The changing meaning of cohabitation and marriage

"In the Netherlands, the social meaning of both marriage and cohabitation has changed. Cohabitation started as an alternative way of living, developed into a temporary phase before marriage, and finally became a strategy for moving into a union gradually....This article addresses the question whether or not individual past and current life-course experiences become increasingly important in explaining the differentiation of entry into marriage across female birth cohorts, and yet become decreasingly important in explaining the differentiation of entry into cohabitation across female birth cohorts. This question is examined using a non-proportional hazard model. Empirical evidence supports this hypothesis strongly, in that both past determinants such as family size or religion and current life-course determinants such as work or education change in their impact on cohabitation and marriage across birth cohorts."     

Trends in divorce and marriage around the world

"A study of 27 [developed] nations indicated that divorce rates rose in 25 of the nations from 1950 to 1985 while marriage rates declined in 22 of the nations. Nations with higher divorce rates in 1950 had steeper increases in the divorce rate subsequently, supporting a critical-mass hypothesis."     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

Where does informatics fit in health care organizations?

Why is medical informatics important to health care leaders? As an emerging science, informatics focuses on applying computing and communication technology to decision making for clinicians and managers. It enhances the understanding of how information and communication systems can impact the work health care managers must accomplish. As the cost of technology for digital information management continues to decline, organizations and individuals will look for ways to offset the human costs of managing and conveying information. The way of the paper medical record is being replaced by the less expensive and more efficient digital information systems. Leaders of health care organizations need to look for every opportunity to deploy networks and computers to reduce the labor costs of data collection, storage, retrieval, and analysis.     

Hospital-sponsored networks. The rush to consolidate and the future of medical practice

As the medical delivery system undergoes fundamental change, there is a growing pressure on hospitals to form networks with physicians. The prime motivation for these entities is to preserve market share and fill beds. There is likewise intense pressure on physicians to join them, even if these networks do not serve their best interests, or the goal of fostering physician-centered practice. A transformation is under way, however, that may well place doctors again in the central role of guiding the new modes of medical practice in the United States.     

Haunts on the Web for physician executives

Listed here are some medical management and health care related Web sites on the Internet worth visiting, as well as favorite search engines and how to use them. From health care systems and hospitals, to health plans and insurers, the industry is using Web technology to promote programs and outcomes, and to provide information on health and wellness.     

Counterurbanisation and rural depopulation revisited: landowners,planners and the rural development process

"This paper reopens the debate between Weekley (1988) and Rowsell (1989) over why pockets of depopulation have persisted within parts of rural Britain which have experienced net growth through counterurbanisation. It argues that Weekley has not fully appreciated the context for local population losses, namely the emergence of a new structural relationship between people, households, and dwellings, and the growing tension between production and consumption interests in rural locales. Moreover, the paper disputes claims that depopulation is triggered by the actions of either the landowner or the planner. Drawing on case study material informed by critical realism, it argues that planners and landowners have been drawn into an asymmetrical power relationship. This has tended to buttress landed interests and, in so doing, reproduce mechanisms which protect the less populous communities from growth and change."     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Nevada gaming: revenues and taxes (1945-95)

In 1931, Nevada legalized casino gambling, an act which allowed its gaming industry to develop. Because many jurisdictions outside Nevada are now embracing legalized gambling as a path to a brighter economic future and because this proliferation presents Nevada with new challenges and opportunities, it is a good time to review the Nevada experience. Here, the focus is on gaming revenues and gaming tax collections during the 1945–95 period. We find that the growth rate of Nevada's gaming industry has slowed over time, with the relative importance of gaming in the Nevada economy peaking in the late 1970's. The Nevada economy has since been gradually diversifying, something which will increasingly pressure Nevadans to look for government revenue sources other than gaming if current levels of government services are to be maintained.