Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.     

The Impact of Minimum-Wage Increases: Evidence from Fast-food Establishments in Illinois and Indiana

Fast-food establishments in Illinois and Indiana were surveyed during a period of state-mandated minimum-wage increases in Illinois. While entry-level wages of Illinois establishments rose substantially in response to the mandated increases, there is little evidence that Illinois establishments ameliorated wage increases by delaying scheduled raises or reducing fringe benefit offerings. There is little evidence of ‘labor-labor’ substitution in favor of women, better educated, or teenaged workers, or increased worker tenure at the new wage, but weak evidence of increased food prices. In contrast, there are large declines in part-time positions and workers’ hours in Illinois relative to Indiana. Aggregate figures from the Bureau of Labor Statistics support relative declines in total fast-food employment in ‘downstate’ Illinois counties, as hypothesized. However, establishments’ responses do not appear proportionate to the strength of the minimum wage change.     

Feminist In(ter)ventions in Family Therapy†

Family therapy is often receptive to new ideas but so far it has only engaged with the second wave of feminisms in a restrained and conditional way. In this article we map the influence of feminisms on the life of family therapy and conclude that its dominant conceptual frameworks have so far resisted feminist revision. Ironically, while feminist post-modernist thought has helped to loosen the modernist grip on family therapy, family therapy's embrace of post-modernism synthesizes and displaces rather than centres feminist concerns. Since post-modernism is not post-patriarchal, the result may be exclusion of feminist perspectives that offer a principled and liberating way through current dilemmas in family therapy. Feminist perspectives are not mere voices among others; they hold promise for the development of a more inclusive theory and practice based on a valuing of inter-connectedness and an ethics of care and responsibilty.     

Single Mothers and Supermyths

Past theories concerning the causation of ex-nuptial pregnancy are reviewed. Current claims that large numbers of single women are deliberately setting out to become pregnant so they will have something to love and something to live on are critically considered. Each of these theories is likely to explain why some women become pregnant, but it is argued that none of them is generally applicable. Statistical and survey evidence supports the argument that the ‘Superdoll Syndrome’ is as mythical as its predecessors.     

The Role of Risk and Future Land Use in Cleanup Decisions at the Department of Energy

As a result of the legacy of the Cold War, the Departments of Energy and Defense are involved in massive cleanup and remediation projects. While health risk to humans and ecological receptors is perceived to be the basis for remediation, this assumption is rarely examined. In this article, we examine the role of risk and future land-use designations in cleanup decisions, using the Department of Energy's self-assessment of 36 sites. We then discuss the risk-related tools that might be required to address the cleanup challenge. Much of the current cleanup program is driven by compliance with federal and state statutes and regulations, presumably to protect human health and the environment. Compliance, however, is not synonymous with cleanup. Although some of these laws and regulations take risk into account, the lack of site-specific data on exposures and risk scenarios, and the lack of attention to future land use or end states, has often resulted in disconnects between risk and cleanup goals, risk and final end states, and cleanup levels and end state or subsequent land use. Partly, these disconnects result from the need for a range of technical, economic, sociological, and public policy tools to address the issues. A better transfer of information among and within Department of Energy facilities, operations offices, and DOE headquarters is required. Further, linking cleanup decisions and goals with the final end state involves a number of risk tradeoffs, including (1) ecological versus human health, (2) worker versus public health, (3) among competing contaminated areas, (4) among temporal patterns of cleanup, (5) among different ecological receptors (plants vs. animals, one animal vs. another), and (6) among the sites across the DOE complex. For the nation, balancing among risks is essential within sites and among Department of Energy sites, as well as among other remediation sites (such as those of Department of Defense and Superfund sites).     

The care manager’s dilemma: balancing human rights with risk management under the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003

In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such ‘care recipients’ from the criminal justice system to a disability sector that values a social model of disability and philosophies of autonomy, choice and normalisation. This research identified dilemmas faced by care managers legally responsible for care recipients. Care managers experienced: tension between imperatives of risk management, rehabilitation and human rights; role ambiguity between ‘custodian’ or ‘therapist’; philosophical incongruity within their services; and ethical dilemmas over decisions to lengthen care orders. The changing care recipient population has intensified these dilemmas: services must now adapt to the needs of young, street-wise people with alcohol and drug problems and histories of criminal behaviour. The article makes recommendations about how these dilemmas can be addressed.     

How a Divorcee’s Sexual Life Is Socially Constructed and Understood in the Iranian Culture

Sexual well-being is an important factor in postdivorce adjustment and presents various challenges for divorced women in Iran. With an alarming number of marriages ending in divorce in Iran, the postdivorce sexuality adjustment process has become a major concern. Meanings attached to the sexuality of a divorcee necessitate different adjustment and coping strategies among women. How these meanings are generated, negotiated, and modified in Iranian contexts has yet to be explored. We used a grounded theory approach to analyze the extensive, rich data obtained through sustained interaction with the informants as well as through in-depth individual interviews and focus group discussions. “Sociosexual problems” was found to be one of the main domains in our study. Participants experienced a negative impact from divorce on their sexual lives, including sexual interactions. Social isolation and social exclusion resulted from the avoidance of stereotypic interactions and were often a consequence of difficulties with concealment of sexual needs due to stigma. Women discussed a range of negative experiences arising in response to their sexual needs in postdivorce life. The analysis revealed the complexities of gendered postdivorce sexual trajectories. Based on the findings, articulating a sexual health model specific for divorced women seems important.     

Demographic components of growth in white,black, and Puerto Rican female-headed families: Comparison of the Cutright and Ross/Sawhill methodologies

This study examines the methodological differences between Cutright's (1974, Journal of Marriage and the Family36, 714–721) and Ross and Sawhill's (1975, Time of Transition: The Growth of Families Headed by Women. The Urban Institute, Washington, D.C.) analyses of demographic components of growth in the number of female-headed families and replicates their procedures within a comparable time/age framework in order to resolve their contradictory findings. The analysis suggests that while changes in living arrangements and population are the two major factors accounting for changes in the number of White female-headed families between 1940 and 1970, marital instability is the major factor responsible for the increase in the number of White female-headed families between 1960 and 1970. Cutright's analysis of long-term changes for nonwhites is debatable. The relative importance of demographic factors in explaining the absolute increase in female-headed families between 1960 and 1970 clearly varies by ethnic/racial group.