Frequent emergency department visits (EDVs) by patients with terminal cancer indicates aggressive care. The pattern and causes of EDVs in 154 patients with terminal cancer were investigated. The EDVs that started during working hours and ended by home discharge were considered avoidable. During the last 3 months of life, 77% of patients had at least 1 EDV. In total, 309 EDVs were analyzed. The EDVs occurred out of hour in 67%, extended for an average of 3.6 hours, and ended by hospitalization in 52%. The most common chief complaints were pain (46%), dyspnea (13%), and vomiting (12%). The EDVs were considered avoidable in 19% of the visits. The majority of patients with terminal cancer visit the ED before death, mainly because of uncontrolled symptoms. A significant proportion of EDVs at the end of life is potentially avoidable.

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This article uses crosscountry data to examine the link between a country's type of political regime and its degree of openness and labor market distortion. The analysis indicates that more authoritarian regimes are associated with higher trade protection and greater labor market distortions. This supports the view that political authoritarianism may be counterproductive to development in important respects. The link between the political system of a country and its economic growth has attracted a great deal of attention in recent years (for an extensive survey of the literature see Alesina and Perotti 1994). Empirical studies have yielded mixed results, and a survey of the literature by Przeworski and Limongi (1993) concluded that they did not know whether democracy fosters or hinders economic growth. Authors from Friedman (1962) to Scully (1988) have argued that politically open societies grow at faster rates than societies where freedom is restricted. Others such as Kormendi and Meguire (1985) have found a negative relationship between civil liberty and growth, and Barro (1994) has argued that more political freedom may encourage a greater role for interest groups in the legislative process, thereby retarding growth. Landell-Mills and Serageldin (1992) summarize this literature by concluding that benevolent dictators are rare and that democracies often resort to populist policies that are inimical to growth. The focus of this article is more narrow. We consider labor policies and, to the extent that they influence labor policies, policies affecting the openness of the economy. What, if any, is the link between such policies and the nature of the political regime? Many governments in developing countries have adopted labor policies-including high minimum wages, public sector overemployment, and job security guarantees-that benefit a small group of "insiders." But these same policies limit the opportunities of "outsiders," thereby aggravating income inequality, generating efficiency losses, and possibly discouraging investment and growth. Other countries in the developing world have resisted the tempta-Arup Banerji and Hafez Ghanem are with the Europe and Central Asia IV Department of the World Bank. This article was originally prepared as a background paper for World Development Report 199S: Workers in an Integrating World. The authors thank Claudio Montenegro for research assistance and help. They also thank Joseph Ryan of Freedom House for providing data on political and civil liberties and

Little is known about the pattern of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in hospitalized palliative care (PC) patients. We reviewed 854 admissions for 289 patients with advanced cancer managed by a PC service in a tertiary care hospital. The MRSA screening was performed at least once in 228 (79%) patients, and 21 (9%) of them were MRSA positive. Other cultures were done in 251 (86.8%) patients, and 8 (3%) patients were MRSA positive. The total number of MRSA-positive admissions was 28 (3%), with a median admission duration of 8 days. A substantial proportion of hospitalized PC patients with cancer are MRSA positive. Research is required to study the impact of infection control measures on the quality of PC delivered to MRSA-positive terminally ill patients in hospitals.

Noting the trend toward more independent trade unions in developing countries, this article examines whether the presence of unions strengthens or weakens the benefits to be gained from economic policy reform. We show that the presence of "passive" unions-ones that choose their wage-employment contract given the firm's cost-minimizing strategy-increases the welfare gains from trade liberalization, because trade reform lowers the wage premium enjoyed by the unionized sector, reducing a distortion in the labor market. These gains are amplified when the unions are "active," namely, when they negotiate a contract with the firm that is off its labor demand curve. Such a contract results in featherbedding-paying workers more than their marginal product-and trade reform reduces the amount of featherbedding. The policy implication for Bangladesh-a country with strong trade unions and a protected unionized sector-is that the benefits of further trade liberalization may be greater than otherwise predicted. In Indonesia, where both unionization and import tariffs are low, allowing greater independence to unions may preserve flexibility and reward workers better than the current minimum-wage policy.