The community health care center: current status and future directions

This paper presents an assessment of The Robert Wood Johnson Foundation's Municipal Health Services Program, a demonstration in five major cities of neighborhood-based health care delivery for inner-city residents, started in 1978 and supported until 1984. The program was successful in achieving higher levels of clinic utilization, as well as in integrating preventive and therapeutic services; it was less successful in reducing the dependence of inner-city residents on hospital-based ambulatory services. Although the neighborhood centers provided care at substantially lower cost than that of other public facilities, they remained dependent on outside financial support. The viability of the community health care centers at the end of the grant period is discussed, in terms of the changes that have affected the health delivery system in the seven years since the program was started, and in terms of expected changes over the next few years that will affect their future usefulness and stability. A series of alternatives that might provide for the health care needs of the indigent are also discussed.     

Online child exploitation: Challenges and future research directions

Given the relatively new phenomenon of online child exploitation – an important area of criminological and policy concern – it is difficult to obtain long term trend data on reported convictions. Existing legislative and prosecution-based approaches, while important, are unlikely to be adequate. This analysis of the legislative and prosecution-based responses in five Commonwealth countries (Australia, Canada, New Zealand, South Africa and United Kingdom), highlights the need for clear national and international definitions as the lack of consistency in the international legislative environment creates opportunities for sexual exploitation of children. To provide a multi-faceted and non-prosecutorial approach to address online child exploitation including the commercial exploitation of children, this paper identifies five potential research questions.     

Elder abuse and neglect: challenges and directions for legal reform

The last two decades have heralded an increased community and professional awareness of the phenomenon of elder abuse and the challenges it poses to the enjoyment of the human rights of some older people. The contemporary Australian legal system provides many of the components of a framework required to assist in the promotion of the rights of the elderly and in the prevention and remedy of elder abuse. This framework acts in concert with health and community services dedicated to the advancement of health and wellbeing into old age. In the future, the acknowledgment and adoption of international legal principles which are directed to the needs of the elderly, the reform of existing domestic legislation and the development of new elder-specific statutes may all impact upon the incidence and consequences of elder abuse. To date, no Australian jurisdiction has adopted a legislative regime targeted specifically at the issues confronting older Australians who may be vulnerable to abuse and neglect. This column looks at some of the options for legal reform in this area.     

Theory and racial profiling: Shortcomings and future directions in research

The volatile political environment that surrounds the issue of “racial profiling” has led local and state police agencies across the nation to start collecting information about traffic and pedestrian stops. The controversy over this issue is overwhelmed by the unsupported assumption that all race-based decision making by police officers is motivated by individual police officers' racial prejudice. This article reviews recently published studies on racial profiling and critiques both their methods and conclusions. Using the conceptual framework for police research presented by Bernard and Engel, it reviews a number of theories that may explain racial disparities in the rates of police stops. The authors argue that to explain police behavior better, theoretical models must guide future data collection efforts.     

International terrorism and mental health: recent research and future directions

International terrorism has become a major global concern. Several studies conducted in North America and Europe in the aftermath of terrorist attacks reveal that international terrorism represents a significant short-term and long-term threat to mental health. In the present article, the authors clarify the concept and categories of terrorism and then present central findings from studies conducted in the United States and Europe, which mainly focus on negative impacts on mental health, such as emotional stress and PTSD. Furthermore, the authors outline experiments that focus on social interaction processes thought to be triggered by international terrorism and which are assumed to be related indirectly to mental health processes. Next, they highlight the potential positive outcomes on the resilience side, in line with the current theory on posttraumatic growth in adversity. Finally, theoretical and practical implications as well as limitations and future directions are discussed.     

Hospital utilization review: past experience, future directions

Utilization review (UR) programs seek to determine whether specific services are medically necessary and whether they are delivered at an appropriate level of intensity and cost. Although UR programs have been operating for more than 40 years, they have changed dramatically during the past two decades. Today, many health care providers, analysts, and policymakers view UR as a possible solution to hospital inpatient cost and quality problems. This paper addresses how UR has evolved, how UR is used today by different delivery mechanisms (i.e., Medicare, health maintenance organizations, preferred provider organizations, Blue Cross, and commercial insurers), the cost effects of various UR approaches, and how UR will be used in the future.     

Issues in violent risk assessment: lessons learned and future directions

Realizing that the assessment of dangerousness with a yes/no format as a poor form of violent risk assessment has been the most important lesson learned about violence in the last 20 years. Further examining (a) what outcome and (b) how the indicators of the outcome should be measured has resulted in better violent risk assessment. The most promising methodological innovation in violent risk assessment has been the introduction of the receiver operating characteristic to assess the efficiency of risk prediction. In the future, the tension between prediction and explanation of violence will need to be maintained while focusing on a mechanism-driven strategy of risk management.     

HIV vaccines in Canada: legal and ethical issues--an overview

In July 2002 the Legal Network released an overview paper on legal and ethical issues related to an HIV vaccine in Canada. The paper, which is based on a more detailed report prepared in collaboration with the Centre for Bioethics of the Clinical Research Institute of Montréal, calls for the establishment of a Canadian HIV Vaccine Plan.     

Preimplantation genetic diagnosis: current and future perspectives

Over the last 30 years prenatal diagnosis has been available to couples at genetic risk to determine the genetic health of a naturally conceived pregnancy. Prenatal diagnosis involves fetal cell sampling either by chorionic villous sampling at 10-12 weeks or by amniocentesis at 12-15 weeks gestation and testing for genetic disease. If the fetus is affected, termination of pregnancy is a difficult and emotional issue for the couple. The advent of assisted reproductive technologies (ARTs) and more recently preimplantation genetic diagnosis (PGD) now provides an alternative reproductive option that allows couples to commence a pregnancy knowing that their baby will not be affected with the indicated genetic condition. This article explores the option of PGD, its clinical application now and into the future and the current status of regulation and legislation. With recent changes to national legislation, scientists now have the opportunity to access affected PGD embryos donated by patients to establish disease-specific stem cells that may be useful models of human disease and a means to develop more effective therapies for treatment.     

Implications of genetic testing: discrimination in life insurance and future directions

This article examines the possibility of genetic discrimination in life insurance and discusses the inability of current Australian legislation to deal adequately with genetic test result information. Genetic information has certain features that distinguish it from other medical information and thus a specialist legislative package is required to regulate its use. This article outlines how current practices in the life insurance industry are inconsistent with notions of human rights. Several legislative options are suggested and examined. Given the negative and damaging impact that adverse selection is likely to have on the life insurance industry should the use of all genetic test results be prohibited, an approach which modifies the current regime is recommended. This includes a comprehensive review scheme and the introduction of additional insurance products tailored to individuals suffering from various genetic illnesses or predispositions to future disease.     

HIV treatments, vaccines, and microbicides: toward coordinated advocacy

In November 2003, the Canadian HIV/AIDS Legal Network convened a meeting in Montréal of global experts working in the fields of treatments, vaccines, and microbicides. The meeting was historic in that it was the first occasion on which advocates from the three fields had the opportunity to meet and exchange views on policy priorities. In this article, John Godwin provides a summary of the background paper produced for that meeting and of the key outcomes of the meeting. The article describes the reasons why developing a joint advocacy agenda has emerged as a priority for advocacy organizations from the three fields, despite their differing histories and the fact that they have often been positioned as competitors rather than collaborators. The role of a human rights approach in informing joint advocacy and the relevance of the prevention-care-treatment continuum are considered. The article then examines possible areas for joint advocacy, including funding, clinical trials, public private partnerships, tax credits, liability issues, equity pricing, bulk procurement, regulatory issues, manufacture, delivery, and national plans. The article concludes by noting upcoming opportunities for joint advocacy efforts, and outlining the next steps to be taken by the Legal Network to support coordinated advocacy.     

Understanding rape and sexual assault: 20 years of progress and future directions

During the past 20 years, researchers have documented the widespread problem of rape in American society. Approximately one in four women are raped in their adult lifetime, which causes severe psychological distress and long-term physical health problems. The impact of sexual assault extends far beyond rape survivors as their family, friends, and significant others are also negatively affected. Moreover, those who help rape victims, such as rape victim advocates, therapists, as well as sexual assault researchers, can experience vicarious trauma. Future research and advocacy should focus on improving the community response to rape and the prevention of sexual assault.     

Liability and criminal justice management: Resolving dilemmas and meeting future challenges

To reduce liability, police executives rely heavily on hierarchically imposed rule adherence to control subordinates’ discretion. This management approach runs counter to current advice on how to “best manage” a public entity. This article develops an innovative approach to police management that reduces liability exposure while improving the management of the organization in keeping with contemporary notions of human resource development.     

上转换发光材料显现指纹技术的研发与应用展望

上转换发光,是指长波长的光辐射转换为短波长的光辐射的过程,对非渗透性客体上背景有荧光或图案花纹干扰的手印显现,是实际案件中经常遇到的难题,常规荧光显现方法效果较差,而上转换发光对此有巨大的潜力。本文对上转换发光材料在疑难背景上手印显现的原理、条件、现状以及未来发展方向进行了系统的阐述。     

Transnational organized crime challenges for future research

This essay and review seeks to assess the state of empirical research on transnational organized crime, drawing on a review of the English language academic literature. It identifies major themes and research questions as well as methodological approaches, and summarizes key findings. It also addresses challenges to meaningful research, arguing that internationally coordinated research projects will be necessary in the future to arrive at the insights necessary to inform theory and policy.