Lessons from the trenches in physician integration

Beyond the theoretical basis for integration, three core considerations stand out as the primary reasons for pursuing integration from a physician's perspective. In the authors' experience, the ability to make a case for physician integration stands or falls based on the ability of the integrated delivery system to address these considerations: Gain greater access to capital; develop human resources with talents in managed care and the full spectrum of care services; and sustain an information infrastructure. This article explores the lessons learned in pursuing physician integration.     

The economic effects of large industrial undertakings on rual economies

This paper uses an adaptation of the input-output method to test the impact of large-scale industrial undertakings on comparatively small and sparsely-populated areas. It explains how, firstly, a model was built based upon a specimen rural area and including a series of vectors which allow local demand to change as incomes change. The model was then generalized so that data could be inserted to simulate any similar area. The paper then explains the results obtained from inserting a large-scale industrial activity into the model.     

Has the HIV Epidemic Peaked?

This study reviews the highly diverse regional and country patterns of HIV epidemics and discusses possible causes of the geographic variation in epidemic sizes. Past trends and projections of the epidemics are presented and the peak years of epidemics are estimated. The potential future impact of new prevention technologies is briefly assessed. A final section summarizes the future impact of the epidemic on key demographic variables. The main finding of this analysis is that the HIV epidemic reached a major turning point over the past decade. The peak years of HIV incidence rates are past for all regions, and the peaks of prevalence rates are mostly in the past except in Eastern Europe, where they are expected to peak in 2008. But owing in part to the life‐prolonging effect of antiretroviral therapy and to sustained population growth, the absolute number of infected individuals is expected to keep growing slowly in sub‐Saharan Africa and to remain near current levels worldwide, thus posing a continuing challenge to public health programs. No country is expected to see a decline in its population size between 2005 and 2050 that is attributable to high mortality related to AIDS.     

Changing the risky beliefs of post-partum women about therapeutic sun-exposure

BackgroundMany post-partum women hold risky beliefs about perceived therapeutic benefits of sun-exposure in the post-partum period and infancy.QuestionCan a maternity hospital based educational intervention reduce the prevalence of such beliefs among post-partum women?MethodsIn this outcome evaluation of an interventional study, two groups of healthy post-partum women (hospital inpatients) were interviewed, 1–4 days following delivery. The first cross-section (106 women) was recruited prior to in-services for maternity staff; the second (203 women) was recruited after completion of the in-services. Data were compared between the groups.FindingsMore pre-intervention than post-intervention women reported they would expose their baby to sunlight to treat suspected jaundice (28.8% vs 13.3%; p < 0.001) or help his/her skin adapt to the sun (10.5% vs 2.5%; p = 0.003); or use sunlight to manage breastfeeding-associated sore/cracked nipples (7.6% vs 2%; p = 0.026).ConclusionThis simple, effective educational intervention could be implemented in programmes for parents, health professionals and students.     

Corporation taxes and the debt policy of multinational firms

This paper analyzes the impact of corporate taxes on the capital structure of foreign subsidiaries of multinational firms. The empirical investigation employs a large micro-level panel dataset of German multinationals covering 31 countries over a 10-year period. A special feature of this dataset is that it allows us to distinguish between internal and external debt financing. Our results confirm a positive effect of local tax rates on both types of debt. Moreover, while adverse local credit market conditions are found to reduce external borrowing, internal debt is increasing, supporting the view that the two channels of debt finance are substitutes. Our findings suggest that internal credit markets give rise to significant advantages and enhance multinationals?? opportunities to use debt as a tax shield.     

Probabilistic Projections of the Total Fertility Rate for All Countries

We describe a Bayesian projection model to produce country-specific projections of the total fertility rate (TFR) for all countries. The model decomposes the evolution of TFR into three phases: pre-transition high fertility, the fertility transition, and post-transition low fertility. The model for the fertility decline builds on the United Nations Population Division’s current deterministic projection methodology, which assumes that fertility will eventually fall below replacement level. It models the decline in TFR as the sum of two logistic functions that depend on the current TFR level, and a random term. A Bayesian hierarchical model is used to project future TFR based on both the country’s TFR history and the pattern of all countries. It is estimated from United Nations estimates of past TFR in all countries using a Markov chain Monte Carlo algorithm. The post-transition low fertility phase is modeled using an autoregressive model, in which long-term TFR projections converge toward and oscillate around replacement level. The method is evaluated using out-of-sample projections for the period since 1980 and the period since 1995, and is found to be well calibrated.     

The withdrawal of the welfare state: Elderly care in Sweden in the 1990s

In Sweden, clear changes in the care of the elderly have occurred during the 1990s, with fewer people being provided public care, although greater efforts are now directed towards those most in need of help. Elderly people are cared for increasingly in other ways: by the family, by means of market-provided care, and by voluntary and informal means. Differences between municipalities are considerable. A comparative study was conducted in eight Swedish municipalities, four of them characterized by extensive reorganization of home-help services, and the other four constituting a reference group where such changes had not occurred. The aim was to examine processes of setting local priorities and adjustments in a period of marked structural change. Interviews with local politicians, administrators, professionals, and union representatives, and with the elderly themselves, were the main sources of data. The process of determining the extent and content of home care services in the municipalities was found to be a complex process, one involving a number of partly interdependent factors. Restructuring was found to be greatest in the context of a traditionally strong reliance on home-help services, rather than in the context of institutionalized care, where administrative decision-making and a medical and rehabilitative perspective dominated.     

Building capacity of maternity staff to discourage the use of sunlight therapy in the post-partum period and infancy

PURPOSE: To describe the development, implementation and evaluation of an educational intervention that addresses risky beliefs held by midwives and nurses working in maternity areas and new mothers about therapeutic sun exposure. PROCEDURE: In 2002-2003, 59 midwives and nurses from a hospital in northern Queensland participated in an educational intervention to discourage mothers from exposing themselves and their infants to sunlight for therapeutic reasons. Intervention staff attended an educational workshop and/or received educational resources. Resources (posters, pamphlets and bookmarks) were developed for the staff to use for educating mothers. Process evaluation of the quality and usefulness of the workshop and resources was conducted immediately after the workshop and 12 months later. FINDINGS: Intervention staff indicated that the workshop was relevant to their work, and increased their knowledge and confidence in talking to mothers about sunlight exposure. Ninety percent of the 59 participants indicated they had used the workshop information in their interactions with post-partum mothers. Of the resources, pamphlets and bookmarks were used most often. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The educational intervention was successful in developing the knowledge of midwives and nurses to provide sound advice to new mothers about therapeutic sun exposure and in developing resources to support them in their education. Although workshops and resources are useful in the short term, they are impractical to sustain. To improve sustainability, content on this topic needs to be incorporated into midwifery and nursing curricula across Australia.