Nondecision making and inertia in Portuguese health policy

Despite there having been a positive context for initiating health care reforms in Portugal in the past fifteen years (accompanied by political consensus on the nature of the structural problems within the health care system), there has been a lack of reform initiatives. We use a process-based framework to show how institutional arrangements have influenced Portuguese health care reform. Evidence is presented to demonstrate inertia and nondecision making in three critical areas of Portuguese health policy: clarifying the public-private mix in coverage and provision, creating financial incentives and motivation for human resources, and introducing changes in the pharmaceutical market. Several factors seem to explain these processes, namely, problems in the balance of power within the political system, which have contributed to a lack of proper policy discussion; a lack of pluralism in the formation of health care policies (with low participation from citizens and high mobilization among structural interest groups); and the low priority of health care in public sector reforms. Portuguese politicians should be aware of the pitfalls of the current political system that constrain participatory arrangements and pluralism in policy making. In order to pursue health care reform, future governments will need to counterbalance the strong influence of structural interest groups.     

Suicidal ideation and self-determination in institutionalized elderly

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.     

From patronage politics to community deliberation: the recent experience of democratic school management in Brazil

The article discusses the limits and possibilities of school empowerment within education systems plagued by pervasive patronage politics. The analysis focuses on reform initiatives implemented by Brazilian sub‐national governments throughout the 1980s and 1990s to allow for the election of school principals by parents, teachers and students. Until the implementation of this reform, state and local authorities had relied on the school system as a source of patronage resources, and principals were nominated according to political criteria. The new system of democratic school management was expected to undermine this patronage‐based system and foster community participation in school decisions. The article relies on secondary evidence to assess the impact of school elections in what concerns the participation of parents, students and teachers in school affairs and the relationship between schools, party politicians and education administrators. It concludes that high levels of social inequality and the lack of a universalistic and effective system of welfare provision constitute serious obstacles to the empowerment of disadvantaged groups in developing societies such as Brazil. On the other hand, the article argues that school empowerment has the potential to undermine resilient patronage structures, by introducing universalistic mechanisms of decision‐making and making school administrators more accountable to their constituencies. Copyright © 2007 John Wiley & Sons, Ltd.     

DNA mixtures in forensic casework: a 4-year retrospective study

Occasionally interpretation guidelines from validation studies are difficult to apply to real forensic casework, especially in the case of mixed samples. Exogenous contamination, an unknown number of contributors or unbalanced proportion of each one in the sample and a varied degree of degradation of the biological materials, contribute to the difficulties in the interpretation of sample profiles. In this paper we have reviewed all the mixed genetic STR profiles encountered in our laboratory over 4 years (1997-2000) and evaluated the problems in the interpretation of the results. From 1547 criminal cases with 2424 samples typed, 163 showed a mixed profile (6.7%). We have observed that occasionally, a mixture appeared in the same sample with one multiplex amplification kit (e.g. Blue) and not with another (e.g. Green). From our results, it can be suggested that technical characteristics of the different fluorochrome groups in the multiplexes override the molecular characteristics of each STR in their capacity to detect mixtures.