationships, and Cybervictimization: Exploring Within-Person Links.

Family economic hardship has been identified as a risk factor for adolescents' cybervictimization. Nevertheless, existing studies have primarily focused on objective economic conditions, and little is known about the within-person association between perceived economic stress and adolescents' cybervictimization and the mediating mechanisms underlying this association. To fill these gaps, the random intercept cross-lagged model was employed to examine the dynamic relations among perceived economic stress, teacher-student relationships, and cybervictimization. The data were obtained from a sample of 2407 Chinese adolescents (Mage = 12.75, SD = 0.58, 50.23% girls at baseline) recruited from seven schools and assessed at three time points over one year. At the between-person level, there were no significant associations among perceived economic stress, teacher-student relationships, and cybervictimization. At the within-person level, perceived economic stress positively predicted later cybervictimization over time, and this effect was unidirectional. The bidirectional relations between perceived economic stress and teacher-student relationships remained stable over time. Cybervictimization significantly and negatively predicted subsequent teacher-student relationships across time, indicating a unidirectional predictive effect. Additionally, perceived economic stress indirectly predicted cybervictimization through teacher-student relationships. The findings highlight the importance of distinguishing within-person from between-person processes and shed light on the longitudinal role of teacher-student relationships in the association between perceived economic stress and cybervictimization.

Humans↗
PubMed2000

Adolescents' perceptions of maternal disapproval of sex: relationship to sexual outcomes.

PURPOSE: To examine the relationship between adolescents' perceptions of maternal abstinence attitudes, adolescent-maternal relationship satisfaction, and the occurrence in the ensuing 12 months of: (a) sexual intercourse, (b) the use of birth control at intercourse, and (c) the occurrence of pregnancy. We also examined the accuracy of adolescents in perceiving the attitudes of their mothers as well as factors that predicted underestimations of these attitudes. Finally, the study evaluated the relative predictive power of adolescent perceptions of maternal abstinence attitudes and the actual maternal abstinence attitudes. METHODS: This was a prospective study using a subsample of the Longitudinal Study of Adolescent Health database, which is a nationally representative school-based sample. The sample for the present study was approximately 10,000 adolescents in grades 7 to 11 who completed 2 interviews in their homes at a 1-year interval. Mothers of the adolescents were interviewed only during Wave 1. Interviews covered a variety of topics, including adolescent risk behaviors and family relationships. Measures at Wave 1 were used to predict outcomes at Wave 2, employing logistic and multiple regression techniques. RESULTS: Adolescents' perceptions of maternal attitudes toward the adolescents' engaging in sexual intercourse, and adolescent satisfaction with the maternal relationship were predictive of the occurrence of sexual intercourse between Wave 1 and Wave 2, as well as the occurrence of pregnancy. The more disapproving adolescents perceived their mothers to be toward their engaging in sexual intercourse and the more satisfied adolescents were with their relationship with their mothers, the less likely adolescents were to initiate sexual activity or to become pregnant. Only relationship satisfaction was predictive of the use of birth control, such that more satisfied adolescents were more likely to use birth control at their most recent intercourse. The correlation between adolescent perceptions of maternal abstinence attitudes and actual maternal attitudes was .26. Adolescent perceptions of maternal attitudes tended to be a more consistent predictor of outcomes than actual maternal attitudes. CONCLUSIONS: The results are consistent with a growing body of literature that suggests the importance of adolescents' perceptions of maternal attitudes in determining sexual risk behaviors. Adolescents may misperceive the attitudes of parents, suggesting the need for communication between parent and teen.

Adolescent↗
PubMed1994

On the linearity of the dose-effect relationship of DNA double strand breaks.

Most radiation biologists believe that DNA double-strand breaks are induced linearly with radiation dose for all types of radiation. Since 1985, with the advent of elution and gel electrophoresis techniques which permit the measurement of DNA double-strand breaks induced in mammalian cells at doses having radiobiological relevance, the true nature of the dose-effect relationship has been brought into some doubt. Many investigators measured curvilinear dose-effect relationships and a few found good correlations between the induction of the DNA double-strand breaks and cell survival. We approach the problem pragmatically by assuming that the induction of DNA double-strand breaks by 125I Auger electron emitters incorporated into the DNA of the cells is a linear function of the number of 125I decays, and by comparing the dose-effect relationship for sparsely ionizing radiation against this standard. The conclusion drawn in that the curvilinear dose-effect relationships and the correlations with survival are real. The problem of why the dose-effect relationship is curvilinear when microdosimetric considerations predict that even for sparsely ionizing radiation energy deposition in and close to the Watson-Crick double helix should give a linear dose-effect relationship remains.

DNA↗
PubMed2000

The "right" to a caring relationship: the law and ethic of care.

The ethic of care is often described as the ethical basis for nursing. While ethics and legal issues are related, it is unclear if perinatal nurses apply this theoretical relationship to clinical practice. There is evidence that medical malpractice litigation may be motivated by dissatisfaction with the caring relationship. A patient's moral "right" to a caring relationship, barriers in clinical practice to caring relationships, and legal remedy for perceived violation of the right to a caring relationship are discussed. Nurses must promote sound caring relationships and articulate to others the impact on perinatal outcomes and legal liability.

Ethics, Nursing↗
PubMed2006

Phenotype-genotype relationship and clinical effects of citalopram in Chinese patients.

Although the relationship of CYP2C19 polymorphism to citalopram disposition has been studied in healthy subject, this relationship in combination with dynamic effects (clinical adverse effect of citalopram) has not been well studied in patients. We carried out the present study to investigate the CYP2C19 genotype-phenotype relationship and potentially relate such relationship to the clinical effect (specifically adverse effects) of citalopram in Chinese patients who are known to have relatively high prevalence of poor metabolizers (PMs) of CYP2C19. Fifty-three Chinese adult patients were recruited. One to 2 blood samples at 4 to 24 hours postdose were collected after a minimum of 2 weeks of citalopram administration. The CYP2C19 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism, and the plasma concentrations of citalopram and desmethylcitalopram were determined by a liquid chromatography-tandem mass spectrometry method. The clinical adverse effects associated with citalopram were assessed according to Toronto Side Effects Scale (TSES). A population pharmacokinetic model was used to analyze the citalopram concentrations. Among 53 patients, 21 were homozygous extensive metabolizers (EMs) (CYP2C19*1/*1), 25 heterozygous EMs (CYP2C19*1/*2 or *1/*3), and 7 PMs (CYP2C19*2/*2 or *2/*3 or *3/*3). The metabolic ratios (plasma concentration of desmethylcitalopram to citalopram) were found to be 0.20 +/- 0.07, 0.15 +/- 0.05, and 0.07 +/- 0.03 in the homozygous EMs, heterozygous EMs, and PMs, respectively (P < 0.001, 1-way analysis of variance). On the basis of the results from our population pharmacokinetic modeling analysis, the citalopram oral clearances in the PMs were 42.9% and 33.3% (both P < 0.05) lower compared with the homozygous and heterozygous EMs, respectively. Statistically significant correlation was observed between the oral clearance and TSES scores in individual patients (rs = -0.37, P = 0.012). The mean TSES score also tended to be higher in PM than EM patients, but the difference was not statistically significant (P = 0.234). The study demonstrated a significant CYP2C19 genotype-phenotype relationship in Chinese patients receiving citalopram treatment. Such a relationship also tended to correlate with the clinical adverse effects of the drug. These results provide important pharmacogenetic implications for citalopram therapy in the Chinese population in whom relatively high frequency of CYP2C19 PM phenotype exists.

Administration, Oral↗
PubMed2002

The modification of emotional responses: a problem for trust in nurse-patient relationships?

This article examines one aspect of the criticism of inauthenticity that can be levelled against the trustworthiness of professional relationships in general and nurse-patient relationships in particular. The overall question is: are such relationships inherently trustworthy or untrustworthy, from the patient's point of view? The author concludes that, in spite of legitimate grounds for concern, and while it remains true that nurse-patient relationships may be untrustworthy, they are not inherently so for reasons of inauthenticity relating to emotional labour. The arguments used to defend this claim take their force from the idea that different criteria may be needed to assess the authenticity of nurse-patient relationships from those used to evaluate authenticity in ordinary social relationships. The utility of Hochschild's idea of 'deep' acting, as offering a useful model for the management of emotions in nursing, is examined and rejected.

Adaptation, Psychological↗
PubMed1985

Relationship between the amount of rice oil ingested by patients with yusho and their subjective symptoms.

The goal of this study was to clarify the subjective symptoms closely related to yusho by examining the relationship between the amount of PCB-contaminated rice oil ingested by patients and the subjective symptoms recorded on their questionnaires. The amount of PCB-contaminated rice oil consumed by the patients was obtained by interviewing the housewife in each yusho family. Individual consumption of the oil was estimated by taking into account age, sex and the number of meals at home. In 1970, 46 patients were available for analysis, and in 1971, 33 patients were available. Among 12 subjective symptoms studied, numbness of the limbs, coughing, expectoration, and the sensation of "elevated" teeth were considered to show a dose-response relationship, which suggests that these subjective symptoms are closely related to yusho. Consistent high rates of complaints of general fatigue and eye discharge were considered possibly to be connected with yusho, although no dose-response relationships have been determined. Other subjective symptoms, such as fever, headache, dizziness, abdominal pain, swelling in the joints, changes in menstruation, and loss of hair failed to show consistent dose-response relationships. It should be noted, however, that for these symptoms which failed to show dose-response relationships, it is impossible to deny a causal relationship.

Disease Outbreaks↗
PubMed2004

Genetic variation in structure-function relationships for the inbred mouse lumbar vertebral body.

UNLABELLED: Structure-function relationships were determined for L(5) vertebral bodies from three inbred mouse strains. Genetic variability in whole bone mechanical properties could be explained by a combination of the traits specifying the amount, distribution, and quality of the cortical and trabecular bone tissue. INTRODUCTION: Although phenotypically correlated with fracture, BMD may be disadvantageous to use in genetic and biomechanical analyses because BMD does not distinguish the contributions of the underlying morphological and compositional bone traits. Developing functional relationships between the underlying bone traits and whole bone mechanical properties should further our understanding of the genetics of bone fragility. MATERIALS AND METHODS: Microarchitecture and composition of L(5) vertebral bodies (n = 10/strain) from A/J, C57BL/6J, and C3H/HeJ inbred mouse strains were determined using muCT with an isotropic voxel size of 16 mum(3). Failure load, stiffness, and total deformation as a measure of ductility were measured in compression using a noncontact strain extensometer imaging system. A correlation analysis related morphological and compositional bone traits to whole bone mechanical properties. A multivariate analysis identified structure-function relationships for each genotype. RESULTS: No single bone trait accurately explained the genetic variation in mechanical properties. However, a combination of traits describing the amount, distribution, and quality of cortical and trabecular bone tissue explained >70% of the variation in vertebral mechanical properties. Importantly, structure-function relationships were unique among genotypes. CONCLUSIONS: Different genetic backgrounds use different combinations of underlying bone traits to create mechanically functional structures. Using a single complex trait such as BMD or BV/TV as the sole phenotypic marker in genetic analyses may prove to be disadvantageous because of the complex relationship between mechanical properties and the underlying bone traits. Therefore, considering multiple bone traits and the interaction among these bone traits is necessary to understand the relationship between genetic background and complex whole bone mechanical properties.

Analysis of Variance↗
PubMed1992

The relationship between the vitamin K cycle inhibition and the plasma anticoagulant response at steady-state S-warfarin conditions in the rat.

The relationship between the inhibition of the vitamin K cycle and the inhibition of the vitamin K-dependent clotting factor synthesis was studied in the rat under a controlled rate of S-warfarin administration. Steady state of drug disposition was achieved from beyond day 2 and stable anticoagulation was achieved from beyond days 3 to 4. Doses up to 0.5 micrograms/kg/h were without effect, whereas 3 micrograms/kg/h reduced prothrombin complex activity to about 10%. Factor II and factor VII activity were equally suppressed as prothrombin complex activity. The concentration-effect relationship for steady-state S-warfarin plasma concentration and the inhibition of clotting factor synthesis revealed a steep sigmoidal response relationship (IC50 = 0.21 +/- 0.01 micrograms/ml, Hill slope = 2.07 +/- 0.3). Contrary to this, the target enzyme vitamin K1 2,3-epoxide reductase showed a dose-dependent response for the entire dose range. The sigmoidal effect relationship for plasma S-warfarin and enzyme inhibition showed a slope of 0.81 +/- 0.07 with IC50 = 16 +/- 1 ng/ml. The results demonstrate a reserve capacity for the coumarin-sensitive reductase; at least 70% of the hepatic vitamin K1 2,3-epoxide reductase activity has to be eliminated before the vitamin K-dependent carboxylation of the clotting factors objectively becomes compromised. In the study, the microsomal warfarin binding sites were compared with the vitamin K1 2,3-epoxide reductase activity, and a strict 1 to 1 relationship was found supporting the relationship between both.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Preserving the physician-patient relationship in the era of managed care.

Even without comprehensive health care reform legislation, the US health care system is undergoing significant changes. Probably the most important change is the expansion of managed care with significant price competition. One of the major concerns about this change is the effect of managed care on the physician-patient relationship. To provide a normative standard for evaluating the effect of changes, we need an ideal conception of the physician-patient relationship. This ideal can be summarized by six C's: choice, competence, communication, compassion, continuity, and (no) conflict of interest. For the 37 million uninsured Americans there is little chance of realizing the ideal physician-patient relationship, since they lack the choice of practice setting and physician, receive care in a rushed atmosphere that undermines communication and compassion, and have no continuity of care. While many insured Americans may believe they have an ideal physician-patient relationship, the relationship is threatened by lack of a regular assessment of competence, by financial incentives that undermine good communication, and by the persistence of conflict of interest. The shift to managed care may improve the choice of practice settings, especially in sections of the country that currently lack managed care; increase choice of preventive services; make quality assessments more routine; and improve communication by making greater use of primary care physicians and nonphysician providers. However, the expansion of managed care and the imposition of significant cost control have the potential to undermine all aspects of the ideal physician-patient relationship. Choice could be restricted by employers and by managed care selection of physicians; poor quality indicators could undermine assessments of competence; conductivity requirements could eliminate time necessary for communication; changing from one to another managed care plan to secure the lowest costs could produce significant disruption in continuity of care; and use of salary schemes that reward physicians for not using medical services could increase conflict of interest.

Conflict of Interest↗