Lessons from the trenches in physician integration

Beyond the theoretical basis for integration, three core considerations stand out as the primary reasons for pursuing integration from a physician's perspective. In the authors' experience, the ability to make a case for physician integration stands or falls based on the ability of the integrated delivery system to address these considerations: Gain greater access to capital; develop human resources with talents in managed care and the full spectrum of care services; and sustain an information infrastructure. This article explores the lessons learned in pursuing physician integration.     

Refugees of Turkish origin: "coerced immigrants" to Turkey since 1945

"While several studies (in both Turkish and English) have been made on migration to the Ottoman Empire from the Caucasus and the Balkans during the nineteenth century...very little systematic and comprehensive research on migration has been undertaken on the period since the establishment of the Turkish Republic. This article, which aims to partially fill the gap, is divided into three parts: the issue of national refugees (refugees of Turkish origin) in relation to Turkey's overall refugee policy; Turkey's policy towards national refugees; and the volume and causes of refugee migration to Turkey since 1945." (SUMMARY IN FRE AND SPA)     

The implementation of the healthy cities project in developing countries: lessons from Chittagong

The Chittagong Healthy City Project was carried out in late 1994 in Chittagong, Bangladesh. This paper presents findings of an evaluation of the project based upon internationally generated process indicators related to the institutional aspects of the project. The following issues are discussed with regard to project implementation: the institutional organization of local authorities, institutions' conceptual understanding of the project, formal insertion of the project into public authorities' activities, institutional leadership of the project, central-local relations, the lack of interministerial coordination, the project's office, international projects, and community organization. Giving consideration to these issues may help program planners detect problems in forthcoming projects prior to their implementation.     

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.     

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.     

Elements of the American Health Security Act of 1993

Over the past several decades, there has been a plethora of proposals that were developed in response to the ongoing debate on how best to solve the problems of the American health care delivery system. In the past decade, calls for modification of our health system have become even more resonant, as measures to control rising costs were unsuccessful and access to basic services was diminished for many Americans. The most recent addition to the list of proposals for modifying the health care system is the American Health Security Act of 1993, introduced by President Clinton in September 1993. This article will examine the position of the Clinton Administration on health reform and the core elements of the reform package.     

The health care Titanic: women and children first?

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.     

An elusive concept: the changing definition of illegal immigrant in the practice of immigration control in the United Kingdom

This paper examines changing concepts of immigration practice in the UK. Immigration control at the port of entry has extended to internal control within the UK. The burden of proof of legality of status is increasingly on the immigrant, against a background of administrative rather than criminal justice. The changing and broadening definition of illegal immigration in the UK is part of a set of policies, which are governmental responses to what is conceived of as public opinion. THE GUARDIAN suggested that the Home Office has tightened up its application of the rules as the price to the Tory Right for their silence over further changes to the immigration law, thus demonstrating the political aspects of the concept of illegality. The Home Office replied that the UK was now one of the most densely populated countries in Europe and that, in terms of services, the country simply could not support all those who would like to come there. Nor can more than a certain number of newcomers be absorbed by any host community without the risk of friction. However, the host community is now multi-ethnic, and there is a black vote. The growth of administrative justice against which there is little effective appeal, the retrospective application of the 1971 Immigration Act, the ever-widening definition of the concept of illegality along with the fact that there is no time limit under the 1971 Act for one of the most common offenses, that of over-staying, have given rise to an increasing number of campaigns in support of individuals or families. These campaigns against the deportation of "illegal" immigrants may be an indication of a change in public opinion.     

阿拉贡:成长与变化

去年,为了庆祝法共作家阿拉贡的八十岁生日,法共通过它的报刊发表文章,对他的创作展开评价.在新里昂大学组织的"阿拉贡月"的一次报告会上,法共作家普列伏斯特作了这个题目的演说,对阿拉贡在创作道路上经历的三个阶段进行了分析.《新评论》杂志1977年6、7月号刊登了这篇演说,摘译如下.