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."     

Prevalence of gambling among Minnesota public school students in 1992 and 1995

The purposes of this study were to examine the prevalence of gambling among youth, compare rates of gambling between 1992 and 1995, and determine what levels of gambling frequency may be considered common and uncommon. The two samples included 122,700 Minnesota public school students in the 6th, 9th, and 12th grades in 1992; and 75,900 9th and 12th grade students in 1995. Students were administered the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple content domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in both 1992 and 1995 to students in their classrooms by the Minnesota Department of Education. There were slight decreases in overall gambling rates from 1992 to 1995. The majority of students gambled at least once during the past year. However, most did not play any game on a weekly/daily rate and did not report any problems associated with their gambling. Gender, grade, and race effects were found for gambling frequency. Boys gambled more often than girls, and 9th and 12th grade students gambled more often than 6th grade students. Asian American and White students reported lower rates of gambling frequency than Mexican/Latin American, African American, and American Indian students. From a statistical standpoint (i.e., beyond the 97.7 percentile), it may be considered in the uncommon range for girls to play two or more games at a weekly/daily rate, and for boys to play four or more games at a weekly/daily rate. Variables associated with gambling frequency included antisocial behavior, gender, and alcohol use frequency. Although the finding that gambling did not increase from 1992 to 1995 is encouraging, this is the first generation of youth to be exposed to widespread accessability to gambling venues and gambling advertising and it will be important to continue monitoring the prevalence of youth gambling.     

Marriage selection and age patterns of mortality: a mathematical investigation

"In this paper, we use simulation models to demonstrate the complexity of the relationship between the marriage selection process and the resulting RMRs [relative mortality ratios]. In particular, we show that marriage selection alone can produce a relative mortality ratio which remains large and relatively constant at ages far beyond the marriage span....Our general objective...is to determine the range of age patterns of relative mortality which could, in theory, result from marriage selection on the basis of health characteristics. We also evaluate the effects of variations in the marriage selection mechanisms on the resulting mortality patterns....We develop and apply several simple mathematical models of the marriage selection process. In order to distinguish the potential consequences of marriage selection from marriage protection, we consider hypothetical populations in which causal effects are absent....We begin by considering an extremely simple marriage selection process and subsequently explore a more realistic selection model based on recent death and marriage rates for Japan."     

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.