The changing academic health center. The death of the traditional academic physician

Organizational change is required if academic health centers (AHCs) are to survive the decreased societal commitment to them. The changes will generate significant emotional responses in the physicians employed by such institutions. This article presents an analogy between the reactions of academic physicians to the changes they are experiencing, and the stages of grief that Dr. Kübler Ross described in terminally ill patients. By placing physician responses in this context, emotional responses to organizational changes can be more easily understood and managed, allowing academic physicians to devote more energy to facing the threats to AHCs in an innovative and constructive manner.     

Labour crunch,foreign workers and policy responses: the experience of Japan

"Japan has experienced labour shortages since the late 1960s....The present study is an attempt to analyse the Japanese government's response to circumvent labour shortages. It focuses on two aspects: perception of Japanese society towards the increasing presence of foreign workers in Japan and associated problems; and measures taken by the government to overcome labour crunch. These aspects are examined within the [framework of an] increasing flow of foreigners to Japan during the past decades." (SUMMARY IN FRE AND SPA)     

Assessing right to die attitudes: a conceptually guided measurement model

This article discusses the current status of research regarding the assessment of attitudes toward euthanasia and other right to die constructs with a focus on conceptual and methodological issues hindering advancement in this area. Two models are presented: a conceptual model for differentiating the various right to die constructs, and a measurement model to guide scale development and refinement. The conceptual model defines the right to die constructs as a function of locus of decision and locus of action. Health status and age are hypothesized as important factors that in some instances are defining attributes in right to die constructs and in other instances are factors influencing people's attitudes toward the right to die. The measurement model considers the importance of construct specificity, individual characteristics, and conviction in the assessment of right to die attributes. An extant euthanasia attitude scale is presented and evaluated in terms of the models to demonstrate how they may be useful for advancing attitude research in this important area.     

The implementation of the healthy cities project in developing countries: lessons from Chittagong

The Chittagong Healthy City Project was carried out in late 1994 in Chittagong, Bangladesh. This paper presents findings of an evaluation of the project based upon internationally generated process indicators related to the institutional aspects of the project. The following issues are discussed with regard to project implementation: the institutional organization of local authorities, institutions' conceptual understanding of the project, formal insertion of the project into public authorities' activities, institutional leadership of the project, central-local relations, the lack of interministerial coordination, the project's office, international projects, and community organization. Giving consideration to these issues may help program planners detect problems in forthcoming projects prior to their implementation.     

Ways of thinking about the long-term care of the baby-boom cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

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.     

From Ellis Island to LAX: immigrant prospects in the American city

"This article seeks to bring the ?urban' back into immigration research. Each immigrant receiving area has its own particular group of newcomers, and the economic and political structures of the immigrant receiving areas are also distinctive. Those structures are not all determining, as immigrant trajectories are shaped by the interaction between distinctive urban institutions and the specific characteristics of the relevant ethnic groups. But in the last analysis, the urban context makes a difference, as this study shows by examining the leading [U.S.] immigrant destinations--New York and Los Angeles."     

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.     

The impact of the social environment on nursing home residents

This study contrasted the experienced quality of life of residents living on one of two nursing home units: a unit for those considered socially intact and a unit combining residents who had moderately impaired cognition or physical function with those requiring skilled nursing or therapy. Qualitative interviews were held with residents of both units. The findings indicate that the social environment of each of the units played a fundamental role in the residents' quality of life. The social environment affected the residents' conceptions of self, their interactions with other residents and their interactions with the nursing staff. The article suggests the processes behind the social environment of each floor that may have resulted in different perceptions of the quality of life.