A rational approach to career change

Recently, the number of physicians who have been interested in alternative careers has vastly increased. Many physicians express dissatisfaction with clinical practice, but they are uncertain about which nonclinical options are appropriate for them. Pursuing a different career after many years of studying and practicing medicine can seem like an overwhelming task. In this article, the author briefly outlines a decision-making process that can be used in analyzing career options and suggests some careers that have provided challenging opportunities for physicians.     

Mortality differences in Norway. Two biographical data analyses and one question about female mortality differentials

"The aim of this paper is, first, to give an overview of the local history approach developed in adult mortality differentials; secondly, to present its potentiality compared with a more usual approach.... Our methodology was applied to Norwegian data."     

Environmental hazards and the health status of women and children in a riverine community in Nigeria: Nikrowa in Edo State

Nikrowa is a riverine village located in Ovia North-East Local Government Area of Edo State. This paper examines the relationship between the environment and the health status of women and children in the village. Data used in this essay were obtained mainly in focus groups from a study of women and health service utilization in Nikrowa. Women in Nikrowa farm, fish, collect water and firewood, and process and prepare food. They also bear many children. Their hard physical labor causes them to suffer continuous body aches and pains. Environment-related illnesses such as malaria, measles, dysentery, and diarrhea are prevalent among children. The geographical isolation of Nikrowa limits access to modern health care facilities, so traditional therapies are used to treat prevailing illnesses. It is suggested that women have access to fertilizers in order to improve soil fertility and agricultural yields. Fuelwood and adequate and safe water supplies should be made readily available to women. Moreover, access roads to rural areas should be improved to facilitate transport to modern health care facilities, and rural primary health care facilities should be helped to provide efficient services by providing trained staff and ensuring regular supplies of drugs.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

Mirror, mirror on the wall: reflections from failure to establish a truly uniform national health care policy

When the author gazed into the proverbial mirror and asked if the U.S. health care system was the fairest of them all, it shattered. In this article, Thompson tells why the system is broken and what failure to fix it means to physician executives. He suggests that we, as Americans, must reinvent ourselves by realigning our value systems and and stifling our obsession with profit before trying to reinvent health care.     

Nondictatorially independent pairs

Suppose that social welfare function f satisfies the Pareto condition and has complete and transitive values. On a domain satisfying the free quadruple property, if the outcome set X has m< outcomes, then the set of pairs of distinct alternatives on which f satisfies both independence and nondictatorship contains at most the fraction 2/m of all pairs. On a domain satisfying the free six-tuple property, if X is a subset of Euclidean space then the set of pairs on which f satisfies both independence and nondictatorship has Lebesgue measure zero.Campbell's research was financed by the National Science Foundation, grant SES 9209039.     

Power, Politics, and the Framing of Environmental Illness

The medical community, along with other government agencies, has created its own frame of environmental illness. This frame has been generally accepted by the American public. In this paper we discuss framing in general and the factors related to how the environmental illness frame has been constructed and maintained. We offer a brief history of the medical institution and illustrate the frame with its definitions of environmental illness. Qualitative data from a study of Oak Ridge, a contaminated community located in Tennessee, are examined to analyze the consequences of challenging the environmental illness frame. Implications for future research are discussed.