Why does cancer cluster?

What do Florida sunbathers, midwestern farmers, rural black men, and Long Island women have in common? They all have higher-than-average risks for certain cancers. Researchers know that cancer clusters are usually caused by several factors. As cancer becomes America's leading cause of death, the public will be keenly interested in sorting out the causes and reducing the risks.     

Income expectations,rural-urban migration and employment in Africa

This article develops a theoretical framework explaining the influence of economic conditions on rural-urban migration in tropical Africa. The model explains the continued process of migration despite high levels of urban unemployment. A lengthy discussion is devoted to short-, intermediate-, and long-term policies for relieving the urban unemployment problem. It is argued that efforts must be made to reduce the differences between the expectation of urban income and real rural income. No one single policy will slow rural-to-urban migration. The author suggests policies that would eliminate factor-price distortions, restrain urban wages, redirect development toward concentrated and comprehensive programs of rural development, resettle and repatriate unemployed urban migrants, and establish capital-goods industries. The capital-goods industries would develop labor-intensive technologies for agriculture and industry. The theoretical model assumes that migrants make decisions about moving on the basis of an expected income and the expectation of an urban job. It is argued that the urban-rural income differences and the probability of securing an urban job determine the rate and extent of rural-urban migration in Africa. If the migrant has a low probability of finding regular wage employment in the short term, but expects the probability to increase over time, the migrant would make a rational decision to migrate. Policies that operate solely on urban labor demand are considered unlikely to reduce urban unemployment. This model better estimates the shadow prices of rural labor.     

Migration and its risks

"This essay applies the theories of Ulrich Beck...to the politics of migration in Germany. In particular, the essay focuses on Beck's notion of the waning influence, indeed even relevancy, of science and scientists regarding postmodern risk phenomena. The essay argues that migration to Germany can be understood as a Beckian risk phenomenon, helping to explain the decreasing influence of social scientists over the politics of migration in the Federal Republic."     

The majority legal status of women in southern Africa: implications for women and families

Women in many countries of southern Africa do not have majority status or have only recently gained this right. Majority status grants individuals adult legal status and the right to bring matters to court, own and administer property, have legal custody of children, and contract for marriage. This article summarizes the legal status of women in Botswana, Lesotho, South Africa, Swaziland, Zambia, and Zimbabwe. Lack of majority status contributes to the ongoing risk of poverty for women and makes them overly dependent on men. Compounding the situation in these countries is the presence of a dual legal system. Improving the situation of women and their families involves targeting changes in the legal system, influencing implementation of laws, educating women about their rights, and giving women needed support to seek their legal rights. The legal status of women must be viewed in the context of historical changes in the economic, educational, political, and cultural developments of society.The research for this paper was conducted during her previous faculty affiliation with the University of Michigan, School of Social Work. Her research interests include the impact of social change on women and families, rural mental health services, and health and mental health linkages. She received her Ph.D. from Rutgers University and her M.S.W. from the Columbia University School of Social Work.Her research interests are gender, work and family, culture and power, social transformations in rural and peri-urban communities, critical education, women and community politics, history of women, family and kinship issues, and community-based program development and evaluation. She received her M.S.W. from Dalhousie University, Halifax.     

Characterizations,length-biasing,and infinite divisibility

SupposeL(X) is the law of a positive random variableX, andZ is positive and independent ofX. Admissible solution pairs (L(X),L(Z)) are sought for the in-law equation $\hat X \cong X o Z$ °Z, where $L\left( {\hat X} \right)$ is a weighted law constructed fromL(X), and ° is a binary operation which in some sense is increasing. The class of weights includes length biasing of arbitrary order. When ° is addition and the weighting is ordinary length biasing, the class of admissibleL(X) comprises the positive infinitely divisible laws. Examples are given subsuming all known specific cases. Some extensions for general order of length-biasing are discussed.     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

The role of public health in population health

The role of public health is central in population health. What distinguishes public health from clinical medicine is that it's focus is on the entire population--not the individual patient. To achieve the goal of population health, healthy communities, or Healthy People 2000 requires physician leadership in medicine and public health at all levels--local, state, and national. The challenge is formidable, but the goals are attainable through strategies that focus on the goal of the common good and through collaboration of public health, medicine, and the community.     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Changes in physician and non-physician relationships

At the end of World War II, one-third of the nation's hospital administrators were physicians. During the 1950's through the mid-1980's a new breed of masters'level administrator, with well-honed coordinating skills, orchestrated a major expansion of new programs, services, and facilities. With the advent of the Medicare prospective payment system (PPS), more governing boards restructured their administrative staffs with corporate titles. Meanwhile, physicians sensed that trustees were becoming far more concerned with bottom line performance to repay a mounting debt that hospitals had incurred to remain technologically competitive. Since mergers and integrated health systems by themselves will be unable to generate significant operating efficiencies, governing boards will be forced to change direction and shift back to recruiting physicians as their CEOs or in other senior positions to assure themselves of the clinical leadership required to implement the managed care concepts of reducing utilization and cost, and simultaneously enhancing quality of patient care.     

Organizational politics: did you hear?

How do you define organizational politics? The underground system of communication, the grapevine, what's really going on in the organization, rumors, knowing who really has the power? However you define it, all sources agree you'd better not ignore it. According to one physician executive: "Organizational politics is how things really get done, who really has the power, how decisions get made. Things are not always what they appear to be on the organizational chart." Presented here are some thoughts about organizational politics from physician executives and their stories of when it helped or hurt their careers or prevented them from accomplishing something in their organizations.