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."     

Exercise self-regulation among older women participating in a heart disease-management intervention

Using behavioral self-regulation processes may facilitate exercise among older women with heart disease. Data from women in a heart disease-management program (n = 658, mean 73 years), was used to explore associations among exercise self-regulation components (i.e., choosing to improve exercise and observing, judging, and reacting to one's behavior) and exercise capacity. General linear models showed that choosing exercise predicted higher exercise self-regulation scores postprogram and 8 months later. In turn, these scores predicted greater improvements in exercise capacity concurrently and 8 months later. Interaction analyses revealed that the effect of self-regulation on exercise capacity was stronger among women who chose to work on exercise.     

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.     

ISOLATION, INTEGRATION, AND ETHNIC BOUNDARIES IN RURAL GUATEMALA

We investigate two perspectives about the effects of reduced discrimination and greater social and economic opportunities on ethnic identity in rural areas of contemporary Guatemala. Our analysis contrasts the effects of new opportunities in Indigenous communities on language use and dress, using data from the 1995 Encuesta Guatemalteca de Salud Familiar (EGSF). While the use of both dress and language has changed substantially in recent years, language use has changed considerably more than dress. We conclude that, in this context, economic opportunities have not necessarily diminished ethnic solidarity, but may have instead reshaped it.