Planning and health care—The approach in a reorganized NHS

From April 1974, National Health Service authorities have been merged to provide integrated and comprehensive services. The reorganization policies place considerable emphasis on the need for management and planning but planning for health services is not well developed. Ambiguous operational objectives and obscured criteria for effectiveness are not the most promising basis for planning. Nevertheless, a commendable beginning is to be made on planning comprehensively through a systematic annual review of Government health service policies and planning and programming procedures for health authorities. The outlines of the system are described and the prospects for success and further development are considered.     

A methodological strategy for a one-number census in the UK

As a result of lessons learnt from the 1991 census, a research programme was set up to seek improvements in census methodology. Underenumeration has been placed top of the agenda in this programme, and every effort is being made to achieve as high a coverage as possible in the 2001 census. In recognition, however, that 100% coverage will never be achieved, the one-number census (ONC) project was established to measure the degree of underenumeration in the 2001 census and, if possible, to adjust fully the outputs from the census for that undercount. A key component of this adjustment process is a census coverage survey (CCS). This paper presents an overview of the ONC project, focusing on the design and analysis methodology for the CCS. It also presents results that allow the reader to evaluate the robustness of this methodology.     

Coming out to parents: perceptions of family relations, perceived resources, and identity expression as predictors of identity disclosure for gay and lesbian adolescents

This paper examines perceptions of family relations, identity expression, and pro-lesbian/gay resources as factors influencing coming out to parents. One hundred seventy-two adolescents responded to a survey originating from a clinical support group for lesbian and gay youth. Findings indicate that weak family relations significantly detract from coming out to parents indirectly through identity expression and perceived resources. Excluding the effects of family relations, adolescents perceiving supportive resources and expressing their lesbian/gay identity were more likely to come out to parents.     

A cross-national look at married women's earnings dependency

Using the Luxembourg Income Study data we examine married women's dependency on their husbands' earnings in nine Western industrialized countries: Australia, Belgium, Canada, Finland, Germany, the Netherlands, Norway, Sweden, and the United States. When we examine the level and degree of dependency, and the labor force participation of married women across countries, the nine countries fall into the three clusters delineated in Esping-Andersen's welfare states typology. But when we examine the determinants of the dependency within each country, the clustering disappears. Wives' dependency increases with age, the presence of young children, and the number of children. It is reduced when wives' labor force participation and education are high relative to their husbands' and in families that rely more on unearned sources of income. The similarity of patterns across countries suggests that gender differences in the work-family nexus are deeply entrenched in all countries and continue even in the face of very active social policy to minize their effects. This is a revised version of a paper presented at the annual meeting of the American Sociological Association, August 1995, Washington DC. Her current research focuses on gender inequality and parents' time allocation between work and family. She conducts research on various aspects of family demography, including household and family characteristics, co-resident grandparent families, cohabitation, and child care. With Suzanne Bianchi, she is completing a research monograph on trends in the American family. Her research focuses on gender, work, and family issues.     

Testing an explanatory model of the development of depressive symptoms in young women during a life transition

Factors to explain the rising incidence of depressive symptoms among young women making the transition from home to university life were investigated. A path analysis of data from 213 18- and 19-year-old women entering a large university indicated that negative life events, interpersonally derived social support, self-esteem, and depressive symptoms were significantly related. Negative life events that affected the women's self-esteem (drawn from the women's performance in interpersonal relationships) were most strongly associated with depressive symptoms, and self-esteem derived through efficacy (i.e., taking control and acting assertively) was not associated with negative events. The women in the sample appeared to derive efficacy self-esteem from relationships. An analysis of the data supported developing interventions to improve interpersonal relationships rather than focusing on competence in gaining access to resources.     

Adolescent Women's Recommendations for Enhanced Parent-Adolescent Communication About Sexual Behavior

Family communication about adolescent sexual health and behavior promotes adolescent health and family connectedness. However, few studies seek the perspective of adolescents regarding their recommended strategies for family communication. Findings of a survey of female adolescent family planning patients (n = 249) indicated adolescent recommendations for better family communication included treat teen as an equal, 63%; increase parental knowledge about lifestyle and peer pressures, 61%, and improve parental listening skills, 61%. There were no statistically significant differences according to age, pregnancy history, or school enrollment status for suggested strategies for improved communication with parents. Sexually active adolescent daughters expressed interest in maintaining family connectedness and support with increased time for family activities as well as increased quality and quantity of dialogue between the adolescent girl and her parents.     

Improving performance in a contracted physician network

Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors.     

Health Risk Assessment of a Modern Municipal Waste Incinerator

During the modernization of the municipal waste incinerator (MWI, maximum capacity of 180,000 tons per year) of Metropolitan Grenoble (405,000 inhabitants), in France, a risk assessment was conducted, based on four tracer pollutants: two volatile organic compounds (benzene and 1, 1, 1 trichloroethane) and two heavy metals (nickel and cadmium, measured in particles). A Gaussian plume dispersion model, applied to maximum emissions measured at the MWI stacks, was used to estimate the distribution of these pollutants in the atmosphere throughout the metropolitan area. A random sample telephone survey (570 subjects) gathered data on time-activity patterns, according to demographic characteristics of the population. Life-long exposure was assessed as a time-weighted average of ambient air concentrations. Inhalation alone was considered because, in the Grenoble urban setting, other routes of exposure are not likely. A Monte Carlo simulation was used to describe probability distributions of exposures and risks. The median of the life-long personal exposures distribution to MWI benzene was 3.2·10^–5 g/m³ (20th and 80th percentiles = 1.5·10^–5 and 6.5·10^–5 g/m³), yielding a 2.6·10^–10 carcinogenic risk (1.2·10^–10–5.4·10^–10). For nickel, the corresponding life-time exposure and cancer risk were 1.8·10^–4 g/m³ (0.9.10^–4 – 3.6·10^–4 g/m³) and 8.6·10^–8 (4.3·10^–8–17.3·10^–8); for cadmium they were respectively 8.3·10^–6 g/m³ (4.0·10^–6–17.6·10^–6) and 1.5·10^–8 (7.2·10^–9–3.1·10^–8). Inhalation exposure to cadmium emitted by the MWI represented less than 1% of the WHO Air Quality Guideline (5 ng/m³), while there was a margin of exposure of more than 10⁹ between the NOAEL (150 ppm) and exposure estimates to trichloroethane. Neither dioxins nor mercury, a volatile metal, were measured. This could lessen the attributable life-long risks estimated. The minute (VOCs and cadmium) to moderate (nickel) exposure and risk estimates are in accord with other studies on modern MWIs meeting recent emission regulations, however.