The medical examiner and deaths in the hospital setting

There has been a perceived increase in the number of medical negligence claims in recent years. The modern metropolitan medical examiner is increasingly called upon to deal with numerous medical, legal, social, and ethical issues. Nowhere is the role of the medical examiner more important than in the investigation of deaths related to surgical, diagnostic, anesthetic, or therapeutic procedures. Medical examiners have an important role in the investigative process. Through utilization of the offices and services of the medical examiner, questions raised by families, physicians, and other hospital employees may be satisfactorily answered a priori, and litigation may therefore be averted.     

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.     

Employment-based health benefits: analysis of the April 1993 Current Population Survey

The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one-half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees.     

Pluralism and ethnic conflict in Tanzania's arid lands: the case of the Maasai and the WaArusha

In Tanzania, the Maasai and Waarusha tribes are experiencing conflict because differences in their modes of productions and economic strategies undermine the peaceful coexistence that they have enjoyed since the 18th century. The Maasai are pastoralists, while the Waarusha are agricultural subsistence farmers who are encroaching on the best pasture lands. A sketch of the history of the two groups shows that the Maasai reached the peak of their land holding in 1880 before the arrival of European colonists who seized land and restricted the Maasai to a semi-arid reserve but allowed the Maasai to remain an autonomous and powerful group. The Waarusha began encroaching on Maasai land after independence due to land and population pressure. While closely tied, each group looks down on the other, and Maasai ascendancy has given way to Waarusha challenges. After independence, the tribal and ethnic rule that was protected by the colonial system was disrupted to allow for increased internal migration and new patterns of settlement. The rights of land ownership were transferred from tribes to the State, allowing privileged groups to benefit. The Waarusha began to engage in illegal land-grabbing and to encroach on the Maasai preserve using legal and illegal means. The Maasai view land as collective property and have had difficulty retaining title of traditional lands in the face of population pressure. This loss of grazing land has forced the Maasai into a mixed economy that depends upon agricultural production as well as livestock production. In the meantime, the Waarusha have deliberately sought political office to gain power to secure their holdings. Immediate action is needed to produce 1) a policy on spontaneous settlement, 2) an immediate adjustment of legal procedures for land acquisition, 3) a land tenure policy that equally emphasizes agricultural and livestock production, and 4) controls on undue expansion of subsistence agriculture into semi-arid rangelands.     

The print media and aging policy: how differential coverage of Medicare Catastrophic led congress astray

This article examines the role of the print media in covering complex policy issues. Two models of journalism are considered. "Pack journalism" predicts that print media coverage will be highly consistent in content due to the reliance by those in the media on the same sources of information. In this article, another model--"Beltway journalism"--is proposed. It implies that coverage by the print media indigenous to the Washington, D.C. area (inside the Beltway) will diverge from that of other print media, presenting a potentially distorted view of the world to policymakers in Washington. Using the Washington Post and the Los Angeles Times as possible indicators of the two models, aging policy is addressed through a case study of newspaper coverage during passage and repeal of the Medicare Catastrophic Coverage Act of 1988. Findings suggest that Congress was unduly influenced by the way that Medicare Catastrophic was framed in the Washington Post, lending credence to the Beltway journalism model. By paying insufficient attention to the way Medicare Catastrophic was being framed by sources of print outside the Beltway area, lawmakers allowed themselves to assume a grassroots-level understanding of the issue and support for the bill, both of which turned out to be illusory.     

The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

The new illegal immigration in Japan, 1980-1992

"This article presents some of the latest available figures on illegal immigration in Japan, a process that did not assume significant proportions until the mid-1980s. It also discusses briefly the latest developments around 'immigration' policy--more precisely, the law on the entry and exit of aliens."     

Women's income generation activities in Merowe Province,Northern State,Sudan

Merowe province in rural northern Sudan has been divided into three local government council areas: Merowe, Karima, and Ed Debba. A government program was instituted to increase the welfare of residents and food production. A baseline survey of 490 respondents was conducted in order to ascertain how illiterate women viewed development in the area and to provide useful information for program design and implementation. Women from 24 villages were administered questionnaires, observed in their daily activities, and engaged in discussion in a local meeting place. Discussions were also held with members of the local Popular Committee. Demographic information was very sketchy about age, and 48% had no formal education in writing and reading. General reading and writing skills of the remainder were very poor. There were 500 female children and 502 male children, and the sex ratio varied among the 3 council areas. 52% were married and 14% were divorced or widowed and living with relatives. The average monthly income was from Ls. 700 to Ls. 3000 based on reports from only 59.3% of respondents. Most of the women had skills in food processing and 25.7% were skilled in handicrafts. Water was obtained primarily from local wells and not decontaminated before use. Pit latrines were the standard. One bathing facility was available in the compound for the entire council area. Health units were either in each village or within 20-30 minutes walk. Child mortality was 4.3% in Merowe province. 77 children 0-5 years old died out of a total of 1002 live births. Life expectancy was 41-50 years for women and 61-70 years for men. Cleanliness and healthful eating were observed. 58% owned no land; plots were under 5 feddans and usually half a feddan. 92.1% had no bank account and 90% had no experience with loans. 70.2% were indifferent about involvement in an income generation program. 26% were interested in part-time participation. Only 3.9% desired full-time participation. 8.6% said they wanted raw materials to produce handicrafts, and 21% said they wanted cash to raise livestock. 28.4% had radios. 80.4% lacked any farm equipment. 7.6% owned an electric pump and 7% had an ox plough. A program could be offered after lunch and coordinated with other activities after 4 P.M. at a local center. The population would have to be oriented to business and income generation would have to be planned very carefully.     

Ropes course training for youth in a rural setting: “At first I thought it was going to be boring ...”

Outdoor structured activities, such as Ropes Challenge Courses, are typically utilized as interventions for youth coming from urban settings. Evaluation of such programs is scanty at best. In this instance, the course experience is used as a prevention tool for high risk youth in a remote, rural setting of high unemployment, alcohol problems, and low income. The authors discuss the effectiveness of this approach, and the intended and unintended consequences for the rural community at large. The evaluation design relies on extensive qualitative methodology as well as quantitative methods to capture the unique nature of this rural project.