Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.     

Immigrant fertility: an examination of social characteristics and assimilation

"This study compares the fertility patterns of foreign-born and native-born women in Canada and examines whether [the] same set of social characteristics accounts for differential fertility among both the groups. The study also assesses the importance of social characteristics and assimilation on immigrant fertility behavior. Two generations of currently married/cohabiting women with spouse present are analyzed using multiple regressions. The results reveal similar effects on fertility of social characteristics for foreign-born and native-born, while in the case of younger generations the effects are stronger."     

Small populations of the north: their problems and how to solve them

The authors examine the present conditions of 26 small, isolated populations living in the north of Russia. The total size of the population under consideration is 181,600, according to the 1989 Soviet census. The conclusion is that these populations are under severe threat of extinction and that there is no consensus about how to resolve their present predicament.     

Spontaneously settled refugees in Northwestern Province,Zambia

The UN High Commissioner for Refugees (UNHCR) commissioned researchers from the University of Zambia to conduct a socioeconomic survey and census of "spontaneously settled" Zairean and Angolan refugees in the Northwestern Province of Zambia in 1982. The sample consisted of 188 Angolans, 201 Zaireans, and 2 South Africans. The difficulties experienced by refugees in Northwestern Province in achieving integration were related to a combination of factors including the lack of a clear national policy on refugees and refugee status, a national concern for maintaining security, the popular belief that aliens are responsible for an increasing crime rate, the desire by immigration officials for stricter laws to control alien infiltration, conflict between traditional and modern leaders, and Zambia's deteriorating economic situation. In spite of the problems described, the integration of refugees into existing communities is a desirable goal and should be encouraged. One should not assume that self-settling refugees are able to live with ethnic kin, receive assistance and hospitality, and thus are better off than those in camps. The Zambian case provides ample evidence that integration is not easy even with kin support, shared ethnicity, language, and historical connections. Moreover, given the fact that Zambia will continue to receive refugees it is vital that there is a well defined refugee policy and an administrative mechanism for implementing that policy at all levels. This will be particularly important in Zambia as it will undoubtedly continue to receive large influxes of refugees, from countries such as Namibia, Uganda, Angola, Mozambique, and South Africa.     

Asian immigrants in Canada: some findings from 1981 census

Immigrant characteristics in Canada are analyzed using data from the 1981 census. "The purpose of this paper is to focus on Asian immigrants and to compare them with immigrants born in the United Kingdom, and also to compare them with Canadian-born persons with respect to age, sex, marital status composition, educational attainment, labour force participation, class of worker, occupation and income." (summary in FRE, SPA)     

Basic humanitarian principles applicable to non-nationals

This article examines the general status in international law of certain fundamental human rights to determine the minimum "no derogation" standards, and then surveys a number of formal agreements between stages governing migration matters, while examining some of the standard-setting work undertaken by the International Labor Organization (ILO) and other institutions. Article 13 of the Universal Declaration of Human Rights, proclaims the right of everyone to leave any country, including his or her own. The anti-discrimination provision is widely drawn and includes national or social origin, birth, or other status. Non-discrimination is frequently the core issue in migration matters; it offers the basis for a principles approach to questions involving non-nationals and their methodological analysis, as well as a standard for the progressive elaboration of institutions and practices. As a general rule, ILO conventions give particular importance to the principle of choice of methods by states for the implementation of standards, as well as to the principle of progressive implementation. Non-discrimination implies equality of opportunity in the work field, inremuneration, job opportunity, trade union rights and benefits, social security, taxation, medical treatment, and accommodation; basic legal guarantees are also matters of concern to migrant workers, including termination of employment, non-renewal of work permits, and expulsion. The generality of human rights is due not because the individual is or is not a member of a partucular group, and claims to such rights are not determinable according to membership, but according to the character of the right in question. The individualized aspect of fundamental human rights requires a case-by-case consideration of claims, and the recognition that to all persons now certain special duties are owed.     

Analyzing mental health evaluation: moral and ethical dimensions

Now that evaluators have been sensitized to the importance of moral and ethical issues in their work, it is time to move beyond generalities and examine the moral and ethical implications of specific evaluation models in specific settings. This paper proposes a framework that can be used to examine moral and ethical dimensions of evaluation and illustrates it by analyzing a selected model of mental health evaluation. Such a systematic identification of moral issues can improve evaluation practice both proactively, by shaping the training of evaluators, and retrospectively, by contributing to meta-evaluation.     

Efforts to improve international migration statistics: a historical perspective

During the past decade, the international statistical community has made several efforts to develop standards for the definition, collection and publication of statistics on international migration. This article surveys the history of official initiatives to standardize international migration statistics by reviewing the recommendations of the International Statistical Institute, International Labor Organization, and the UN, and reports a recently proposed agenda for moving toward comparability among national statistical systems. Heightening awareness of the benefits of exchange and creating motivation to implement international standards requires a 3-pronged effort from the international statistical community. 1st, it is essential to continue discussion about the significance of improvement, specifically standardization, of international migration statistics. The move from theory to practice in this area requires ongoing focus by migration statisticians so that conformity to international standards itself becomes a criterion by which national statistical practices are examined and assessed. 2nd, the countries should be provided with technical documentation to support and facilitate the implementation of the recommended statistical systems. Documentation should be developed with an understanding that conformity to international standards for migration and travel statistics must be achieved within existing national statistical programs. 3rd, the call for statistical research in this area requires more efforts by the community of migration statisticians, beginning with the mobilization of bilateral and multilateral resources to undertake the preceding list of activities.     

Therapy for male couples experiencing relationship problems and sexual problems

This article examines four issues that need to be explored by the therapist as possible causes of stress for a male couple: stereotypic male roles, stereotypic sexual roles, homophobia, which includes the "coming out" process, and sexual dysfunctions. These issues can cause anxiety and stress, which may in turn cause relationship problems for a male couple. The role of the therapist is clarified and suggestions for treatment are given.