The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

The Decline of marital fertility in Japan

Summary Studies concerning the demographic history of Tokuwara and Meiji Japan suggest that fertility rose substantially before declining during the twentieth century. Were the motivations and circumstances which held down natality during the feudal period similar to those which account for the modern fertility decline and the low birth rate obtaining in the Japan of to-day? The thesis of this paper is that the pre-modern situation was fundamentally different from the modern one. During the Tokugawa era infanticide and abortion were used, independently of parity, to eliminate weak offspring whose chances of survival were deemed poor. Desired natality generally exceeded natural fertility. With the rise of income per head during the Meiji period the population's need for these desparate practices vanished. To-day parity-specific control characterizes fertility. Parityspecific control was diffused throughout Japan in response to declining desired fertility. Desired fertility fell significantly below natural fertility sometime during the late nineteenth or early twentieth century and the wish to reduce actual fertility to the desired level stimulated the adoption of parity-specific control. The speed of decline in marital fertility was partially governed by official policies toward contraception and abortion, contraception and abortion.     

Understanding the bear movement in gay male culture: redefining masculinity

The bear movement emerged in the gay male culture of the 1980s, but little research on this group has been conducted. The purpose of this qualitative study was to examine the meanings and functions of bear identity. Six bear-identified men participated in intensive interviews investigating this question. Results suggest that men who identify as bears consciously adopt a masculine aesthetic that signifies values of self-acceptance and maturity. The participants described the acceptance of diverse body shapes and ages within the bear community as leading to positive self-esteem and body image. Results are discussed in relation to clinical and advocacy work. They broaden the awareness of the diversity of cultures that exist within the gay community.