Schizophrenia, AIDS and the decision to prescribe HAART: results of a national survey of HIV clinicians

Individuals with schizophrenia are at risk of developing HIV and are known to experience barriers to optimal medical care. Our goal was to determine, among a cohort of HIV clinicians, whether or not the diagnosis of schizophrenia affected the clinical decision to offer highly active antiretroviral therapy (HAART) to AIDS patients. This is a cross-sectional study of a random, national sample of HIV experts drawn from the membership of the American Academy of HIV Medicine. Participants were mailed a self-administered questionnaire with a case vignette of a new onset AIDS patient and were specifically asked whether or not they would recommend HAART treatment. Vignettes were randomly assigned to include a diagnosis of schizophrenia or not. We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Recommendation of antiretroviral treatment did not differ between those who received a case vignette with schizophrenia versus those who did not(95.8% vs. 96.6%, p=0.69). Compared to those who received a case vignette without schizophrenia, those who received vignettes with schizophrenia were more likely to avoid prescribing efavirenz, a medication with known neuropsychiatric side effects(17.7% vs. 45.5%, p < 0.01), more likely to agree to be helped by a specialist(34.5% vs. 12.9%, p < 0.01), and more likely to recommend directly observed therapy (20% vs.10%, p = 0.01). HIV clinicians recognize the importance of recommending HAART treatment to individuals with schizophrenia and AIDS and avoid using antiretroviral medication with known neuropsychiatric side effects.     

Governing under advanced liberalism: sport policy and the social investment state

Since the election in 1997 of a New Labour Government in the United Kingdom, a growing number of analyses have provided insights into, and critiques of, what has been termed the “social investment state”. To date, these analyses have interrogated particular developments and distinct issues in a number of key social welfare policy-related sectors, including education, citizenship, the family, and poverty/employment. Notable by its absence, however, is the contribution that policies for sport and physical activity are now playing in the realisation of New Labour’s social investment strategies. This article therefore interrogates and registers the growing salience of sport policy interventions for the construction of a social investment state within the broader political context of governing under “advanced liberal” rationalities. The “active citizen”, and children and young people, in particular, are valorised and appear centre-stage as the focus for these interventions. This child-centred focus is problematised, as is the argument that, under prevailing political rationalities of advanced liberalism, government “steers” rather than “rows” and “enables” rather than “commands”. Under these conditions, while children are deemed deserving of investment, there may be other groups who are deemed less deserving, for example, older people who, unlike children and young people have little currency in a future-oriented world.

How ‘Vulnerable’ young people describe their interactions with police: building positive pathways to drug diversion and treatment in Sydney and Melbourne,Australia

This article describes findings from an Australian mixed method study, and explores young people’s perceptions of police. We focus on the nature of positive experiences, and the potential for positive encounters to improve outcomes for young offenders affected by problematic alcohol and other drug use. Buber’s concept of dialogical interaction is used to articulate the components of a positive experience and how this increases police legitimacy. In doing so, we demonstrate that, despite negative experiences, young people can be sympathetic to the tensions of modern policing, and can envisage police as positive role models. As such, police can enhance outcomes for ‘vulnerable’ young people through more respectful interactions.     

Bill of Sale Lending: Reforming a ‘Toxic’ Form of Credit

The Bills of Sale Acts were enacted in Victorian times as a form of secured credit whereby ‘goods’ owned by a borrower could be assigned under the bill of sale to a lender who would have title to the goods transferred to him. The lender would then allow the borrower to retain possession of the goods in exchange for instalment payments with interest. In the twenty‐first century these bills are most commonly used as ‘logbook loans’ for vehicles with extortionate interest rates and very little protection for individual consumers. This article examines the operational background to the Bill of Sale Acts. It focuses upon particular concerns for consumers and businesses and provides critique of the registration process before examining the proposals and consultations for reform currently before the Law Commission.     

Punishing the Wicked: Examining the Correlates of Sentence Severity for Convicted Sex Offenders

Objectives

To examine the correlates of sentence severity for convicted sex offenders under sentencing guidelines, contrasted with individuals convicted of non-sexual, violent offenses.

Methods

Drawing on 7 years of data from the Pennsylvania Commission on Sentencing, we utilize a logit-negative binomial hurdle model to examine the predictors of incarceration and sentence length, and an accompanying Oaxaca–Blinder decomposition of the gap in sentencing outcomes between the groups. We then implement a quantile regression framework to examine variation in effects across the distribution of sentence lengths. All analyses are contrasted with a matched sample of violent offenders to consider the extent to which estimated associations are unique to sex offenders.

Results

The analyses suggest several predictors of sentence severity for sex offenders, and that these predictors vary between the incarceration and sentence length decisions. In comparing effects for sex and matched violent offenders, divergent effects were observed for both case and offender characteristics. An Oaxaca–Blinder decomposition suggests that differences in the coefficient estimates account for less than one-fifth of the gap in average sentencing outcomes between sex and violent offenders. Subsequent quantile regressions indicate that these effects vary considerably over the sentence length distribution in ways that are not captured or obscured by the hurdle models.

Conclusions

The predictors of sentence severity for sex offenders, and points of divergence from violent offenders, are congruent with the notion that judges utilize crime-specific stereotypes in arriving at sentencing decisions. Further, the application of quantile regression following point-based estimation can reveal meaningful patterns in sentencing disparities.

     

Limits to partnership working: developing relationship-based approaches with children and their families

Located within a context of widespread change social work professionals are required to navigate tensions between organisational imperatives and developing effective relationships with families. Achieving effective partnership working is premised on the development of relational ways of working where trust is formed through co-creation. The recent emergence of 'Fast-track' approaches in education and training reflects a shift away from developing skills in critical/analytical reflection, towards an employer-led approach that prioritises the need for 'ready practitioners'. Simultaneously there has been change in the family justice system, culminating in the Children and Families Act 2014 and the 26-week time frame for the completion of care cases. This paper explores current contradictions within social work practice. Pivotal is defining the role of social work within a contemporary English jurisdiction. Adopting deeper relational ways of working with families may help to define the boundaries of a profession that appears to have lost its identity. Rather than facing the prospect that the door is closed on the possibility of reclaiming practice that prioritises and values professional judgement and discretion, this paper reflects upon some positive examples of relational work with families by social workers within different sectors of practice.     

Online fraud victims’ experiences of participating in qualitative interviews

Institutional Review Boards often raise concerns about qualitative research with vulnerable populations such as crime victims, and assume that research with vulnerable populations will be distressing for participants. It is therefore vital to examine whether participants do in fact experience adverse effects stemming from their participation. The existing research is clear that some members of vulnerable populations do feel distressed when they participate in research; however, in most cases, this distress is outweighed by the benefits of participation, such as a sense of having contributed to community awareness raising. This literature is, however, predominantly quantitative. In addition, it overwhelmingly focuses on violent trauma, providing no insight into participants’ experiences of research on non-violent traumatic events. The current study addresses these shortcomings by examining the research participation experiences of victims of online fraud. Specifically, an online questionnaire designed to elicit qualitative data was administered to victims of online fraud who had previously participated in a semi-structured qualitative interview. Among other findings, the study suggests that perceptions about the outcomes of research, in addition to the research process, influence victims’ satisfaction with their participation in qualitative research.