Health care report cards: implications for vulnerable patient groups and the organizations providing them care

Standardized public reporting on the quality of health care (report cards) offers an opportunity to empower purchasers and consumers so that they can make choices that can result in better health care for less money. However, not all population subgroups are equally well served by the publication of such data. In particular, vulnerable patient groups such as the poor, the less educated, the chronically sick, and members of ethnic or linguistic minorities may find issues of importance to them largely neglected. In addition, the way that report card data are collected, analyzed, and presented may further marginalize the experiences of these groups who in any case are already underserved by the health system. This observation also has important implications for health care providers who serve primarily large numbers of vulnerable patients. The differential impacts of report card data on vulnerable patient groups (and their providers) need to be addressed by researchers and policy makers if access issues are not to be damaged further by the providers' pursuit of quality and value.     

Ironie als Methode

Dieser Artikel stellt theoretische und methodische Ansätze einer neoklassischen Soziologie vor. Die neoklassische Soziologie versteht sich als eine Habermas’sche Rekonstruktion der von ihren klassischen Theoretikern, hier vor allem Max Weber, konzeptualisierten, grundlegenden Idee der Disziplin. Mit Blick auf die Entwicklungen in Ost- und Mitteleuropa widersprechen wir der dominanten Vorstellung einer einzigen, homogenisierenden Globalisierungslogik. Sowohl in der Geschichte als auch in der Gegenwart lässt sich nämlich eine bemerkenswerte Vielfalt kapitalistischer Formen und Ausprägungen feststellen. Weder soziologische Netzwerktheorien oder Theorien der ?Einbettung“ noch ökonomische Modelle rationalen Handelns vermögen diese Vielfalt angemessen zu erfassen. Der hier vorgestellte neoklassische Ansatz verknüpft empirische, vergleichende Ansätze der Untersuchung des Kapitalismus mit einem ironischen historischen Analyseansatz und ermöglicht so erst eine differenzierte und kritische soziologische Analyse der verschiedenen Formen des Kapitalismus.     

NGOs and the policy‐making process in Russia: The case of child welfare reform

This article explores the issue of the major reform of the child welfare sector that has been carried out in Russia in recent years. Focusing on deinstitutionalization and a child's right to a family, this reform moves Russia in the direction of international trends in this area and represents a break with previous state‐ and institution‐dominated approach to “problem families.” The article explores how and why this process has come about in a traditionally top‐down hybrid regime and applies the Multiple Streams Framework first developed by Kingdon to argue that Russian child welfare nongovernmental organizations have acted in concert with government officials to act as policy entrepreneurs in framing the policy problem and presenting solutions to it in a way that has influenced national priorities in this area. At the same time, the article acknowledges that major challenges remain in terms of implementing the reform at the regional level of government in Russia.     

The use of DNA stabilizing solution to enable room temperature storage and transportation of buccal and trace sample swabs

It is proposed that a DNA stabilizing solution (DNA Genotek Inc.) designed to preserve DNA in saliva samples at room temperature can be extrapolated to the storage of swab heads. The aim of this study was to evaluate the effectiveness of the solution for the preservation of reference swabs (buccal) and trace samples (facial swabs). To this end, the solution was used during a twin-site DNA transfer project assessing background levels of carer DNA present in children. Tubes containing 400 μl of solution were used to store and transport swab heads. At the laboratory, samples were extracted using the QIAamp DNA Mini Kit (Qiagen), quantified using the Quantifiler Duo Kit and profiled using the AmpF?STR^® SGM Plus^® PCR Amplification Kit (both Applied Biosystems). Twenty-eight PCR cycles were applied to all samples. Thirty-four cycles or a longer electrophoresis injection time was applied to trace samples where necessary. All Reference swabs produced high quantities of DNA and full DNA profiles after 28 cycles. Profile morphology indicated good quality DNA with no degradation. Of the trace samples, sufficient profiles were achieved to study the transfer of carer DNA making the solution fit for continued use in this project. DNA stabilizing solution enables the storage and transportation of swabs without freezing. This is convenient, reduces transportation costs and enables instant analysis of samples upon arrival at the laboratory. This is a useful alternative for a multi-site research project as well as a reliable storage tool for use in remote areas.     

Comparison of molecularly imprinted solid-phase extraction (MISPE) with classical solid-phase extraction (SPE) for the detection of benzodiazepines in post-mortem hair samples

This preliminary study compares the benzodiazepine results for 10 post-mortem scalp hair samples using a classical solid-phase extraction (SPE) and a molecularly imprinted solid-phase extraction (MISPE) system. The hair samples selected for testing were from drug-related deaths where a positive benzodiazepine blood result was obtained. Samples were decontaminated with 0.1% sodium dodecyl sulfate, distilled water and dichloromethane, incubated overnight in methanol/25% aqueous ammonium hydroxide (20:1), extracted by SPE or MISPE and subsequently analysed by liquid chromatography-tandem mass spectrometry (LC-MS-MS). Both extraction methods detected diazepam, nordiazepam, oxazepam, temazepam and nitrazepam in the samples. Diazepam was detected in a greater number of samples using MISPE due to both its lower limit of detection (LOD) and higher extraction recovery as a result of excellent molecular recognition of the template (diazepam) imparted by the imprinting process. The selective recognition of two diazepam analogues, nordiazepam and oxazepam, was demonstrated using MISPE since they were also detected in a greater number of samples. In contrast, another diazepam analogue, temazepam, was detected in a greater number of samples using SPE since the LOD using this extraction was lower than with MISPE. Nitrazepam was detected in one sample using both extraction methods. Overall the MISPE and SPE hair results were in good qualitative agreement. For the samples, where both extraction methods detected nordiazepam, temazepam and oxazepam, the concentrations were always higher for SPE. This is probably due to the MIP procedure producing extracts with fewer matrix interferences than the extracts produced using the classical SPE method. MISPE could be used as a complementary method to classical SPE for the analysis of benzodiazepine positive hair samples collected from chronic users.     

Promoting Well-Being and Desistance Through Sport and Physical Activity: The Opportunities and Barriers Experienced by Women in English Prisons

Despite an increased focus on the benefits of participation in sport and physical activity for men in custody, little attention has been paid to its potential role in meeting the specific needs of female prisoners. Qualitative data from female offenders (n = 45) within the English prison estate illustrated that, despite low levels of participation, prison-based sport and physical activities have clear physical and psychological benefits and can be valuable in promoting desistance from crime. Institutional barriers to participation, such as in the provision of activities and the prison regime, coupled with gendered barriers, such as self-presentational and motivational concerns, are identified and explored. Findings are discussed in the context of existing policy and principles of best practice.     

Producing facial composite sketches in remote Cognitive Interviews: a preliminary investigation

Justice systems around the world are increasingly turning to videoconferencing as a means to reduce delays and reduce costs in legal processes. This preliminary research examined whether interviewing a witness remotely – without physical co-presence of the witness and interviewer – could facilitate the production of quality facial composite sketches of suspects. In Study 1, 42 adults briefly viewed a photograph of a face. The next day they participated in Cognitive Interviews with a forensic artist, conducted either face-to-face or remotely via videoconference. In Study 2, 20 adults participated in videoconferenced interviews, and we manipulated the method by which they viewed the developing sketch. In both studies, independent groups of volunteers rated the likeness of the composites to the original photographs. The data suggest that remote interviews elicited effective composites; however, in Study 1 these composites were considered poorer matches to the photographs than were those produced in face-to-face interviews. The differences were small, but significant. Participants perceived several disadvantages to remote interviewing, but also several advantages including less pressure and better concentration. The results of Study 2 suggested that different sketch presentation methods offered different benefits. We propose that remote interviewing could be a useful tool for investigators in certain circumstances.