This issue of the journal continues with the focus from the last issue on patient satisfaction and consumer involvement. Both Allen and Rust separately analyze issues pertaining to women's health care issues. From a broad societal perspective there are many puzzling aspects about the health of men as compared to women. Although there are substantial differences in health between men and women, these two groups are not homogenous. White females live about fifteen years longer than black males. Put differently, while we know from many studies that income correlates positively with health outcomes, the poorest women of both races have death rates as low as the highest income of men. There are many societal issues at play, such as cuts in Medicaid services that predominantly affect women, and the dramatic rise of women in the prison population. The first two articles in this issue of the journal examine methods of improving services to women.

The next set of articles focuses on organizational pressures impacting ambulatory care. Kralewski and Kaissi examine the patterns of use of nurse practitioners in medical group practices. Bazzoli and colleagues provide us with the results of a study on managed care arrangements with health networks, including physician practices. This journal has always tried to provide up-to-date reports on case mix and risk adjustment. Rosen examines the issue of differences in provider reports based on different case mix measures.

For those of us who are providers of care, noise levels in the ambulatory setting can reach significant levels. Schuster provides us with a scientific approach to this challenge.

Physicians continue, unfortunately from the perspective of nonclinical administrators, to be a lynchpin within our health care system. Cochran examines the factors that explain medical director's satisfaction in community health centers. I am certain that there are many similarities to other clinical practice settings. Rabinowitz and associates present the results of a comparative study between the perceived need and actual receipt of mental health services in several HMOs in Israel. From an ethical and legal perspective, Rubenstein, the executive director for Physicians for Human Rights (PHR), summarizes, in PHR's regular column, a recent PHR report on the dual loyalty that physicians, and health professionals, often have-to their profession/patients and to their employer. Managed care has provided many ethical challenges to health care providers-particularly in the Republic of Texas and Dr. Holt brings us up to date on the happenings in that state, which has brought us many famous leaders-both past and present.

Editor