Regional Offices in the New NHS: An Analysis of the Effects and Significance of Recent Changes

This article reports on a two-year, multi-method, qualitative study in two regional offices in the UK National Health Service of the changing role of the regional tier from the autumn of 1994. The nature of the changes from fourteen semiautonomous regional health authorities to eight regional offices of the NHS Executive, whose staff became civil servants, are described together with the way this reorganization changed the role and relationships of NHS Executive HQ, the regional offices and the field. By the end of our research in the autumn of 1996, the change from regional health authority to regional office had gone well in the two regional offices studied; they had become smaller organizations, had established closer working with HQ and believed they had more influence over policy, while retaining good relations with health authorities. Emerging issues from the changes and some of their implications are discussed, particularly the pressures towards greater centralization and the particular forms that these have taken, despite the aim, and in part the achievement, of greater devolution, and the cultural differences between the NHS and the civil service. We conclude by assessing what the future holds for regional offices, in the light of the recent NHS White Paper (Secretary of State for Health 1997)     

Race, economic inequality, and violent crime

The current study used data drawn from the National Incident-Based Reporting System (NIBRS) and the census to investigate the relationship between indicators of interracial and intraracial economic inequality and violent crime rates, including White-on-Black, White-on-White, Black-on-White, and Black-on-Black offenses. Multivariate regression results for ninety-one cities showed that while total inequality and intraracial inequality had no significant association with offending rates, interracial inequality was a strong predictor of the overall violent crime rate and the Black-on-Black crime rate. Overall, these results were interpreted as consistent with J.R. Blau and Blau's (1982) relative deprivation thesis, with secondary support for P.M. Blau's (1977) macrostructural theory of intergroup relations. The findings also helped to clarify the unresolved theoretical issue regarding which reference group was most important in triggering relative deprivation among Blacks. It appeared that prior studies were unable to find support for the relative deprivation thesis for Black crime rates because of data and methodological limitations.     

Length variation in HV2 of the human mitochondrial DNA control region.

Hair samples were typed from three individuals who exhibited length heteroplasmy in the homopolymeric cytosine stretches (C-stretch) in hypervariable region 2 (HV2). The study demonstrated that for different hairs within an individual, the HV2 C-stretch region can vary with respect to the number of cytosines and/or proportion of C-stretch length variants. Length heteroplasmy may occur regardless of the prominent length variant present in this region. Differences in the number of cytosines at the C-stretch region, or a variation in the relative amounts of heteroplasmic length variants, cannot be used to support an interpretation of exclusion.     

Health facility characteristics and the decision to seek care

Utilisation of healthcare facilities is low in many developing areas. One possible explanation is that treatment costs, in time or money, are high. Another is that parents perceive treatment benefits to be low. We combine Philippines DHS data with a subsequent facilities survey in order to examine these issues with respect to treatment for respiratory infections and diarrhoea in young children. Controlling statistically for the selectivity of the initiating illness, we find that the staffing level of nearby health facilities is a determinant of the probability that parents take their ill children for curative care.     

Aviation Security,Risk Assessment,and Risk Aversion for Public Decisionmaking

This paper estimates risk reductions for each layer of security designed to prevent commercial passenger airliners from being commandeered by terrorists, kept under control for some time, and then crashed into specific targets. Probabilistic methods are used to characterize the uncertainty of rates of deterrence, detection, and disruption, as well as losses. Since homeland security decisionmakers tend to be risk‐averse because of the catastrophic or dire nature of the hazard or event, utility theory and Monte Carlo simulation methods are used to propagate uncertainties in calculations of net present value, expected utility, and probabilities of net benefit. We employ a “break‐even” cost‐benefit analysis to determine the minimum probability of an otherwise successful attack that is required for the benefit of security measures to equal their cost. In this context, we examine specific policy options: including Improvised Physical Secondary Barriers (IPSBs) in the array of aircraft security measures, including the Federal Air Marshal Service (FAMS), and including them both. Attack probabilities need to exceed 260 percent or 2.6 attacks per year to be 90 percent sure that FAMS is cost‐effective, whereas IPSBs have more than 90 percent chance of being cost‐effective even if attack probabilities are as low as 6 percent per year. A risk‐neutral analysis finds a policy option of adding IPSBs but not FAMS to the other measures to be preferred for all attack probabilities. However, a very risk‐averse decisionmaker is 48 percent likely to prefer to retain FAMS even if the attack probability is as low as 1 percent per year—a level of risk aversion exhibited by few, if any, government agencies. Overall, it seems that, even in an analysis that biases the consideration toward the opposite conclusion, far too much may currently be spent on security measures to address the problem of airline hijacking, and many spending reductions could likely be made with little or no consequent reduction of security.     

Estimating the health impact of industry infant food marketing practices in the Philippines

The decline in the prevalence and duration of breast‐feeding in less developed countries and the accompanying increase in bottle feeding is a concern. Little research has been done tracing the links from infant food marketing to infant and child health outcomes. In this study, Philippine mothers’ feeding decisions and infantile diarrhoeal morbidity rates are modelled and jointly estimated using semiparametric estimation methods. The data clearly support the hypothesis that infant feeding practices are important determinants of diarrhoeal morbidity and that breast‐feeding reduces the incidence of diarrhoea. Our results also show that marketing activities have affected infant feeding choices.     

Preventing juvenile sexual offending through parental monitoring: a comparison study of youth’s experiences of supervision

ABSTRACT

The parental monitoring literature has long observed a link between parental monitoring and juvenile antisocial behaviour. This study extends this line of research to juveniles who commit sexual abuse. The present study investigates whether juvenile reports of parental monitoring differ between juvenile sexual offenders (n?=?338), juvenile delinquents (n?=?346), and non-incarcerated juvenile controls (n?=?256). Results indicate that both incarcerated groups reported significantly less parental knowledge compared to juvenile controls. Further, both juvenile sexual offenders and juvenile controls reported significantly more parental control compared to juvenile delinquents. With regard to parental solicitation, the results were mixed for sexual offenders. They reported high levels of solicitation for some items (e.g. what the youth was doing, who they were with), and lower levels for other items (e.g. where the youth was, whether an adult would be present). When repeating these analyses with the exclusion of non-parent caregivers, a similar pattern of results emerged; however, item-level analyses revealed that parents of juvenile delinquents reported certain types of solicitation and control behaviours more frequently (e.g. asked where the youth was going, made sure the rules were followed) compared to findings from the main sample. Potential explanations for these findings as well as practical implications for prevention are discussed.     

Lustration in poland and the former czechoslovakia: a study in decommunization

This article examines the process of decommunization in Poland and the former Czechoslovakia as it impacted opportunity for public services employment in elected or civil service offices. In each setting we describe the motivations expressed for and against lustration in the public service, explain the patterns of decommunization in each country and consider these events from legal, ethical and political points of view.