Family limitation among the Old Order Amish

Summary This paper shows that the Indiana Amish, a high-fertility Anabaptist population, regulate their marital fertility according to their family finances. We linked demographic data from the Indiana Amish Directory with personal property tax records at 5, 15 and 25 years after marriage and found fertility differences by occupation and wealth. Correlations between family size and wealth at the beginning, middle and end of childbearing years were positive. Wealthier women exhibited higher marital fertility, had longer first birth intervals, were older at the birth of their last child, and had larger families than poorer women. Over the past 30 years, marital fertility has remained constant among older women; but birth rates among younger women have been rising rapidly.     

Corporate planning at Rolls-Royce Motors Limited

In this article the authors describe the introduction to date of a formal planning process at a British manufacturing company which, according to its recent performance, had no pressing need to implement radical change. Is Rolls-Royce Motors' decision the symptom of a new trend in industry to overhaul planning techniques while the going is good? How was company morale used to justify a new planning style? Why did an evidently capable organization choose to engage consultancy assistance? While the company's intentions are not yet fully achieved, its experience may be of benefit to others contemplating a similar decision.     

Out-migration and ethnic communities

"Comparative analysis of out-migration [in the United States]...reveals substantial ethnic differentials. Part of the variation results from group compositional differences in social class and other characteristics normally related to migration, particularly age, education and local birth. Equally important, however, are indicators of social and economic bonds." The data concern 3,345 adults who were first interviewed between 1967 and 1969 in Rhode Island and were reinterviewed in 1970, 1971, and 1979. "The results suggest that ethnic groups characterized by a dense network of social and economic ties do not sponsor out-migration, which has been the emphasis of many past studies of chain migration and migrant assimilation. Rather, they deter out-migration by providing alternative opportunities within the ethnic community."     

The use of traditional and modern methods of fertility control in Kinshasa, Zaire

Abstract The practice of post-partum abstinence has been a long-standing tradition in many societies of tropical Africa, yet recent research suggests an erosion of the taboo on post-partum sexual relations as a means of fertility control. The current study among women in the lower income groups in Kinshasa, Zaire, provides evidence of this. There is strong motivation toward child-spacing, as shown by 80 per cent of the women who reported to be currently practising some means of fertility control: 73 per cent with traditional methods, only 7 per cent with modern contraceptives. There appears to be some carry-over of traditional practice, in that abstinence is related to the age and nursing status of the last born child. However, the most widely practised method is withdrawal. This suggests a desire on the part of this population for alternatives to abstinence, an issue with important implications for future family planning programs in Zaire.     

Comparison of indirect and direct approaches to measuring patient satisfaction

One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.     

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.     

Medical care, living conditions, and children's well-being

We examine the effect of medical care and living conditions on children's physical and psychological well-being. We develop a causal model in which living conditions (including the socioeconomic status of the family and the social-psychological aspects of family functioning) may affect well-being both directly, and indirectly through medical care. We find that families in the higher social classes and families that function well tend to go to large prepaid groups where they receive good medical care. High quality technical care of illness, in turn, improves physical health. The quality of psychotherapeutic care, on the other hand, has no effect on psychological well-being. For this aspect of health, the effect of living conditions is largely direct, rather than indirect by way of medical care. Families characterized by high levels of functioning have children who are psychologically healthy. In addition, physical health affects psychological well-being, but not vice versa.