Hospital Performance and Regional Equity

The objective of this article is to see whether or not the attainment of regional equity within the hospital sector has involved any sacrifice in hospital performance.¹ For most health services providing medical care free of charge, regional equity is usually an important objective; but when doctors decide who gets into hospital and for how long regional equity may be difficult to achieve in practice. We look at certain indicators of hospital inpatient performance in relation to regional equity within the hospital sector in both England and Wales and Czechoslovakia. The comparison with Czechoslovakia is an interesting one because that country is as much concerned with regional equity in its hospital service as is the United Kingdom (UK). At the same time there have been substantial differences between the two countries in the availability of hospital resources.     

Self-perceived unpopularity: Its relationship to emotional and behavioral problems

Childhood unpopularity has been a focus of study but earlier studies have not highlighted children's self-perceptions and their relationship to childhood adaptation. The authors studied 404 children preschool to third grade to examine early risk and current factors associated with feelings of unpopularity. Children who perceived themselves as unpopular in grade three experienced multiple problems in functioning, although they were largely unobtrusive silent sufferers. Self-perceived unpopularity was most strongly related to current factors and served as a marker of emotional difficulties. Implications for identification of these vulnerable children and suggestions for future research are presented.     

Considering Improvisation: Play,Transitional Space,and Discovery

This article explores the concept of improvisation in the therapeutic setting as a complex construction when elaborated in the idiom of jazz music. A composite clinical case is offered that illustrates an impasse and how improvisational thinking offers a way forward. Improvisation has recently been conceptualized through the metaphor of theater improvisation, dance, and rhythm. The therapeutic hour is considered an improvisational dialogue with the main theme (melody) and counter melodies, and harmonic possibilities that underlie the rhythmic pulse of the hour. Improvisation requires a reflective/interpretive process that draws on patterns, structures, and experiences reformulated in the relational field of the participants. The client initiates the call and response pattern, from which improvisation emerges as a mutual process of discovery. A more relaxed, receptive, and reflective posture extends Winnicott’s 1971 notion of play to integrate classic understanding and relational interaction.     

Region,Social Identities,and Disclosure Practices as Predictors of Heterosexist Discrimination Against Sexual Minorities in the United States

Exposure to heterosexist discrimination may vary by a person's place of residency. Utilizing a minority stress perspective, an online survey of self‐identified lesbian, gay, and bisexual (LGB) individuals (n = 285) examined whether rural and small town inhabitants experienced greater exposure to six types of enacted stigma. After comparing the frequency of enacted stigma by community type, findings demonstrated that rural LGBs reported experiencing more homophobic statements, property damage, and employment discrimination than urban LGBs. Small town LGBs also encountered additional amounts of housing discrimination and were more often chased by strangers compared with urban sexual minorities. Finally, disclosure practices and hierarchies based on race and social class also influenced exposure to discrimination. The importance of spatial factors often intensified when respondents disclosed their sexual identity more publicly. When exploring racial and class differences, affluent sexual minorities experienced less employment discrimination and white sexual minorities were less likely to experience several forms of heterosexist events (especially being punched and kicked).     

Beyond Public Opinion Polls: Punitive Public Sentiment & Criminal Justice Policy

The punitive turn in criminal justice policy, epitomized by policies like three-strikes, truth in sentencing, and mandatory minimums, is often attributed in part to demand for harsher criminal justice responses from an increasingly punitive public. It has been argued that public opinion, known to be both largely uninformed and often misunderstood, might both indirectly and directly affect policy. This survey article on punitiveness in public opinion opens with a discussion of competing depictions of the nature of the relationship between a punitive public and increasingly punitive criminal justice policies. The article then focuses on some of the most influential explanations for variations in punitiveness within individuals and across groups. A review of what we know about public attitudes toward punishment and a brief explanation of how we know what we know (e.g. the methodologies by which we gauge public opinion) follow. The article concludes with the observation that as methodologies continue to improve and the literature in this area continues to grow, so too does our understanding of punitive public opinion in all of its complexity.     

Prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey

Introduction The Aging Male Symptoms' (AMS) scale was designed as a health-related quality of life (QoL) scale and standardized as a self-administered scale, first, to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, second, to evaluate the severity of symptoms/QoL over time, and, third, to measure changes pre- and post-androgen replacement therapy. The scale is in widespread use (17 languages currently available) and a recent review of methodological data documented good psychometric characteristics and ability as a clinical utility. This paper describes test characteristics of the AMS (positive and negative predictive values), taking two internationally established and published screening scales for androgen deficiency as the available standard.

Method A sample of 150 German males aged 40–69 years completed the AMS scale and two screening scales for androgen deficiency: the ADAM scale of Morley and colleagues and the screener of Smith and colleagues. The technique of a computer-assisted telephone interview was applied.

Result The comparison of the AMS with the two screening instruments for androgen deficiency showed sufficiently good compatibility despite conceptual differences. The AMS scale sufficiently predicted the results of the two screening instruments. A positive predictive value of 92% and a negative predictive value of 50% were found regarding the ADAM scale. The respective figures regarding Smith's screener were 65% and 49% for positive and negative predictive values, respectively.

Conclusion The AMS scale obviously measures a similar phenomenon as the two established and widely used screeners for androgen deficiency, although it was not developed as a screening instrument.     

Family group conferences: evidence,outcomes and future research

This is the second article of a two‐part review of the literature relating to family group conferences (FGCs); it explores outcomes and challenges in implementing FGCs. The complex data relating to outcomes, drawing on a range of national contexts, is presented. The challenges of researching outcomes and the role of longitudinal and randomized, controlled trials are considered. The article concludes with a discussion of the implementation of FGC policy and practice in the contemporary context.