Book reviews

Realism, Idealism and International Politics: A Reinterpretation

By M. Griffiths, Routledge: London, 1992, 206pp(hbk), £35.00

International Conflict Resolution: The US‐USSR and Middle East Cases

By Louis Kriesberg, Yale University Press: 1992.

Deterring Democracy

By Noam Chomsky, Vintage Press, 1992, 439pp £7.99(pbk) ISBN 0–09–913501–9.

Arab Military Industry: Capability, Performance, and Impact

By Yezid Sayigh. Brassey's, London, £38.00/$49.50. ISBN 0–08–041777–9.

The Velvet Revolution: Czechoslovakia 1988–91

By Bernard Wheaton and Zdenek Kavan, Westview Press, 1992.

Peace Without Hiroshima: Secret Action at the Vatican in the Spring of 1945

By Martin S. Quigley. Madison Books: Lanham, Maryland, 1991. 169pp.

Historical Discord in the Nile Valley

By Gabriel R. Warburg, London: Hurst & Company Ltd, 1992, £27.50.

To Loose the Bands of Wickedness: International Intervention in Defence of Human Rights

Nigel Rodley (Ed). Brassey's (UK), 1992. 287pp(HBk). ISBN l‐85753‐()47‐().     

Simulating Emotional Responses in Posttraumatic Stress Disorder: An fMRI Study

This study tested the extent to which coached participants can simulate the neural responses of participants with posttraumatic stress disorder (PTSD) when they are presented with signals of fear. Functional magnetic resonance imaging (fMRI) was used to study blood oxygenation level-dependent signal during the presentations of fearful and neutral faces under both conscious and nonconscious (masked) conditions. Participants comprised 12 patients with PTSD and 12 trauma-exposed controls who were instructed to simulate PTSD. During conscious fear processing, simulators showed greater activation in the left amygdala and medial prefrontal cortex (MPFC) than PTSD participants. By contrast, during nonconscious processing, PTSD participants had greater MPFC activation than simulators. These findings suggest that coached simulators produce a profile of ‘over-responding’ to fear when controlled conscious processing is possible, but are not able to simulate the exaggerated medial prefrontal responses observed in PTSD participants under conditions of nonconscious processing.     

Health‐care reform and the dimensions of professional autonomy

Abstract: A “managed competition” model was introduced in the Canadian province of Ontario as part of the government's reform of home care. With this model, it was assumed that competitive forces would encourage quality while driving down costs. While such reforms often achieve cost controls by constraining the incomes and practices of health‐care workers, there has been relatively little analysis of the extent to which self‐governing health‐care professionals, particularly those outside of medicine and nursing, may experience a decline in their ability to control the content and context of their professional work. In this article, the authors analyse the results of thirty‐six in‐depth interviews with representatives of Community Care Access Centres (CCACs), the organizations that purchase and coordinate the delivery of home‐care services, and rehabilitation provider agencies to examine the impact of Ontario's managed competition reform on rehabilitation professionals. Findings suggest that the impact of the reform varied across the economic, political, and clinical dimensions of professional autonomy and that, despite a general loss of autonomy under the managed competition model, market forces also served to mitigate the loss of autonomy, thus contributing to a remarkable resilience of professional autonomy. Sommaire: Un modèle de « concurrence dirigée » a été introduit récemment dans la province canadienne de l'Ontario dans le cadre de la réforme gouvernementale des soins à domicile. Avec ce modèle, il était présumé que les forces de la concurrence encourageraient la qualité tout en faisant baisser les coûts. Alors que de telles réformes parviennent souvent à maîtriser les coûts en réduisant les revenus et les pratiques des travailleurs de la santé, il y a eu relativement peu d'analyses de faites sur la mesure dans laquelle les professionnels de la santé autonomes, particulièrement ceux qui exercent en dehors de la médecine et de la profession infirmière, connaissent une perte de contrôle sur le contenu et le contexte de leur travail professionnel. Dans le présent article, les auteurs analysent les résultats de trente‐six entrevues en profondeur menées auprès de représentants des Centres d'accès aux soins communautaires (CASC), organismes qui achètent et coordonnent la prestation des services de soins à domicile, et organismes de prestation de soins de réadaptation, afin d'examiner les conséquences de la réforme de la concurrence dirigée de l'Ontario sur les professionnels de la réadaptation. Les résultats laissent entendre que l'effet de la réforme a varié en fonction des dimensions économiques, politiques et cliniques de l'autonomie professionnelle et que, malgré une perte d'autonomie générale liée au modèle de concurrence dirigée, les forces du marché ont également permis d'atténuer la perte d'autonomie, contribuant ainsi à la remarquable résilience dont font preuve ces professionnels en la matiére.     

Learning the Limits of Power: Privatization and State-Labor Interactions in Mexico

Despite repeated conflict with organized labor, the government of Carlos Salinas de Gortari (1988–94) pushed an aggressive divestment agenda that transformed Mexico into Latin America's leading privatizer. Explanations of Salinas's achievements typically emphasize centralized presidential power (including control over the ruling party) and autonomy; technocratic and political savvy; and weak labor opposition. This article questions such a pure "capacity-outcome" approach. Of equal importance are the learning effects of repeated interaction between the state and labor, which changed the course of divestment struggles and thereby influenced their outcomes. Lessons learned in successive confrontations led to patterns of interaction conducive to widescale privatization. The article develops this argument through comparative analysis of major divestment episodes in the aviation, mining, steel, and telecommunications sectors.