The mandate for investigational cancer therapies

The heated national health care reform debate of the summer of 1993 has now simmered down, but pieces of the debate are still percolating along at the state level. Within the past year, numerous states have introduced bills that would mandate insurance coverage for investigational cancer therapies--in particular high-dose chemotherapy and bone marrow transplant for breast cancer. The problem with these initiatives, well-intended though they may be, is that they threaten to spread unproven technologies at a rapid rate and at the same time miss the opportunity to collect data that would prove the safety and effectiveness of the methods. The author explores these issues and suggests how managed care companies can play a more aggressive role in parrying the threat.     

Lifestyle Options and Economic Strategies: Subsistence Activities in the Mississippi Delta1

Abstract "Subsistence" and "informal economy" are contrasted in their utility as sociological concepts and their ability to explain a variety of activities in two rural Mississippi Delta communities. Literature on subsistence stresses that the desired outcome of participation is not an increase in income but the social rewards of participation itself. Two underlying dimensions of participation in these activities are documented through the literature and through a confirmatory factor analysis of empirical data: life-style choice and economic strategy. These were constructed into indexes and examined individually and in combination as dependent variables using regressors at the community, household, and individual levels. Community ties were weakly associated with participation in such activities. Whites and those with higher incomes participated more in lifestyle choice oriented activities. Participation in general was statistically related to households needing less weekly income and being of larger size. Potential connections with persistent rural poverty are discussed.     

Health care 2015: flight of the butterfly

Projecting out to the year 2015 sounds presumptuous. Who can predict that far ahead? Perhaps no one can. Social and organizational arrangements come slowly. It takes five years or so to implement simple concepts, sometimes decades for more radical changes. Once you have the ideas in tangible form, it can take another five years to get it working right. Early adopters bring others into the movement and, over 15-25 years, new directions dominate. It takes at least a generation of new practitioners to take on the new values and methods so what is likely to dominate in 2015 is beginning to be taken somewhat seriously as the successor movement to our current fad with externally imposed managed care. Put another way, entire generations of people will resist new ideas, making implementation unlikely until their control fades and a new generation takes the helm. The exciting challenge for the observer is to address the issue of where health is and should be going. Both are difficult challenges. Agreeing on what is important and what is not represents a competitive challenge. How do we perceive the world? Surely our value sets will color what we see. Who is not predisposed to select a future where they fit and their pet theories are likely to become reality. For these and other reasons, it is probably easier to agree on what we would like to see happen in the future than on what is happening. Unfortunately, unless we see the world as it is, we are less likely to be able to shift it in a direction we would like to see.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.     

Why social status matters for understanding the interrelationships between testosterone,economic risk‐taking,and gender

We conduct an extensive review of the literature on testosterone and economic risk‐taking behavior. In sum, there is evidence of a positive association between testosterone and economic risk taking, although it is unlikely to be a strong association given the abundance of null results. However, we argue that the existing literature may overstate the causal effects of testosterone on economic risk taking (or even report a spurious correlation) because this research has not considered the potentially confounding role of social status. Status could concurrently influence both testosterone and economic risk taking, given that testosterone is a social hormone with a reciprocal relationship with social status, and social status has been found to drive risk‐taking behavior. We also argue against using findings from this literature to make gender essentialist claims, primarily because social phenomena influence the size—and existence—of gender differences in economic risk‐taking behavior. We conclude with suggestions for future research.     

Snake parasitism in an urban old-growth forest

Urban-associated changes can have immediate or long-term consequences on animal populations. Such changes may be assessed through parasite prevalence and abundance in wildlife hosts, as urbanization can influence parasitism and disease transmission in wildlife. Snakes are widespread and diverse vertebrates that often persist in urban environments; however, parasitism of snakes in urban environments has yet to be studied, leaving the roles of snakes in parasite transmission uncharacterized. Field ecology, microscopy, molecular techniques, and geographic information science (GIS) were integrated to characterize parasitism of snakes in an urban old-growth forest park. The species, sex, mass, length, location, and prevalence of ecto-, hemo-, and fecal parasites were determined for 34 snakes of 6 species. Ectoparasites (mite), hemoparasites (Hepatozoon spp.), and fecal parasites (Entamoeba spp., Trichomonas spp., Strongloides spp., and an unidentified helminth) were detected in snakes and 64.7?% of snakes were infected by at least one of these parasites. Parasite infections were generally not related to the sex, age, or body condition of snakes. The locations of infected snakes were used to produce risk maps indicating where parasite prevalence is predicted to be greatest. The analysis of these maps indicated that snakes with fecal parasites were closer than non-infected snakes to the edge of the forest. This study confirms that snakes may be important parasite hosts or reservoirs in parasite transmission pathways in urban environments and it provides an integrative multidisciplinary approach that may be used to monitor parasitism dynamics in other urban wildlife areas.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.