Report on complementary/alternative health care and HIV/AIDS

In 2001, the Canadian HIV/AIDS Legal Network published a lengthy report on Complementary/Alternative Health Care and HIV/AIDS: Legal, Ethical & Policy Issues in Regulation. The document is the first in a series of papers to be produced by the Legal Network on priority legal and ethical issues related to HIV/AIDS care, treatment, and support. The article below summarizes the contents of the report.     

Fatal outcome of poisoning with the benzodiazepines flunitrazepam and diazepam

On a wintry day a 29-year-old woman was found dead beside her car showing head injuries and signs of hypothermia. Several empty packets of sedative and hypnotic drugs were lying inside the car. Toxicological analysis revealed the presence of flunitrazepam (heart blood of the left and right chamber 0.033 mg/L each), norflunitrazepam (left heart blood 0.029 mg/L, right heart blood 0.027 mg/L), 7-amino-flunitrazepam (left heart blood 0.090 mg/L, right heart blood 0.104 mg/L), diazepam (left heart blood 0.395 mg/L, right heart blood 0.386 mg/L), nordazepam (left heart blood 0.112 mg/L, right heart blood 0.115 mg/L) and temazepam (left heart blood 0.034 mg/L, right heart blood 0.033 mg/L). Neither alcohol nor other drugs were found. It was concluded that benzodiazepine intake led to a disturbance of consciousness. Whether the woman died in this situation due to the icy temperature as a result of hypothermia or whether she died or would have died solely due to benzodiazepine overdosage could not be clarified.     

Fatal versus non-fatal heroin "overdose": blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers

The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.     

Theory and the Public Administration Student/Practitioner

The modern theory that dominates our classrooms and training programs meets the needs of staff-oriented practitioners and public administration students. Line managers, present and future, are less well served by our offerings. Open systems and constructed reality describe both postmodern theory and the world faced by the line manager. Incorporating the learning principles imbedded in postmodernism would add diversity and strength to our MPA curricula.     

The Same Old Song?—Stability and Change in Relationship Schemas from Adolescence to Young Adulthood

Relationship schemas are core elements of personality that guide interpersonal functioning. The aim of this study is to examine stability and change in relationship schemas across two developmental epochs—adolescence and young adulthood—in the stories that people tell about their interactions with others. Using the Core Conflictual Relationship Theme Method, relationship themes were coded from semistructured interviews conducted in adolescence and again at age 25. The sample consisted of 40 participants in a longitudinal study of adolescent and young adult psychological development. There was considerable stability in the frequency with which particular themes were expressed in the narratives of adolescents and young adults. Significant changes from adolescence to young adulthood included a decrease in the perception of others as rejecting and of the self as opposing others. Young adults saw themselves and others more positively, and used a broader repertoire of themes in their relationship narratives than they had as adolescents. The basic continuity and particular changes in relationship schemas found in this study are consistent with knowledge about the adolescent-to-young-adult transition derived from other empirical and clinical findings. Relationship schemas may be rich units of study for learning about the development of interpersonal functioning.     

Social policy in rich and poor countries

Nomination: Does politics matter? A perennial question! by Hans Keman, p.159
Reflections: Politics does indeed matter! by Manfred G. Schmidt, p.164     

The proximity and the directional theories of issue voting: Comparative results for the USA and Germany

Abstract In several recent studies George Rabinowitz and his co–authors challenge the 'classical' spatial model of issue voting, the proximity model, by introducing a directional model. In this article we examine whether different measurement of perceived issue positions of candidates or parties leads to diverging judgments about the predictive power of the directional model (which is claimed to be empirically superior), as compared to the proximity model, using data from the USA and Germany. The results demonstrate that the measurement preferred by Rabinowitz et al. tends to bias empirical findings in favour of directional theory. If we use a more plausible operational definition of issue positions of candidates and parties the directional model in both countries fails to turn out superior.     

Electoral formulas: A macroscopic perspective

The paper offers a macroscopic view of the legislative electoral formulas in force in 166 sovereign countries, whether democratic or not. The purpose is to determine which formulas are the most widespread, and whether the prevalence of a formula is correlated with geographical, historical, economic, and political factors. While plurality and PR systems are equally frequent, the former tend to be found in more populated countries. PR prevails in Europe and South America, and among the most democratic countries, while the plurality rule is more typical of Asia, Africa, and North America, and is especially popular among former British colonies. Large countries are more likely to opt for single–member districts. No significant correlation emerges between the level of economic development or French colonial background and any electoral formula. The study suggests that the selection of an electoral system is not merely the outcome of party interest, but is also strongly influenced by ideas about what is good, just, or efficient.