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."     

European Community legislation and intergovernmental cooperation on migration

Recent trends in migration policy in the European Community are outlined. The focus is on the need to increase cooperation between the member states and to increase the power of the Community's Court of Justice in decision-making about migration and refugee policy.     

The spatial and socio-occupational mobility of the population

The author describes topics included in a study of spatial, social, and occupational mobility in Poland. These include rural migration, the effect of the family life cycle on migration, the social impact of migration, the effect of migration on spatial distribution, and migration prospects until the end of this century.     

Stochastic modelling of regional annual rainfall anomalies in East Africa

ARIMA (p, d, q) models were fitted to areal annual rainfall of two homogeneous regions in East Africa with rainfall records extending between the period 1922–80. The areal estimates of the regional rainfall were derived from the time series of the first eigenvector, which was significantly dominant at each of the two regions. The first eigenvector accounted for about 80% of the total rainfall variance in each region.

The class of ARIMA (p, d, q) models which best fitted the areal indices of relative wetness/dryness were the A R M A (3, 1) models. Tests of forecasting skill however indicated low skill in the forecasts given by these models. In all cases the models accounted for less than 50% of the total variance.

Spectral analysis of the indices time series indicated dominant quasi-periodic fluctuations around 2.2–2.8 years, 3–3.7 years, 5–6 years and 10–13 years. These spectral bands however accounted for very low proportion of the total rainfall variance.     

The politics of health in the fourth world: a northern Canadian example

This paper describes the major structural and historical dimensions of health ideology and praxis in the Canadian Arctic. It examines the problems that occur when primary care services exclude their clients from meaningful involvement in planning and administration. It argues that the structure of health services in northern Canada reflects an internal colonial political economy which is characteristic of most Fourth World situations.     

Empirical findings on socioeconomic determinants of fertility differentials in Costa Rica

"This paper seeks to (1) identify socioeconomic variables that are expected to generate fertility differentials; (2) hypothesize the direction and magnitude of the effect of each variable by reference to a demand-for-children model; and (3) test empirically the model using evidence from Costa Rica. The estimates are obtained from a ten-percent systematic random sample of all Costa Rican individual-family households. There are 15,924 families in the sample...." The authors specifically seek "to capture the effects of changing relative prices and available income and time constraints on parental preferences for children. Least-squares estimates show statistically significant relationships between household fertility and opportunity cost of time, parental education, occurrence of an extended family, medical care, household sanitation, economic sector of employment, and household stock of nonhuman capital."     

Reintegration of circulating families in southwestern Puerto Rico

Puerto Rican migration to the US has been a more or less continuous process since 1917. The perspective of viewing return migration as a circulation process suggests that there are entries, exits, and reintergration into the metropolitan labor market. This study explores the circulatory movements of Puerto Rican families, events that influence the adaptation process when returning to Puerto Rico, and cultural identity aspects. Data collected by means of 2 research instruments that were administered to the respondents simultaneously were used: 1) a life history matrix and 2) an open-ended questionnaire. These interviews outlined the principal problems of adaptation as mentioned by the circulating migrants. The most difficult problems to adjust to were economic and employment (58%), followed by social acceptance (23%), education (17%), and language (15%). Transportation, medical services, and recreational facilities were also problems mentioned as being significant. It is expected that a great majority of migrant laborers will go to live in immigrant residential locations in large US cities. It is also expected that these migrants will meet with certain value conflicts by living in urban ghettos. These families will have serious difficulties finding economic stability and will possibly consider migrating once again as an alternative to their social reality. This study illustrates that: 1) the migrants return in family groups; 2) they face discriminatory problems in employment agencies and schools; 3) they look forward to a formal education as a means of social mobility; 4) they identify themselves with values, habits, and Puerto Rican traditions; and 5) they value the quality of life in Puerto Rico.