Improving Primary Care for Persons with Disabilities: the nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.     

Book reviews

As we have seen, there are great differences between the three books, both in the way demography is treated and in the way the issues are raised: the thematic outline is different, as are the methods used to tackle the many topics covered and the attitudes to the problems triggered by development trends.However, despite these differences, there is a stress throughout on the need to closely follow demographical behaviour and its importance for society as a whole. Thus, while certain trends are common to each of the three countries, future prospects are not quite the same, and there is a call for policy directions which reflect these differences. The underlying motive is not to condition trends (which past experience has shown to be little open to change) but rather to tackle promptly and effectively the problems which these give rise to.     

Property,wealth, and social change: Piketty as a social science engineer

This paper applauds the vision and originality of Piketty's Capital and Ideology. We draw attention to the distinctive methodological perspective which he adopts, which we liken to call “social science engineering.” This allows a problem oriented perspective on long‐term global social change which sidesteps siloed disciplinary debates in social science and history about the meaning of modernity, the rise of capitalism, the formation of social groups, and the primacy of nations. We bring out how his theory of property permits him to take forward his overarching insight that economic growth leads to wealth accumulation. This, therefore, challenges long standing sociological perspectives by insisting that modernity is a conservative, rather than a revolutionary and transformative process. We build on this essential contribution by noting some areas where his work can push forward even further, notably that his focus on shifting relativities obscures qualitative historical changes, and more particularly means his analysis of the 20th century is not as provocative as that of the 19th century.     

Positive Youth Development and Foster Care Youth: A Digital Perspective

The virtual world of the Internet may be used to support positive youth development. Accessing resources in educational, employment, health, and social domains is enhanced by the ability to effectively use digital technology. Foster youth are at risk for poor developmental outcomes and may face barriers to competent use of the Internet. We discuss the benefits and risks of Internet use and the importance of digital literacy to protect against risks, and we offer suggestions on ways that child welfare agencies, case managers, and foster parents can work with youth to support safe and effective use of digital technology.     

Spatial Aspects of the Rise of Nonmarital Fertility Across Europe Since 1960: The Role of States and Regions in Shaping Patterns of Change

This article investigates the role of states and regions in shaping spatial patterns of nonmarital fertility in Europe since 1960 using a dataset of 497 European subnational regions and smaller countries. Almost all regions registered substantial nonmarital fertility increases over the last 50 years. Prior research has shown that in the first half of the twentieth century states played a dominant role in drawing the demographic map of Europe (Watkins, From provinces into nations: demographic integration in Western Europe 1870–1960. Princeton University Press, Princeton, 1991). As a result, subnational regional variation decreased, while differences between countries increased. In this article, we investigate whether states continue to play such a dominant role in delineating patterns of nonmarital fertility between 1960 and 2007. We find that variation in nonmarital fertility levels increased as a whole across Europe, and states continued to be important for determining these patterns. However, the role of states relative to regions declined in the latest period examined (1990 and 2007). Possible explanations for the changes include increased supranational integration, for example, within the European Union, and decentralisation within states leading to increases in variation in subnational contextual conditions.     

The Interplay of Science, Values, and Experiences Among Scientists Asked to Evaluate the Hazards of Dioxin, Radon, and Environmental Tobacco Smoke

To investigate the extent to which personal values and experiences among scientists might affect their assessment of risks from dioxin, radon, and environmental tobacco smoke (ETS), we conducted an experiment through a telephone survey of 1461 epidemiologists, toxicologists, physicians, and general scientists. Each participant was read a vignette designed to reflect the mainstream scientific thinking on one of the three substances. For half of the participants (group A) the substance was named. For the other half (group B), the substance was not named but was identified only as Substance X, Y, or Z. Knowing the name of the substance had little effect on the scientists' evaluation of dioxin, although those who knew the substance to be dioxin were more likely to rate the substance as a serious environmental health hazard (51% vs. 42%, p = 0.062). For radon, those who knew the substance by name were significantly more likely to consider it an environmental health hazard than were those who knew it as substance Z (91% vs. 78%, p less than 0.001). Participants who knew they were being asked about ETS rather than substance X were significantly more likely to consider the substance an environmental health hazard (88% vs. 66%, p less than 0.001), to consider the substance a serious environmental health hazard (70% vs. 33%, p less than 0.001), to believe that background exposure required public health intervention (85% vs. 41%, p less than 0.001), and to believe that above-background exposure required public health intervention (90% vs. 74%, p less than 0.001). These findings suggest that values and experiences may be influencing health risk assessments for these substances, and indicate the need for more study of this phenomenon.     

Role versatility among men who have sex with men in urban Peru

Role versatility refers to the practice in which individual men who have sex with men (MSM) play both insertive and receptive sexual roles over time. Versatility has been thought to be relatively uncommon among Latin American MSM but possibly rising. Versatility has also been shown to be a potentially large population-level risk factor for HIV infection. In this study we examine the correlates of versatile behavior and identity among 2,655 MSM in six Peruvian cities. Versatile behavior with recent male partners was found in 9% of men and versatile ("moderno") identity was reported by 16%. Significant predictors included high education, white-collar occupation, sex work, and residence in Lima. Age was not significant in any analysis. Since sex work is negatively correlated with other predictors, versatile men appear to comprise two distinct sub-populations. Insertive-only men appear to play a strong role in bridging the HIV epidemic between MSM and women.     

Social norms theory-based interventions: testing the feasibility of a purported mechanism of action

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking. OBJECTIVE: The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis. PARTICIPANTS AND METHODS: The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition. RESULTS: Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later. CONCLUSIONS: Social norms-based interventions can contribute to more accurate drinking perceptions among college students.     

Policy development: An analysis of disability inclusion in a selection of African Union policies

Contemporary debates in international development discourse are concerned with the non‐tokenistic inclusion and participation of marginalized groups in the policy‐making process in developing countries. This is directly relevant to disabled people in Africa, which is the focus of this article. The United Nations Convention on the Rights of Persons with Disabilities delineates the principles of inclusion in society. Furthermore, the African Union (AU) plays a key role in advising its Member States about disability issues, and this advice should be reflected in disability‐inclusive policies. This article analyses nine policy or strategy documents produced by the AU, covering the policy domains of education, health, employment and social protection that are crucial to the inclusion of disabled people in international development. These were analysed according to seven discrete elements (rights, accessibility, inclusivity, implementation plans, budgetary allocations, enforcement mechanisms or disaggregated management information systems) using a rating scale of one to four, with four being the highest level of inclusion. The process (for example, level of consultation), the context (for example, the Sustainable Development Goals) and actors involved in the policy development were reviewed as far as was possible from the documents. None of the policies reached even 50% of the total possible score, indicating poor levels of genuine inclusion. Rights scored a highest rating, but still at a low level. This suggests that there is recognition of the rights of disabled people to inclusion, but this is not generally integrated within inclusive implementation plans, budgetary allocations, enforcement mechanisms or disaggregated management information systems for monitoring. The limited socio‐economic inclusion of disability within AU policies is a lost opportunity that should be reviewed and rectified. The findings have broader ramifications for the non‐tokenistic and genuine involvement of poor and marginalized groups in the international policy‐making arena.