Running toward the roar

How do you embrace paradox, changing and growing without losing your sense of who you are? We talked last time about the paradox of reaching for the new, without losing your ground in the old. Paradox is the place of insight. Accepting paradox, not as a momentary distraction but as a place to live, lies at the heart of dealing successfully with change. We can see this most clearly if we ask ourselves, "What business am I in? What am I about?" In health care, this did not used to be a meaningful question. Today, it is a critical one. But to really develop, we have to seek out the situations that are the most difficult for us, work them through, hang out with them long enough to begin to be at home in the paradoxical, ambiguous, and strange circumstance.     

Population statistics] as of July 1, 1997

In thousands, Thailand's total population as of July 1, 1997, was 60,440, of which 30,202 were male and 30,238 were female. 19,087 live in urban areas and 41,353 live in rural areas. 12,141 live in the northern region, 19,678 to the northeast, 7566 in the South, 13,112 centrally, and 7943 in the Bangkok metropolis. 16,288 were under age 15, 39,073 aged 15-59, and 5079 aged 60 and over. There were 15,558 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 15.6 and 5.0, respectively, with an overall natural growth rate of 1.1%. Infant mortality was 25.0 per 1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 18.8 and 22.0 years, respectively. The rate of total fertility per woman was 1.98 with a contraceptive prevalence rate of 72.2% and an anticipated population of 70,642 in the year 2012.     

Mixed estimation of old-age mortality

"Section 2 will first extend the method of mixed estimation to maximum likelihood estimation in general. Then, we will review generalized linear models with logistic and Poisson regressions as examples. In Section 3 we discuss different approaches for formulating the auxiliary information in practice. Section 4 first reviews the method of Coale and Kisker, provides empirical estimates for it, and then proceeds with the mixed estimation variant. In Section 5 we apply the methods to the estimation of mortality at ages 80+ in Finland in 1980-1993. We will first consider the evidence for mortality crossover between males and females....Then we will estimate life expectancies at age 100." (EXCERPT)     

Second generation decline? Children of immigrants,past and present--a reconsideration

"Is the contemporary second generation on the road to the upward mobility and assimilation that in retrospect characterized the second generation of earlier immigrations? Or are the American economic context and the racial origins of today's immigration likely to result in a much less favorable future for the contemporary second generation? While several recent papers have argued for the latter position, we suspect they are too pessimistic. We briefly review the second generation upward mobility in the past and then turn to the crucial comparisons between past and present."     

Ireland: an "emigrant nursery" in the world economy

"This paper focuses on historical and contemporary aspects of Irish emigration and argues that a world-systems, comparative approach avoids the pitfalls of behaviouralism and national exceptionalism in conventional accounts of Irish emigration. It suggests that causes and consequences vary with social class, ethnic group and regional context, compares 'traditional' with 'new wave' emigration and argues that it is premature to talk of the 'Europeanisation' of Irish emigration." (SUMMARY IN FRE AND SPA)     

Informed decision making: the new paradigm

Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition.     

Patterns of Australian and Canadian immigration 1900-1983

A historical analysis of trends in immigration to Australia and Canada from 1900 to 1983 is presented. The important role that immigration has played in the development of both countries is stressed. The steps taken to rethink immigration policies following the international economic crises of the mid-1970s are also considered, as is the increased demand for immigration by political refugees. The close relationship between political objectives and migration policies in both countries is emphasized. (summary in FRE, SPA)     

Immigration reform in France and the United States: reflections and documentation

This paper analyzes similarities and dissimilarities in French and American efforts to come to grip with irregular migration. The symbolic importance of immigration reform is argued to be a key political concern in both nations, although the politics of immigration reform has assumed a more partisan flavor in France, particularly since the municipal elections of 1983. In France, the theme of control and security, associated with the notion of preventing "automatic" immigration which would endanger the cohesion of French society, was widely utilized for political ends prior to and after May 10, 1981 (the date of Francois Mitterand's investiture). The American government, on the other hand, is confronted with the unenviable task of obtaining a legislative consensus on legalization and employer sanctions through an approach seeking to harmonize and integrate the demands articulated by various groups: employers, unions, and alien and ethnic interest groups (principally Hispanic groups divided into a hierarchy along a recently arrived/established cleavage). The American situation most sharply differs from the French case in terms of the absence of a right/left political cleavage. The real effects of clandestine immigration are to be found at the local level. In France, as in the US, the ability of local actors to exert pressure raises the fear that legalization and sanctions will change little, except in terms of symbolic legitimacy.