Physician glut. Physicians--the next victims of "downsizing?"

Should physicians really be polishing up their CVs or preparing to enter another line of work? In a word: No. What a recent survey makes clear is that, while managed care is driving physicians from some markets, jobs are still available in other markets traditionally underserved by physicians. This is not to suggest that the physician employment market has gone unchanged. Many physicians, particularly specialists, have taken income hits, and some specialists truly are in need of work. Primary care physicians, however, have seen their stars rise and are now in a position to work wherever they want. Physicians may no longer be able to practice within 50 miles of where they were raised or where they were trained, as has been their wont. Instead, they will have to do what other professionals have long done--go where job opportunities take them. In short, they will have to add a career strategy to their scientific mindset, and that means an aggressive job search, coupled with a strong consumer orientation.     

Sustainability of family planning and health projects

USAID has assisted the Ghanian Ministry of Health since 1991 to boost family planning services under the Ghana Family Planning and Health Project by providing supplies and information and increasing the effectiveness of HIV/AIDS prevention and control. The sustainability of the health system is endangered by favoring capital expenditures in lieu of continuous expenditures; the lack of linkage between project activities and regular activities; the centralization of resource flow; and too ambitious targeting. Capital outlays provided by USAID featured in the construction of four public health laboratories, but their operation also requires continuous financing amounting to about 10% of the whole investment. The latter is the responsibility of the government, although the details of these recurrent costs were not detailed at the outset and providing these funds for continuous operation may impair the operation of other systems. The resource constraints could be alleviated by an effective cost-recovery system or by the general improvement of the economy. The lack of linkage between project and regular activities is serious at regional and district levels. The centralization of resource flow means that most resources are kept for headquarter level activities, thus other activities suffer and the health sector becomes excessively reliant on donor support. Too ambitious planning stems from pressure on donors and hastily implemented projects result in duplication and waste. Closer consultation with the parties involved would improve the situation. The rivalry of technical and policy groups has contributed to past deficiencies. Double funding for the same activity has also occurred further increasing the dependence on donor funding. By concentration on people and systems sustainability would be enhanced, while cost recovery would help the operation of the laboratories. The Health Education Unit (HEU) recognized the importance of IEC and obtained financing for such activities.     

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.     

A problem in household composition

"Distinction made between household-persons and household-markers [the person who identifies the family or household as a unit] is formalized in the notion of nested populations. This leads to an extension of the Leslie model into a formulation of growth for both population and households. The extended model involves the matrix presentation of household composition where ratios of household-persons who are age 0, per household-marker, function as surrogate values for fertility rates. The extended model describes change over time in the distribution of population by age, and in the distribution of households by age of household-marker, or household-head. The model involves the inversion of a nonnegative matrix, and is feasible only if it yields, projected over time, nonnegative entries in vectors representing distribution of population by age, and distribution of household-heads by age. Conditions for the feasibility of the extended model are discussed, and a sufficient condition for feasibility over a single interval is identified." (SUMMARY IN FRE)     

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.     

Matching anonymous pre-posttests using subject-generated information

Sensitive research issues call for anonymous questionnaires. This makes accurately matching pretests with posttests difficult or impossible. Various subject-generated coding schemes have been developed, but their accuracy has been unknown. This anonymous study, with 745 students, used subject-generated coding to match pretests with posttests. The matching was verified for accuracy with the use of a collateral, anonymous, sticker identification system. The coding system was able to accurately match 75.2% of all the pretest-posttest pairs. An additional 22.1% of the pairs were left unmatched and only 2.7% were matched incorrectly. Subject-generated coding systems can be very effective where confidentiality is important to protect.     

The health status of elderly people and the new direction of health services

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program--consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials--was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.     

Premarital relationships and livelihoods in Ghana

This study is based on interviews with a sample of 400 single women aged 18-25 years from the Fante ethnic group in Cape Coast, Ghana, in 1991, and on focus groups. This case study illustrates the importance of economic and living arrangement support expected from partners in premarital relationships. Support may be for living and maintenance ('chopmoney', provisions, household items, and rent); for financial security (provision of capital); and for clothing and hairdressing. Women did not always require economic support in premarital relationships. Women expect boyfriends to provide 'chopmoney' (money for food and general upkeep) and contribute some money for the rent. Only 36% of sexually active women expected their boyfriends to supply food provisions. Premarital sexual relationships are used to obtain start-up capital. The author refers to evidence that senior government officials engaged in sexual transactions with clients before loans and credit facilities were offered. 87% of sexually experienced women expected their partners to pay for at least part of clothing expenses. The study revealed that there was considerable disparity between women's expectations and actual receipt of economic support. 56% desired, but only 36% received, 'chopmoney' in full. 40% expected their partners to pay for household furnishings in full, while only 10% did so. 55% expected capital, but only 15% received it. The three most frequently received benefits in full were hair dressing, shoes, and dresses. Men provided most non-negotiable items as a means of "boosting their egos." Many young women rely on the support of men in order to improve their status. Ghanaian men control financial resources and economic power. Mothers of adolescent daughters encourage premarital sexual behavior. Prostitution is considered different from sexual exchange relationships. It is argued that gender inequalities and domestic abuse are perpetuated through sexual exchange relationships.