Assimilation vs. multiculturalism: Views from a community in France

A recent American survey of attitudes toward societal multiculturalism vs. assimilation has found surprisingly widespread support for maintaining heritage cultures not only among immigrant minority groups but also among most subsamples of majority host groups, black and white. Working-class whites are the one exception. This pilot study explores the same attitude domain in a contrasting European setting. Randomly selected samples of middle- and working-class families (a mother, father, and teenage son or daughter) from a small city in France were interviewed. As a group, they were neutral to slightly favorable to immigrants maintaining heritage cultures and languages rather than losing them through assimilation. On measures of attitudes toward specific immigrant groups, there were marked intergroup dyfferunces with Maghrebian Arabs rated leist favorably and Southeast Asians, the model immigrants, most favorably. Comparisons of subgroups of respondents who varied in terms of (a) political left-right orientation, (b) social class standing, (c) degree of religiosity, and (d) generational level provide the base for a more general discussion of cultural assimilation and multiculturalism.     

Religion: friend or foe of the aging?

Religion can be a guide in the quest of older adults for a fuller understanding of their lives and purposes as they cope with the diminishments brought about by aging.     

CONTEXT EFFECTS FOR CENSUS MEASURES OF RACE AND HISPANIC ORIGIN

This paper reports on the results of a split-ballot experimentconducted in 1987 to test alternative versions of the decennialcensus long form. Two forms were randomly assigned and self-administeredin group sessions involving a total of 515 respondents. Theorder of race and Hispanic origin items was experimentally manipulated.The standard long form asks race, then Hispanic origin. Theexperimental form reversed the order of the items in order toreduce perceived redundancy, and to create a more restrictedframe of reference for the race item. The objectives of thecontext manipulation were (1) to reduce item nonresponse forthe Hispanic origin item, and (2) to reduce reporting of "Otherrace" by Hispanics in the race item. Objective (1) was met.Objective (2) was met for Hispanics born in a U.S. state, butnot for immigrants. The results are interpreted as reflectinga process of acculturation that affects how Hispanic respondentsapply U.S. racial categories "white" and "black" in the census.     

Triangular empathy: “The other” in psychotherapy with individuals

This paper seeks to explore triangular dimensions in individual psychotherapy. In addition to serving as the dyadic object of transference projection and/or as selfobject for a person in psychotherapy, the therapist may be called upon to help the patient work on relationships with certain early, important people or their representations and on the interplay between such relationships and the therapeutic one, that is, in a triangular configuration. Because patients' attempts to introduce others into individual psychotherapy are sometimes experienced by therapists as resistant rather than as integral to the therapeutic process, I propose an empathic reconsideration of such patient efforts to get us to help with the complicated dimensions of human relatedness.     

Population and towns in Senegal: demo-geographic growth

Using data from the 1976 and 1988 censuses, the author notes that the population of Senegal has grown by 37.6 percent over the period and that this growth is concentrated in urban areas. One feature of this trend has been the growing primacy of the capital Dakar and a decline in the relative importance of smaller towns. The need to discourage rural-urban migration by promoting socioeconomic development in rural areas is stressed. (SUMMARY IN ENG)     

Bringing baby home: a comprehensive case management program for obstetrical services

Originally presented to the Society of Home Health Care Management of the American College of Physician Executives at its November 16, 1993, meeting in Tucson, Ariz., the program described in this article was the winner of the College's 1994 Innovations Award in Medical Quality Management, sponsored by Merck Sharp & Dohme. The program shows the potential of case management for both improvement in the quality of care and containment of costs for a managed care population with a substantial Medicaid segment. This article is part of a continuing series on innovative programs in home health care.     

I get paid fast; what about you?

The process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cost containment experts who claim that automation will help reduce costs in the U.S. health care delivery system. Key to success for the provider in adapting to this change will be understanding the coding used in the billing process and following standards of accuracy and fairness. This article is not intended to represent the adjudication rules of any particular insurance company. It is the result of experience as a practicing surgeon and as a consultant in the health care field.     

Practice standards use with internal partners

U.S. Department of Defense experience with internal partnership programs has indicated that a lack of close supervision by medical treatment facilities can result in cost increases. The use of medical practice guidelines or standards is the subject of active investigation. The global guidelines tend to be too rigid or too vague to affect the provision of care. Their general acceptance can often be low. The use of clinical guidelines, with supervision by a clinic peer, has been determined to be a provider-friendly method of delivering cost-effective, high-quality care. Comparisons were made between the supervised partners against the total expenditures for ENT outpatient CHAMPUS care. The results indicated not only a savings but a reduction in the rate of cost increases by more than 250 percent. It is our feeling that specialty provider, peer-directed medical standards can be applied in a cost-effective manner. Their adoption as an organization-wide standard for referral can be an important tool in maintaining quality while containing costs.     

Housestaff coverage in a nonteaching community hospital

In August 1992, a project team of senior medical and administrative personnel was formed (Housestaff Coverage Project Team) at the Park Ridge Health System, Rochester, N.Y.. The team was given a mandate to address housestaff coverage, primarily from an economic standpoint. Through total quality management (TQM), the project team sought to develop a house coverage plan that was sustainable, efficient, and effective. A plan was developed that includes three layers of service. A minimum "standard hospital coverage" would be available to all physicians and their patients and cover the basic needs of admission, crisis intervention, and issues of length of stay. A complete level of service would be available under the title of "case management" and would consist of total patient management, under the direction of the attending physician, from admission through discharge. The third level of service available to both "standard" and "case managed" patients would be a "consultative service." The latter would function as a traditional in-house medical service and would bill for its services. Park Ridge Hospital believes it has developed a system of housestaff coverage that is sustainable, efficient, and effective. An evaluation mechanism, primarily addressed at length of stay, will tell if we are correct in this assumption.