SPECIALIZATION OF NURSING HOME CARE AND OUTCOMES1

Implications of nursing home specialization for health outcomes were examined. The formal hypothesis tested in this study was that facilities specializing in the treatment of certain kinds of residents, as reflected in a critical mass of such residents, are more likely to experience better health outcomes over time compared to facilities that do not specialize in the treatment of such residents. Activities of Daily Living (ADLs), survival, and several diagnosis‐specific outcomes were analyzed for residents. Multivariate state‐dependence and logistic regression models were estimated for residents of six diagnostic sub‐groups. Specialization was empirically defined in terms of concentration of residents with certain diagnoses within nursing facilities. Empirical results indicate that specialization has some positive effects on some outcomes. For instance, facilities specializing in the care of Alzheimer's disease patients appear to produce comparatively better outcomes with respect to restraint use and accidents. Residents with diagnoses of hypertension or ischemic heart disease in specialized facilities also fare better in terms of survival. Residents with a diagnosis of cerebrovascular disease in specialized facilities were found to experience worse outcomes with respect to most of the outcomes modeled in this study, however. Overall, specialization only appears to make a difference in the outcomes of residents with certain medical conditions for some health outcomes. Regression results also indicate that basic measures of frailty such as functional deficiencies, incontinence, and behavioral problems largely contribute to detrimental effects irrespective of the diagnostic group or the outcome considered.     

Roles of government in a mixed economy

This essay argues that market failure analysis provides an unsubstantial basis for assessing the kinds of things governments should be doing if they could do them well, and modern public choice theory an inadequate guide to obstacles to effective governmental action. The argument is supported by analysis of political rhetoric and actual policy in two arenas: support of R&D, and help for poor children.     

Detection of the rare PGM1(3) allele. Further biochemical and genetic characterization of the PGM1(3) isozymes

A family possessing the rare PGM1(3) allele has been found in North Carolina, and criteria for the electrophoretic separation and accurate typing of the PGM1(3) isozymes are outlined. The PGM1(3) isozymes detected proved to be useful in helping to determine parentage in an incest investigation. The pattern of segregation of the PGM1(3) allele in four generations of this family and thermostability studies on the PGM1(3) isozymes are presented.     

English court upholds ban on newspaper publishing identity of HIV-positive health-care worker

In the last issue of the Review, we reported about an HIV-positive health-care worker in the UK who brought legal proceedings to prevent the National Health Service from notifying his previous patients that he is infected. In February 2002, the Court of Appeal for England and Wales (Civil Division) upheld a ban on publishing his name and that of the health authority for which he worked.     

HIV-positive child made ward of court after father refuses treatment with antiretroviral drugs

In 1999, we reported a number of cases in Canada, the US, and the UK in which child-welfare authorities have disputed parents' decisions to refuse HIV testing or treatment for their children. This article reports on new developments in one of those cases. On 10 May 2002, the English High Court heard submissions regarding the future of a three- year-old HIV-positive girl who was made a ward of the court after her father refused to allow her to be treated with antiretroviral drugs.     

Blood or blood products: Minister's decision to deny application to Extraordinary Assistance Plan upheld

In April 2002, the Federal Court of Canada decided the federal Minister of Health does not have the authority to award compensation under the Extraordinary Assistance Plan unless an independent medical review board finds that the applicant was infected with HIV as a result of the receipt of blood or blood products in Canada between 1978 and 1989.     

The case of Jeffrey Dahmer: sexual serial homicide from a neuropsychiatric developmental perspective

Sexual serial homicidal behavior has received considerable attention during the last three decades. Substantial progress has been made in the development of methods aimed at identifying and apprehending individuals who exhibit these behaviors. In spite of these advances, the origins of sexual serial killing behavior remain for the most part unknown. In this article we propose a biopsychosocial psychiatric model for understanding the origins of sexual serial homicidal behavior from both neuropsychiatric and developmental perspectives, using the case of convicted serial killer Jeffrey Dahmer as the focal point. We propose that his homicidal behavior was intrinsically associated with autistic spectrum psychopathology, specifically Asperger's disorder. The relationship of Asperger's disorder to other psychopathology and to his homicidal behavior is explored. We discuss potential implications of the proposed model for the future study of the causes of sexual serial homicidal crime.