Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.     

Networking in the Penumbra: Public Management,Cooptative Links,and Distributional Consequences

ABSTRACT

Recently, some researchers have begun to emphasize that governance networks can have a “dark” side as well as a relatively benign one. This work thus far has mostly emphasized illegal and violent forms of action. But even networks that operate in accord with the law often include covert, or at minimum difficult-to-observe, ties and pathways of influence. Likewise, managers involved in networking engage in behavior that is only partially observable. They can use their discretion to shape network action in ways that are hard to discern—and therefore analyze. Research on such subjects is limited, and the practical results of such behavior can include lack of accountability as well as inequitable distribution of outputs and outcomes. This article shows that individual network nodes can work to bias the actions of the organization in ways that are likely to benefit the organization's more advantaged clientele. This study reports on tests for differential impacts of managerial interactions of and with various network partners. The argument is supported with an analysis of performance data from 500 organizations over an eight-year period. Networks and managerial networking can generate considerable benefits but can also have a less palatable impact that managers and scholars need to consider seriously.     

The Political Economy of Improving Health Care for the Poor in Rural Africa: Institutional Solutions to the Principal–Agent Problem

Both governments and private for-profit markets have been disappointing in meeting the needs of the African poor for health care. NGO services provide a much more attractive alternative for this clientele, despite the fees they charge. They do so because they represent an institutional solution to the ‘imperfect information’ problem in health care. Through simulations based on data from Cameroon, we demonstrate that if fee-charging NGOs replace the highly subsidised but poorly managed facilities operated by African governments the poor would be better off. Those NGOs that are decentralised in their financial and personnel management are most effective. The politics of making the recommended changes are assessed.     

The Left and Constitutional Reform,Gladstone to Miliband

Nineteenth‐century constitutional reformers focussed on parliament. Their central idea was citizenship, modelled variously on the democracy of ancient Athens, small communities like Switzerland, and especially the United States, a particular inspiration for Gladstone who admired its constitution. The 1911 Parliament Act marked the final triumph of the Victorian Liberals legacy, with a very different impetus coming from Lloyd George during his coalition. Labour focussed on class, not the constitution, though the ILP favoured localism and devolution, before succumbing to a centralising unionism. Tawney championed the idea of social citizenship, emphasising activism and education. After 1945, Labour did not prioritize constitutional reform until the dramatic changes that came after 1997. Gordon Brown then revived the notion of citizenship, and possible codification, in pursuing the values of Britishness. Labour's legacy was a confusing one. But Ed Miliband's policy revision could reclaim the idea of citizenship, an egalitarian concept to counter the inequalities of class.     

Oxytocin and the Biological Basis for Interpersonal and Political Trust

Political scientists have documented the many ways in which trust influences attitudes and behaviors that are important for the legitimacy and stability of democratic political systems. They have also explored the social, economic, and political factors that tend to increase levels of trust in others, in political figures, and in government. Neuroeconomic studies have shown that the neuroactive hormone oxytocin, a peptide that plays a key role in social attachment and affiliation in non-human mammals, is associated with trust and reciprocity in humans (e.g., Kosfeld et al., Nature 435:673–676, 2005; Zak et al., Horm Beh 48:522–527, 2005). While oxytocin has been linked to indicators of interpersonal trust, we do not know if it extends to trust in government actors and institutions. In order to explore these relationships, we conducted an experiment in which subjects were randomly assigned to receive a placebo or 40 IU of oxytocin administered intranasally. We show that manipulating oxytocin increases individuals’ interpersonal trust. It also has effects on trust in political figures and in government, though only for certain partisan groups and for those low in levels of interpersonal trust.     

From Birth to School: Early Childhood Initiatives and Third‐Grade Outcomes in North Carolina

This study examines the community‐wide effects of two statewide early childhood policy initiatives in North Carolina. One initiative provides funding to improve the quality of child care services at the county level for all children between the ages of 0 to 5, and the other provides funding for preschool slots for disadvantaged four‐year‐olds. Differences across counties in the timing of the rollout and in the magnitude of the state financial investments per child provide the variation in programs needed to estimate their effects on schooling outcomes in third grade. We find robust positive effects of each program on third‐grade test scores in both reading and math. These effects can best be explained by a combination of direct benefits for participants and spillover benefits for others. Our preferred models suggest that the combined average effects on test scores of investments in both programs at 2009 funding levels are equivalent to two to four months of instruction in grade 3.     

Improving performance in a Swedish police traffic unit: Results of an intervention

This article describes the results of a feedback system designed to improve performance for a Swedish traffic police unit and examined whether such a feedback system was beneficial or detrimental to the attitudes of the officers. As in many Western countries, government organizations are being required to demonstrate their effectiveness with quantitative performance measures. An approach called the Productivity Measurement and Enhancement System (ProMES) was used with three groups of Swedish Traffic Police to do this. ProMES is a method for identifying unit's objectives, developing measures for these objectives, and using this information as feedback. ProMES was developed with these police units and feedback from the system was used over a four-year period. Results indicate that there were substantial increases in performance. There were also decreases in accidents, injuries, and fatalities compared both to baseline and to comparison groups in Sweden. These improvements were made with fewer and fewer police officers each year.