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All physicians must care for some patients who are perceived as difficult because of behavioral or emotional aspects that affect their care. Difficulties may be traced to patient, physician, or health care system factors. Patient factors include psychiatric disorders, personality disorders, and subclinical behavior traits. Physician factors include overwork, poor communication skills, low level of experience, and discomfort with uncertainty. Health care system factors include productivity pressures, changes in health care financing, fragmentation of visits, and the availability of outside information sources that challenge the physician's authority. Patients should be assessed carefully for untreated psychopathology. Physicians should seek professional care or support from peers. Specific communication techniques and greater patient involvement in the process of care may enhance the relationship.

There is a widely held view within the general public that large corporations should act in the interests of a broader group of agents than just their shareholders (the stakeholder view). This paper presents a framework where this idea can be justified. The point of departure is the observation that a large firm typically faces endogenous risks that may have a significant impact on the workers it employs and the consumers it serves. These risks generate externalities on these stakeholders which are not internalized by shareholders. As a result, in the competitive equilibrium, there is underinvestment in the prevention of these risks. We suggest that this under-investment problem can be alleviated if firms are instructed to maximize the total welfare of their stakeholders rather than shareholder value alone (stakeholder equilibrium). The stakeholder equilibrium can be implemented by introducing new property rights (employee rights and consumer rights) and instructing managers to maximize the total value of the firm (the value of these rights plus shareholder value). If there is only one firm, the stakeholder equilibrium is Pareto optimal. However, this is not true with more than one firm and/or heterogeneous agents, which illustrates some of the limits of the stakeholder model.

Adolescent pregnancy (i.e., in females 13 to 19 years of age) is associated with an increased risk of maternal complications during pregnancy and delivery, as well as increased risk to the fetus and neonate. Complications associated with adolescent pregnancy include preterm delivery, low birth weight, and infant mortality.1 However, age-related biologic factors alone are not associated with an increased risk of fetal death.2 In infants of teenage mothers, much of the risk of low birth weight is related to behavioral and psychosocial factors.3 Thus, psychosocial risk factors should be a major focus of care.

This paper studies a simple monetary model with a Ricardian fiscal policy in which equilibria are indeterminate if monetary policy consists solely of a rule for fixing the short-term interest rate. We introduce explicitly into the model the agents' expectations of inflation which create the indeterminacy and show that there are two types of policies—a term structure rule or a forward guidance rule for the short rate—which lead to determinacy. The first consists in fixing the interest rates on a family of bonds of different maturities as function of realized inflation; the second consists in fixing the short-term interest rate and the expected values of the short-term interest rate for a sequence of periods into the future as a function of realized inflation. If the monetary authority chooses an inflation process that satisfies conditions derived in the paper and applies one of these rules, it anchors agents' expectations to this process, in the sense that it is the unique inflation process compatible with equilibrium when the interest rates or expected future values of the short rate are those specified by the term structure or forward guidance rule.

The model of general equilibrium with incomplete markets is a generalization of the Arrow-Debreu model which provides a rich framework for studying problems of macroeconomics. This paper shows how the model, which has so far been restricted to economies with a finite horizon, can be extended to the more natural setting of an open-ended future, thereby providing an extension of the finite horizon representative agent models of modern macroeconomics to economies with heterogeneous agents and incomplete markets. There are two natural concepts of equilibrium over an infinite horizon which prevent agents from entering into Ponzi schemes, that is, from indefinitely postponing the repayment of their debts. The first is based on debt constraints which place bounds on debt at each date-event; the second is based on transversality conditions which limit the asymptotic rate of growth of debt. The concept of an equilibrium with debt constraint is a natural concept of equilibrium for macroeconomic analysis; however the concept of an equilibrium with transversality condition is more amenable to theoretical analysis since it permits the powerful techniques of Arrow-Debreu theory to be carried over to the setting of incomplete markets. In an economy in which agents are impatient (expressed by the Mackey continuity of their preference orderings) and have a degree of impatience at each date-event which is bounded below (a concept defined in the paper), we show that the equilibria of an economy with transversality condition coincide with the equilibria with debt constraints. An equilibrium with transversality condition is shown to exist: it follows that for each economy there is an explicit bound M such that an equilibrium with explicit debt constraint M exists, in which the constraint is never binding--this latter property ensuring that the debt constraint, whose objective is to prevent Ponzi schemes, does not in itself introduce a new imperfection into the model over and above the incompleteness of the markets.

This article uses Taylor series expansions and the assumption of small risks to derive a comoment criterion that firms should maximize so that the resulting equilibrium is Pareto optimal. This is done in two models of production under uncertainty: the state-of-nature (SN) model in which the firms' outputs depend on states of nature and financial markets are complete with respect to these states of nature and the probability (P) model in which the firms' risky outputs are modeled by their joint probabilities and financial markets span the outcome space of the firms. The comoment criterion provides a unifying framework for the two equilibrium models of production under uncertainty, has the merit of being based on information which is readily available to firms, and provides greater insight than the theoretical criterion into the risk characteristics of its profit stream that a firm should focus on when choosing its investment plan.

The management of hypertension has evolved over the past decade. Isolated systolic blood pressure elevation, the most common form of uncontrolled hypertension, is recognized as a significant risk factor for vascular complications in patients with hypertension. Nutritional management of hypertension has moved beyond simply restricting sodium intake to ensuring that patients consume adequate amounts of the major food groups, particularly those containing calcium, potassium, and magnesium. Selective aldosterone receptor blockers are a new class of antihypertensive medication, and the angiotensin-receptor blocker class has several new additions. However, the main-stay of treatment remains a diuretic or a combination of a diuretic and either a beta blocker or an angiotensin-converting enzyme inhibitor. Hypertension is a significant risk factor for vascular complications of diabetes, and the target blood pressure in patients with diabetes or chronic renal disease and hypertension should be lower than that in patients with hypertension alone. Controlling hypertension in elderly patients can reduce their complications at least as much as it does those of younger patients with hypertension.

Multiple chemical sensitivity (MCS) is a syndrome in which multiple symptoms reportedly occur with low-level chemical exposure. Several theories have been advanced to explain the cause of MCS, including allergy, toxic effects and neurobiologic sensitization. There is insufficient scientific evidence to confirm a relationship between any of these possible causes and symptoms. Patients with MCS have high rates of depression, anxiety and somatoform disorders, but it is unclear if a causal relationship or merely an association exists between MCS and psychiatric problems. Physicians should compassionately evaluate and care for patients who have this distressing condition, while avoiding the use of unproven, expensive or potentially harmful tests and treatments. The first goal of management is to establish an effective physician-patient relationship. The patient's efforts to return to work and to a normal social life should be encouraged and supported.

We develop an alternative approach to the general equilibrium analysis of a stochastic production economy when firms' choices of investment influence the probability distributions of their output. Using a normative approach we derive the criterion that a firm should maximize to obtain a Pareto optimal equilibrium: the criterion expresses the firm's contribution to the expected social utility of output, and is not the linear criterion of market value. If firms do not know agents utility functions, and are restricted to using the information conveyed by prices then they can construct an approximate criterion which leads to a second-best choice of investment which, in examples, is found to be close to the first best.