Psychiatric Morbidity Differences in Male and Female Adolescent Inpatients With Alcohol Use Disorders

Objective: To examine gender differences in demography, cooccurrence of Diagnostic Statistical Manual (third edition, revised; DSM-III-R) axis I disorders and axis II personality disorders, and self-reported psychological distress in adolescent psychiatric inpatients with alcohol use disorders. Method: A consecutive series of 61 adolescent inpatients (36 boys and 25 girls) with either alcohol abuse or dependence were reliably assessed with structured diagnostic interviews for DSM-III-R Axis I and Axis II personality disorders. Results: Boys and girls did not differ in age, ethnicity, socioeconomic status, global functioning, age at first psychiatric contact, or number of hospitalizations. Girls were more likely to meet criteria for oppositional defiant disorder, eating disorders, and additional drug use disorders. Girls were also more likely than boys to meet criteria for at least one personality disorder and borderline personality Contrary to gender patterns in the general population, the proportion of girls and boys with affective disorders and conduct disorders did not differ significantly. Conclusions: Relatively few gender differences were found in adolescent inpatient alcohol abusers even where they would be expected, based on non substance-abuse general population gender patterns. When observed, gender differences were in the direction of greater psychiatric disturbance among girls. Some of the gender patterns observed among alcohol abusing adolescents are at odds with gender differences observed in non substance-abuse samples.     

Patterns of childhood poverty: New challenges for policy

Poverty takes many forms. Using data from the U.S. Panel Study of Income Dynamics, this article (1) distinguishes different kinds of childhood poverty, defined in terms of the spacing, severity, and duration of spells; and (2) establishes the extent and distribution of childhood poverty, employing new measures that take into account both duration and severity. Some strategies for targeting assistance on particular forms of poverty are briefly considered.     

The Effect of EU Accession on Internal Migration in Poland

This article examines the impact European Union (EU) policies have on internal migration in Poland. It argues that the EU indirectly through its cohesion funding and internal market policies creates push and pull incentives that affect internal migration. It focuses on the impact of three EU regulated factors: foreign direct investment, international migration, and EU funding. It contends that both foreign investment to a voivodeship as a result of the EU’s internal market policy, and EU funding to a voivodeship as a result of the EU’s cohesion policies, attracts internal migrants to that voivodeship and discourages residents from leaving. The article further argues that increasing international migration from a voivodeship as a result of the EUs labor policies decreases the incentive for internal migration. A cross-sectional time-series statistical analysis finds that higher levels of foreign investment and EU funding attract migrants to a voivodeship, while higher levels of international migration, FDI inflow, and EU funding decreases the incentive for residents of that voivodeship to relocate internally.     

Whatever happened to regionalization? The curious case of Nova Scotia

Abstract: The case of Nova Scotia well illustrates the complexities involved in implementing a strategy of regionalization in health care. In 1996, under the leadership of Liberal Premier John Savage, thirty‐six local hospital boards were amalgamated into four regional health boards. By 2001, however, Conservative Premier John Hamm had expanded the four regions into nine district health authorities. Both measures were justified by explicit references to cost containment and greater accountability, even though the first took numerous units and amalgamated them, while the second took the few units and multiplied them. How can this seeming contradiction be explained, and what does it say about the nature of regionalization as a policy tool for health care? The authors find that neither cost containment nor citizen engagement can explain the system of regionalization which currently informs the health care system in Nova Scotia. Rather, the present form of regionalization exists because it is useful politically in two ways: it maintains the centralization of power that existed previous to the formal decentralization of health care; and it restores the system of representation that existed prior to the implementation of regionalization. The authors conclude that, to understand how regionalization has been implemented in any given jurisdiction, one must pay close attention to the political context in which strategies of regionalization have been executed. Sommaire: Le cas de la Nouvelle‐Écosse illustre bien les complexités inhérentes à la mise en œuvre d'une stratégie de régionalisation dans les soins de santé. En 1996, sous le leadership du Premier ministre libéral John Savage, 36 conseils d'hôpitaux locaux ont fusionné pour former quatre conseils de sante régionaux. En 2001, cependant, le Premier ministre conservateur John Hamm a élargi les quatre régions pour les transformer en neuf conseils de santé de district. Ces deux mesures ont été justifiées par des références explicites à la compression des coûts et à une plus grande imputabilité, même si la première a consistéà prendre de nombreuses unités et à les fusionner, tandis que la seconde a consistéà prendre quelques rares unités et à les multiplier. Comment peut‐on expliquer cette apparente contradiction, et qu'est‐ce que cela nous dit sur la nature de la régionalisation en tant qu'outil de politique en matière de soins de santé? Les auteurs trouvent que ni la compression des coûts, ni la participation des citoyens ne peuvent expliquer le système de régionalisation qui caractérise actuellement le système de soins de santé en Nouvelle‐Écosse. Au contraire, la forme actuelle de régionalisation existe parce qu'elle est politiquement utile de deux manières: elle maintient la centralisation du pouvoir qui existait avant la décentralisation officielle des soins de santé; et elle restaure, jusqu'à un certain point, le système de représentation qui existait avant la mise en œuvre de la régionalisation. Les auteurs concluent que, pour comprendre la manière dont la régionalisation a été mise en œuvre, il faut prêter une grande attention au contexte politique dans lequel ces stratégies de régionalisation ont étéélaborées.     

SUPERVISED ACCESS

This article addresses the question of whether long-term supervised access is an appropriate solution when unsupervised access is unlikely to become possible in the future. The article assesses judicial decisions and theoretical commentary on this issue in light of the opinions and practices of service providers and in light of the best interest of the child standard. The opinions and practices of service providers were gleaned from published materials and from interviews with service providers at supervised access facilities in Vermont and New Hampshire and in Ontario, Canada. The supervised access facilities surveyed for this research were diverse in their practices and experiences but remarkably similar in their approach to long-term supervised access. Outside the scope of the research for this article was the question of whether the opinions and practices of the service providers at the facilities surveyed are representative, and this question requires further investigation .     

A middle-aged female serial killer

The case of a 48-year-old woman accused of killing at least 12 elderly women and attempting to kill another one during the last 3 years is presented. Extensive neuropsychological, electrophysiological, and neuropsychiatric testing showed no evidence of a DSM-IV-TR Axis I diagnosis, but a decrease in executive functions and abnormalities in the processing of affective stimuli were found. Behavioral and psychophysiological studies revealed dissociation between knowing how to behave and actually behaving in socially acceptable ways. According to the woman, killing was just her response to "humiliating situations." Two potentially significant conditions in her past history are found: (i) childhood abuse; and (ii) multiple head injuries. It is conjectured that the nature of her crimes, paranoid and personality traits, a probable frontal brain dysfunction, as well as a specific demographic and social context represent unusual factors accounting for her violent behavior.     

For Both Love and Money: Viviana Zelizer's The Purchase of Intimacy

Viviana Zelizer's recent book, The Purchase of Intimacy (2005), presents an innovative theory of how social and legal actors negotiate rights and obligations when money changes hands in intimate relationships—a perspective that could change how we understand many things, from valuations of homemaking labor to the 9/11 Victim Compensation Fund. This essay describes Zelizer's critique of the reductionist “Hostile Worlds” and “Nothing But” approaches to economic exchange in intimate relationships and then explains her more three‐dimensional approach, “Connected Lives.” While Zelizer focuses on family law, the essay goes beyond that context, extending Zelizer's approach to transfers of genetic material and concluding that her approach could point toward a more equitable resolution of disputes in and about these markets.