Risk management: a general framework for rural development

This paper proposes a new concept of rural development in an uncertain world. The nature of risk and uncertainty is discussed and risk management is defined as a positive model of economic and social behaviour. Some relevant paradigms for rural development are reviewed and evaluated within the general approach of risk management. It is demonstrated that the proposed view of risk management can effectively combine and reconcile different approaches by highlighting their advantages and shortcomings. Departing from a subjective definition of risk management, we progressively include its social dimensions which introduce both complexity and structure into the process of rural development.     

Health technology assessment between our health care system and our health

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals. So as to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites. We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit.     

Interactionism,Social Organization,and Social Processes: Looking Back and Moving Ahead

With its roots in American pragmatism, symbolic interactionism has created a distinctive perspective and produced numerous important contributions and now offers significant prospects for the future. In this article, I review my intellectual journey with this perspective over forty years. This journey was initiated within the American society, sociology, and symbolic interaction of circa 1960. I note many of the contributions made by interactionists since that time, with particular focus on those who have contributed to the study of social organization and social process. I offer an agenda for the future based on currently underdeveloped areas that have potential. These are inequality orders, institutional analysis, collective action across space and time, and the integration of temporal and spatial orders. The article concludes with calls for further efforts at cross‐perspective dialogues, more attention to feminist scholars, and an elaborated critical pragmatism.     

Earnings Inequality in the Nonmetropolitan United States: 1967–19901

Abstract Nonmetropolitan (nonmetro) inequality patterns are contrasted with those of metropolitan (metro) areas to assess the utility of neoclassical and restructuring theoretical frameworks. Inequality measures are constructed from March Current Population Surveys for the years 1968–1991. Results indicate that inequality is greater in nonmetro areas than in metro areas. Results of decomposition procedures suggest that the observed inequality is due to a mix of neoclassical and restructuring factors that account for more inequality in metro than nonmetro areas. National policies must take account of metro/nonmetro differences in patterns and sources of inequality.     

UNDERSTANDING THE DECISION TO PARTICIPATE IN A SURVEY

The lack of full participation in sample surveys threatens theinferential value of the survey method. We review a set of conceptualdevelopments and experimental findings that appear to be informativeabout causes of survey participation; offer an integration ofthat work with findings from the more traditional statisticaland survey methodological literature on nonresponse; and, giventhe theoretical structure, deduce potentially promising pathsof research toward the understanding of survey participation.     

The peripheral position of sex in a psychotherapy: An illustrative case of a mirror transference

Understanding the role of sexualization in a depressed patient gives us the opportunity to re-examine the place of sexual activity in psychopathology. The self psychological concept of the mirror transference is used to explain the therapist's activity in the case illustration.     

Differences in preferred level of arousal in two sub-groups of problem gamblers: A preliminary report

Twelve problem poker machine players and thirteen horse race gamblers (20 males and 5 females; age range 28–69) completed a series of questionnaires which assessed levels of anxiety, their preferred state of arousal and their motivations to gamble. As predicted, problem poker machine gamblers were found to be more anxious and reported avoiding arousal more frequently than the horse race gamblers. Alternately, problem horse race gamblers were found to prefer heightened levels of arousal and appeared to gamble to achieve these optimal levels of arousal. However, there was no difference between the groups on proneness to boredom. The present results provide evidence which is consistent with the Reversal theory and its application to the field of problem gambling.     

Screening for patients with alcohol problems: severity of patients identified by the CAGE.

Primary care physicians are well situated to identify patients with substance abuse problems and motivate them to seek appropriate assistance, but active programs are the exception. A study in a community setting was undertaken to assess the CAGE (the first letters of key words in a series of four questions about drinking: cut down; annoyed; guilty; and eye-opener), instrument in the routine screening for alcohol problems in both new and established patients. The screening process identified subjects for a pilot evaluation of a motivational interview designed to encourage problem-solving behavior. This article focuses on the screening results and the use of the CAGE instrument. During June and July of 1990, 687 patients of two primary care physicians belonging to a large group practice were asked to complete a health questionnaire that included the CAGE. Those who responded affirmatively to at least two of the four CAGE questions were requested to participate in follow-up assessment of problems associated with alcohol and health. The type and severity of alcohol problems experienced by patients who scored positive on the CAGE are described. Prevalence of a positive score on the CAGE was 8.6 percent with males, smokers, and blue collar and unemployed persons being more likely to score positive. The positive predictive value was .68. Primarily, persons with moderate alcohol problems were identified. Results show that the CAGE instrument is a useful screening device for identifying those with mild to moderate substance abuse problems, increasing the opportunity for intervention prior to serious medical complications. The instrument is easily administered, and has demonstrated relatively high levels of sensitivity and specificity. When combined with assessment and motivational interviews, the CAGE shows promise in the secondary prevention of substance abuse and related health problems.