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We expect that mothers vary in the degree to which they perceive their children as burdensome, and that this variation may help explain why past research on the effect of children on mothers' psychological distress often finds insignificant or inconsistent effects: mothers who feel their children are a burden may have high distress levels compared with mothers who do not feel burdened. We find that mothers experience their children as differentially burdensome at different stages in the life cycle: younger mothers' perceived burden increases with each additional child, but older mothers are less affected by increasing numbers of children. Preschool children increase all mothers' perceived burden because they tend to make mothers feel that they cannot be alone when they want to. Employed mothers feel less burdened by their children than the nonemployed. Social context - the density of people in the home, integration into the neighborhood, and the presence of relatives in the area - had a number of unexpected effects. Crowding in the home increased the perception that children are burdensome by way of subjective crowding - the perception that there is too much activity in the home, the perceived inability to be alone, and dissatisfaction with living space. However, controlling for subjective crowding, the more adults in the home, the less the burden of children, presumably because these other adults can help care for the children. Integration into the neighborhood increased the likelihood of sharing child care with friends and neighbors, but this shared child care increased the perception of burden. We had expected the opposite. Possibly it increases perceived burden because it increases the obligation to care for one's neighbors' children in return for their help. Having relatives in the area increased the likelihood that these family members would care for one's children, but this child care had no significant effect on reducing burden. Instead, relatives in the area increased a mother's perception that she could not be alone when she wanted to, which increased burden. Thus, we find a number of costs of social integration for mothers.

The percentage of patients with at least 1 unnecessary test is a suitable end point for monitoring providers' ordering. The incidence can be high despite efforts at improvement, but may be reduced if anesthesiologists rather than surgeons order presurgical tests and consults. However, anesthesia groups should be cognizant of potential heterogeneity among them based on time since training.

Using the records of 2,171 rural residents of Illinois who received inpatient treatment for mental illness or substance abuse, this paper examines factors that influence the tendency to seek service from a distant rather than a local hospital. Results indicate that the age and insurance coverage of the individual, the per capita income of the community area, surrogates for the service orientation of the local hospital and the proximity of the patient's residence to an urban center are significant influences. With the exceptions of drug abuse requiring detoxification or other symptomatic treatment, drug abuse accompanied by comorbidity and psychosocial disorders, psychosis, and childhood disorders, the primary diagnosis of the individual failed to have a significant effect on the propensity to bypass local sources of inpatient treatment.