South-East Asia

This article reviews the literature on migration and HIV infections in the Mekong Region countries of Cambodia, China, Laos, Myanmar, Thailand, and Viet Nam. The HIV/AIDS situation is profiled in each country. The populations at risk include legal and undocumented cross-border migrants, internal migrants, sex workers, and mobile occupational persons, such as truck drivers, fishermen, seafarers, and cross-border traders. Currently, there is little regional cooperation on the issue of HIV among migrants. Prevalence is high in most of the region. Programs range from being very developed in Thailand to minimal in China. Recently, nongovernmental organizations have created innovative models. AIDSCAP studies have focused on river trade routes along the Thai-Lao border and fishing ports in Thailand and Cambodia. The Asian Research Center for Migration has researched fishermen in 6 countries; Burmese women in Thailand; migrants along the Thai-Myanmar borders; and the impact of transportation routes on the spread of HIV/AIDS along six main inter-country routes. Coordination of Action Research has engaged in research and action projects in 8 southeast Asian countries. The region would benefit from information exchanges about lessons learned and best practices. Field researchers could use better technical support. Regional strategies are useful for providing support from origin to destination.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Application of Markov chain Monte Carlo methods to modelling birth prevalence of Down syndrome

Data collected before the routine application of prenatal screening are of unique value in estimating the natural live-birth prevalence of Down syndrome. However, much of these data are from births from over 20 years ago and they are of uncertain quality. In particular, they are subject to varying degrees of underascertainment. Published approaches have used ad hoc corrections to deal with this problem or have been restricted to data sets in which ascertainment is assumed to be complete. In this paper we adopt a Bayesian approach to modelling ascertainment and live-birth prevalence. We consider three prior specifications concerning ascertainment and compare predicted maternal-age-specific prevalence under these three different prior specifications. The computations are carried out by using Markov chain Monte Carlo methods in which model parameters and missing data are sampled.     

Learning how to learn: the key to CQI

All CQI/TQM efforts share a common purpose: to learn something that can correct past mistakes and/or to create better futures. Because learning is a dynamic circular process, the information about a problem or an opportunity will be limited unless four perceptions of the truth--each valid, and each incomplete--are accepted. These four types of learning styles or ways of perceiving are: abstract conceptualizers, active experimenters, concrete experiencers, and reflective observers. Unless all the stages of the learning process have been fully completed, unless all the strokes work in harmony, we cannot be confident that a CQI effort has added its full value. A CQI team's interpersonal process, the tools by which individually limited truths are forged into a consensual holistic truth, must ensure that the group's effort goes "around in circles."     

Making the journey into the networked enterprise, Part 2

In the May issue of Physician Executive, the authors described the difficulties other industries have had with vertical integration and why so many corporations have abandoned it for other organizational structures. In this second part of the series, they explore the ways health care organizations can make the shift into integrated delivery systems, avoiding the trap of the hierarchical, vertically integrated monolithic structures that will become the dinosaurs of the future.     

Going to Pieces: Paul Monette and the Fragments of the Tribe

Author of the highly acclaimed Borrowed Time: An AIDS Memoir (1988) and winner of the 1992 National Book Award for his autobiography Becoming a Man: Half a Life Story, Paul Monette died of complications from AIDS in Los Angeles on February 12, 1995. His most recent work, Last Watch of the Night: Essays Too Personal and Otherwise (1994), is his third volume in a trilogy of autobiographical writing on growing up gay, coming-out, and living with AIDS. A graduate of Phillips Academy and Yale University, Monette received a number of awards for his writing and his work as an outspoken voice in the battle against AIDS, including the National Book Award, three Lambda Literary awards, the PEN Center West Freedom to Write Award, and three honorary doctorate degrees, from Wesleyan University, the City University of New York, and the State University of New York at Oswego. A memorial service was held for Monette on Sunday, February 19, 1995, at the Directors Guild of America on Sunset Boulevard in Los Angeles. Paul Monette was 49.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

The NTEE classification system: tests of reliability/validity in the field of higher education

An analysis of the field of higher education reveals a surprisingly large number of classification errors within the (US) National Taxonomy of Exempt Entities database. Of the nearly 4,000 non-profit entities coded within the universe of institutions of higher education, we estimate that approximately 60 per cent were incorrectly included (Type II errors). Institutions incorrectly excluded from the higher education universe (Type I errors) represent roughly 10 per cent of the institutions coded correctly. These errors result primarily from assigning codes on the basis of the names of organisations (for example, College Park Towers is classified as a college, when it is in fact a housing complex for senior citizens) and from trying too hard to assign codes in ambiguous situations. The consequences can be significant for the users of these data, and we recommend raising bright warning flags while simultaneously enlisting the help of the entire non-profit sector in improving the classification coding process.The authors are with The Andrew W. Mellon Foundation. In addition to our colleagues on the staff of the Foundation, we wish to thank Helmut Anheier, Ted Bozovich, Harvey Dale, Virginia Hodgkinson, Stephen Noga and Christopher Toppe for helpful suggestions.     

A method of computing the marital composition of the population between population censuses

A method for calculating the marital status distribution of the population of the USSR between censuses is outlined. The method is based on the use of population census and vital statistics data.