Can epidemiological studies assist in the evaluation of community treatment orders? — The experience of Western Australia and Nova Scotia

Epidemiological studies using administrative databases have several advantages over other methodologies in studying the effectiveness of compulsory community treatment such as community treatment orders (CTOs). We compared patients placed on CTOs in Western Australia with controls drawn from both within the jurisdiction and from another without this measure (Nova Scotia). Although in different countries, the mental health services in both jurisdictions share common characteristics. Notably, we were able to control for forensic history in our comparison within Western Australia. We analysed predictors of admission and number of bed-days using multiple, logistic or Cox regression as appropriate. Of the 274 subjects placed on a CTO, we were able to find controls for up to 96% (n = 265). CTO placement was not associated with reduced admissions or mean bed-days, although there was a threshold effect with a reduced risk of inpatient stays exceeding 100 days. Outpatient contacts were significantly greater for the CTO group. However, we do not know whether the intensity of treatment, or its compulsory nature, effected outcome.     

Pain, Impairment, and Disability in the AMA Guides

Physicians use the American Medical Association's Guides to the Evaluation of Permanent Impairment, 5th edition to evaluate millions of disability applicants each year. As major contributors to the chapter in the Guides devoted to assessing impairment associated with pain, we confronted the difficulties of incorporating pain into the Guides' overall evaluation system. Analysis of these difficulties is complicated by the paucity of research on the Guides, and by ambiguities and contradictions that pervade it. We propose that the ambiguities can be reduced if impairment is consistently defined in terms of organ or body part derangement, and disability in terms of activity limitations at the level of the whole person. We also propose a distinction between objective factors that may influence a person's ability to perform activities following injury. We suggest that when physicians examine disability applicants, they should evaluate both objective measures of organ or body part dysfunction and subjective reports of applicants -- especially ones regarding pain. We conclude that a comprehensive medical evaluation of disability applicant encompasses more than an impairment assessment.     

Gender equality and social security

He is author of Capitalism and the Welfare State; Clients and Constituents;and co-author (with Barbara Gilbert) of The Enabling State: Modern Welfare Capitalism in America;and (with Joel Duerr Berrick) With the Best of Intentions: The Child Sexual Abuse Prevention Movement.     

Generic Prejudice and the Presumption of Guilt in Sex Abuse Trials

In 25 Canadian criminal trials involving charges of sexual abuse, 849 prospective jurors were asked under oath whether they could hear the evidence, follow the judge's instructions on the Jaw, and decide the case with a fair and impartial mind. Knowing only the nature of the charges against the accused, on average 36% of the jurors stated that they could not be impartial Some jurors explained that they themselves had been victims of abuse, others expressed fears for children, while others stated simply that they could not set aside a presumption of guilt. These findings from real trials are consistent with a body of social science literature about attitudes toward sexual abuse and sexual assault charges. The article distinguishes between prejudices arising from specific pretrial publicity and generic prejudices that cause prejudgments of the case of any defendant perceived as belonging to a general class of defendants who likely are guilty of the crime(s) charged.     

PPB: Its relevance to financially constrained municipalities

Abstract. This paper assumes that Planning-Programming-Budgeting (ppb ) is preferable to the current historical budgeting procedure of municipalities. This is in part because ppb necessitates policy-making (defined as the setting of goals). The paper argues that the ability of municipalities to adopt ppb and policy-making is severely constrained by fiscal imbalance. The reliance of Canadian municipalities on conditional transfers and on the property tax has negated ppb procedures by distorting priorities and narrowing decision-making. The paper further argues that inflation will accentuate the financial problems of municipalities because of different revenue and tax elasticities. The point of departure is a brief examination of the logic behind urban government and the division of responsibilities. The second section looks at municipal fiscal imbalance, and the third analyses how fiscal imbalance negates policy-making and ppb . A final section suggests three remedies that might induce adoption of ppb . One would reduce the distortions of transfers and the other two would ease fiscal imbalance. Sommaire. Cet article suggère que le processus de Planification-Programmation et Budgétisation (ppb ) est préférable au processus de budgétisation couramment en usage dans les municipalités, en partie parce que le ppb implique la détermination d'objectifs politiques. L'article soutient que la possibilité d'adoption du ppb et d'une politique précise par les municipalités est très limitée à cause du déséquilibre fiscal. La subordination des municipalités canadiennes aux subventions conditionnelles et a Fimpôt fonder, en changeant les priorités et en limitant le pouvoir de décision, a rendu impossible le ppb. L'article soutient de plus que l'inflation accentuera les problèmes financiers des municipalités à cause des différentes élasticités des taxes et des revenus. L'étude commence par un bref examen des principes qui régissent l'administration urbaine et 3a division des responsabilités. La deuxième partie traite du déséquilibre fiscal des municipalités, et la troisième indique pour quelle raison le déséquilibre fiscal rend impossible une politique suivie et l'application du processus du ppb . Une dernière partie suggère trois solutions qui pourraient faciliter l'adoption du ppb. L'une réduirait les distortions dues aux subventions conditionnelles et les deux autres permettraient d'alléger le déséquilibre fiscal.