Maternal employment in Scandinavia: a comparison of the after-birth employment activity of Norwegian and Swedish women

A striking characteristic of recent Western labour market trends is the rise in employment among mothers of very young children. So far, few studies have analysed the impact of public policies on employment rates of young mothers. In this study we address this issue by comparing two similar countries, Norway and Sweden, which have the same set of policies with slight variations, using data sets with similar designs. We analyse rates of re-entry into paid work after first birth for mothers in 1968–88 by means of hazard regression. One important finding is that the right to paid maternity leave with jobsecurity greatly speeds up the return to work.We want to thank Jan Kowalski for programming assistence and the Swedish Research Council for the Social Sciences and the Swedish Council for Research in the Humanities and Social Sciences for financial support for the Swedish study. We are grateful to John F. Ermisch, Siv Gustafsson, to two anonymous referees and to colleagues at the Demography Unit for valuable comments. Responsible editors. Siv S. Gustafsson, John F. Ermisch.     

Batch sampling to improve power in a community trial. Experience from the Pawtucket Heart Health Program

Experiments involving large social units, such as schools, work sites, or whole cities, are commonly limited in statistical power because the number of randomized units is small, leaving few degrees of freedom for residual (between-unit) error. The authors describe a method for increasing residual degrees of freedom in a community experiment without substantially increasing cost or difficulty. In brief, they propose that the experimental units should be divided into random subsamples (batches). Batch sampling can improve statistical power if the community endpoint means are stable over time or if their temporal variation is comparable in period to the batch-sampling schedule. The authors demonstrate the theoretical advantages of the batch system and illustrate its use with data from the Pawtucket Heart Health Program, in which such a design was implemented.     

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.     

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.     

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.     

"How much do you spend gambling?" ambiguities in survey questionnaire items

The validity of a survey's findings is dependent upon the clarity and lack of ambiguity contained in each individual item yet minimal attention has been directed to this issue in most prevalence studies. Researchers have shown a tendency to accept the uncritical assumption that respondents interpret seemingly simple and straightforward items such as 'how much do you spend gambling?' in a consistent manner. No attempt is made to confirm the uniformity of responses by clarifying the mathematical formulae used by respondents to derive their answers. The purpose of this paper was to examine the consistency shown by a sample of 181 medical undergraduate subjects in estimating the level of gambling expenditure in a series of five case vignettes describing various scenarios of wins and losses during a session of gambling. Results revealed a wide variation in calculated figures depending upon whether or not subjects interpreted the item to mean net expenditure or turnover. Only two thirds or less of subjects calculated the figure to be the difference between the initial amount risked and the residual at the conclusion of the session. It is suggested that more attention be paid in prevalence and clinical studies to providing subjects with clear instructions on how to calculate expenditure estimates.