Quality. A tightrope for the '90s

How accurately can you measure quality of care in health care? Recently, HMOs and other types of managed care organizations have been in the process of defining quality in quantitative terms. Physicians who utilize fewer resources and who care for more patients per-unit-of-time are valued as providing better care than colleagues who may work at a slower (more expensive?) pace. The pressure to evaluate or treat greater numbers of patients in shorter periods of time can produce adverse consequences. And numbers do not necessarily take into account the quality of the care delivered. There is clearly a middle road. Physicians must take care of a sufficient number of patients with a given problem to gain and maintain expertise and mastery. But they must also guard against the insidious pressure for the procedure to become the end in itself.     

Marriage selection and age patterns of mortality: a mathematical investigation

"In this paper, we use simulation models to demonstrate the complexity of the relationship between the marriage selection process and the resulting RMRs [relative mortality ratios]. In particular, we show that marriage selection alone can produce a relative mortality ratio which remains large and relatively constant at ages far beyond the marriage span....Our general objective...is to determine the range of age patterns of relative mortality which could, in theory, result from marriage selection on the basis of health characteristics. We also evaluate the effects of variations in the marriage selection mechanisms on the resulting mortality patterns....We develop and apply several simple mathematical models of the marriage selection process. In order to distinguish the potential consequences of marriage selection from marriage protection, we consider hypothetical populations in which causal effects are absent....We begin by considering an extremely simple marriage selection process and subsequently explore a more realistic selection model based on recent death and marriage rates for Japan."     

Transforming the Way We Live Together: A Model to Move Communities From Policy to Implementation

Most cities, counties, and neighborhoods are not designed for an aging population. By providing a range of services to all residents, Lifelong Communities allow individuals to age in place. Although the Lifelong Communities Initiative is based on established guiding principles, little information exists regarding the realities of moving from policy to implementation. The Atlanta Regional Commission conducted a case study in Mableton, Georgia, and found successful implementation requires a combination of support from local citizen groups and government. The Atlanta Regional Commission is replicating these best practices in other communities and providing support to those aspiring to launch or expand Lifelong Communities.     

Salience,Valence, Context,and Integration: Conceptualizing the Needs of Sexually and Gender Diverse Youth in P–12 Schools

A framework for conceptualizing the needs of lesbian, gay male, bisexual, transgender, questioning, and other sexually and gender diverse youth is essential for guiding service delivery throughout educational settings. Review and synthesis of the literature reveals that integrating assessment of the salience, valence, and context of issues related to sexual and gender diversity facilitates affirmative practice at the individual student, group, and school-wide levels. The authors describe the components of the salience, valence, context, and integration (SVCI) model with emphasis on practical application. The theoretical and empirical support for each component of the model is also discussed.     

Social Responsibility,Substance Use,and Sexual Risk Behavior in Men Who Have Sex With Men

Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status—a behavior that helps men protect their partners but does not protect themselves from the virus—also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.     

Leadership ambiguity in universities and K–12 schools and the limits of contemporary leadership theory

This paper explores the differences in context, assumptions, and behavior of leaders both in modern American universities and in elementary and high schools. The paper's main section examines the utility of five leadership theories (situational, charismatic, transformational, path–goal, and leader–member exchange [LMX]) in explaining leader behavior in each educational sector. We show that while each theory has some merit, none adequately incorporates the larger internal and external “system” pressures on leaders whose institutions are undergoing changes. The paper concludes with a recommendation for a reformulation of the leadership dilemmas in education that sets the five theories in a broader, systemic conceptual framework.     

From Rags to Riches: Jewish Oligarchs in Russia

SELECTIVE REMINISCENCES

KHRUSHCHEV REMEMBERS. THE LAST TESTAMENT, translated and edited by Strobe Talbott. London, André Deutsch; New York, Little Brown, 1974. xxxi, 602 pp. Illus. Appendix. £4.95; $12.95.

HISTORY OF ZIONISM IN RUSSIA

HA‐TENUAH HA‐TSIYONIT BE‐RUSYA (The Zionist Movement in Russia), by Yitshak Maor. Jerusalem, Ha‐Histadrut ha‐Tsiyonit, 1974. 597 pp.

A CONTRIBUTION TO JEWISH DEMOGRAPHY

STUDIES IN JEWISH DEMOGRAPHY: SURVEY FOR 1969–1971, edited by U. O. Schmelz, P. Glickson and S. J. Gould (Institute of Contemporary Jewry, Hebrew University, Jerusalem; and Institute of Jewish Affairs, London), 1975. 375 pp. N.p.

ANTI‐ZIONISM AND ANTISEMITISM

SOVIET ANTI‐SEMITISM: THE PARIS TRIAL, ed. and with an Introduction by Emanuel Litvinoff, London, Wildwood House, 1974. 120 pp. £3.00.

POLZUCHAYA KONTRREVOLYUTSIYA (Creeping Counterrevolution), by Vladimir Begun, Minsk, Izdatelstvo “Belarus”, 1974. 191 pp. 28 kop.

AN UNSATISFACTORY STUDY

THE SOVIET TREATMENT OF JEWS, by Harry G. Shaffer. New York, Washington, London, Praeger, 1974. 231 pp. £6.50.

FASCISM AND ANTISEMITISM IN THE DANUBE BASIN

THE SHADOW OF THE SWASTIKA. THE RISE OF FASCISM AND ANTI‐SEMITISM IN THE DANUBE BASIN, 1936–1939, by Bela Vago. Farnborough, Saxon House, D. C. Heath, for the Institute of Jewish Affairs, London, 1975. 431 pp. Docs. Maps. Index of Names. Subject Index. Appendix. £6.50.

THE JEWS OF HUNGARY

EVKONYV 1973/74 (Yearbook 1973/74), ed. by Sándor Scheiber. Budapest, Magyar Izraeliták Országos Képviselete, 1974. 382 pp. Illus. 40 Ft.

A PICTURE OF POLISH SOCIETY BETWEEN THE WARS

SPOLECZENSTWO DRUGIEJ RZECZYPOSPOLITEJ 1918–1939 (The Society of Interwar Poland 1918–1939), by Janusz Zarnowski. Warsaw, PWN (State Scientific Publishers), 1973. 435 pp. 40 zl.