GPs and Contracts: Bringing General Practice into Primary Care

This paper argues that the terms on which GPs entered the NHS, as self-employed contractors, have proved remarkably resistant to the managerial pressures which have come to dominate other sections of the National Health Service. However, this traditional mode of financing and organizing the delivery of a key element of the National Health Service has become increasingly incompatible with wider health policy objectives—the development of an integrated network of good-quality, equitable and well-coordinated primary and community health services which are responsive to local needs. Furthermore, primary health services have themselves come to play a crucially important role in securing other strategic changes in the wider health policy arena, such as securing and sustaining a shift in the traditional balance between hospital and community-based health services and controlling expenditure in a needs-led service. The paper argues that, notwithstanding the change of government, the 1997 NHS (Primary Care) Act and the White Paper "The New NHS" are both integral to the achievement of wider strategic health policy objectives, such as improving the quality and coherence of services, and increasing professional accountability for the financial consequences of clinical decisions. However, the greatest significance of these and other related measures is that they shift the emphasis of health policy from commissioning and purchasing by primary care to commissioning and contracting for primary care. They thereby extend the exposure of GP-based services to managerialist scrutiny and control.     

Moral Economy or Political Economy? Property and Credit Markets in 19th Century Rural Portugal

Peasants are often represented as a distinctive rural type with a reverent attitude toward the land, a disdain for commerce, and a set of institutions that sustain homogeneity and community. An alternative to this "moral economy" approach is a differentiation or political economy perspective that emphasizes articulation and integration within a broader regional, national and institutional framework, as well as individual and household strategies. Focusing on the rural population of nineteenth and twentieth century northwestern Portugal, this article addresses these two approaches through an analysis of peasant engagement with the property and finance capital markets. It explores the motives that pull peasants into these markets, how these transactions not only link rural and urban populations into a single regional economic system, but also connect individuals to the international market of labor through emigration, and finally how these transactions are embedded in village institutions including family, neighborship, and religious brotherhoods.     

Reverberations of Racism and Sexism Through the Subjective Sexualities of Undergraduate Women of Color

Young women of color (among others) face both subtle and overt discrimination on a regular basis, but few studies have examined relations between discrimination and sexual outcomes using quantitative tools. We surveyed 154 self-identified undergraduate women of color to examine connections between race- and sex-based discrimination and subjective sexual well-being (i.e., condom use self-efficacy and sexual life satisfaction) and also tested whether sexual autonomy mediated these relations. When examined individually, each form of discrimination was related negatively to condom use self-efficacy and sexual life satisfaction, such that as women reported more discrimination, they reported poorer sexual well-being. However, when examining both racism and sexism as joint predictors, only racism remained significant and there were no racism × sexism interaction effects. In a path model, sexual autonomy mediated the relation between racism and each measure of subjective sexual well-being; racism was negatively related to sexual autonomy, which in turn was positively related to both condom use self-efficacy and sexual life satisfaction. These findings are consistent with the broader literature on the negative impact of discrimination on various aspects of mental and physical health. They also reinforce the position that redressing social inequality is a vital component of promoting individual health.     

Career Counseling Is Personal Counseling

Despite many changes that have occurred in the field of career counseling, counselors continue to rely on models of counseling that emphasize the rational, informational aspects of career decision making. The author argues that career counselors need to pay more attention to the affective, psychological issues confronting clients with career problems. The impact of significant psychological variables that influence career decision making are discussed: developmental stages and tasks, identity formation and status, self-concept, psychological needs, and internal barriers.     

Getting Along or Getting Your Own Way: The Development of Young Children's Use of Argument in Conflicts with Mother and Sibling

The development of children's use of argument in conflicts with their mother and sibling during their fourth vear, a period of marked changes in their understanding of others, was studied in 49 children observed at home with their mothers and siblings at 33 and 47 months. Children's use of reasoned argument in conflict increased: however, the proportion used for conciliation and compromise decreased, and children used justifications increasingly to support their own position. Mothers, hut not siblings, changed in parallel to the children over this period. Both the initiator of a dispute and children's expression of affect were related to children's use of argument; children used less reasoned argument when they were upset. Results are discussed in relation to differences in the development of children's relationships with mother and sibling and the importance of the link between affective expression and the use of argument in family disputes.     

Sociology and the case for realism

It is argued that in the present era of ecological threat we need a critical sociology, which requires a realist ontology. Using Beck's Risk society as an example, I maintain that to the extent that postmodernist sociology rejects realism, its critical and substantive potential is compromised. The second half of the article argues that realism must extend also to moral positions, which are assessed in terms of knowledge of the natural and social world. Through various examples it shows that while postmodernist thinkers reject meta-narratives and universal truth, they are inevitably moral realist in practice when talking politics. Contra Bauman, sociology cannot dispense with the project of emancipation. The moral realist discourse of human needs permits us to move from statements about the world to recommendations for action.