Pretreatment self-esteem and posttreatment sexual recidivism

The relationship between self-esteem assessed prior to treatment using the Self-Esteem Scale and sexual recidivism was explored in two samples of adult male sex offenders, 53 of whom were beginning treatment in the community and 172 of whom were beginning treatment in prison. Sexual reconviction rates were obtained for both samples using a 6-year followup for the community sample and an average follow-up of just less than 4 years for the prison sample. Lower levels of self-esteem were associated with higher sexual recidivism rates with similar trends being apparent in both samples. The linear main effect of self-esteem was significant at beyond the .01 level in a logistic regression analysis. Receiver operating characteristics analysis was used to assess the strength of this association and an area-under-the-curve coefficient of .69 was obtained. Results are discussed in terms of their meaning for the relevance of self-esteem as a predictor of recidivism and as a target for treatment.     

Book Reviews

Book Review in This Article:
G ood L ife /G ood D eath : A D octor's C ase F or E uthanasia and S uicide . By Dr. Christiaan Barnard
A M atter of L ife . By Robert Edwards and Patrick Steptoe
G enetics and the L aw II. Edited by Aubrey Milunsky, M.B.B.Ch., M.R.C.P., D.C.H. and George J. Annas, J.D., M.P.H.
L egal A spects of H ealth P olicy : I ssues and T rends . Edited by Ruth Roemer and George McKray
F ederal R egulation : H ospital ATTORNEY'S DESK REFERENCE. By the American Society of Hospital Attorneys
I ndustry W age S urvey : H ospitals and N ursing H omes , S eptember 1978     

Legal anxieties and end-of-life care in nursing homes

Many persons spend their final days as nursing home residents. It has been suggested that one set of factors powerfully and unfavorably influencing the quality of end-of-life (EOL) care provided in American nursing homes involves the anxieties that nursing home providers experience regarding potential negative legal entanglements and repercussions associated with the provision of EOL care to their residents. This article critically examines the hypothesis that the quality of EOL medical care provided in nursing homes often is skewed in a perverse way because providers are driven unduly by legal apprehensions. The author offers practice and policy recommendations for trying to resolve or mitigate the tension present between legally defensive practice (real or perceived) by nursing homes, on one hand, and ethically optimal EOL care, on the other.     

IMPLEMENTING POLICY-A BUREAUCRATIC POWER PERSPECTIVE

Abstract: This paper argues that theories of organisational power which are based on the concepts of dependence and uncertainty may constitute a useful approach for explaining the manner in which government policies come to be implemented. In the intra-organisational context, studies by Crozier and Hickson demonstrate that subgroups which can control sources of uncertainty and create dependencies rise to positions of relative power within the organisation and may use this position to bargain for increased organisational rewards. Subgroups within public sector organisations that achieve power in these terms may, as their organisational reward, seek to impose particular values on policy programs carried out by the organisation as a whole. Activities in the inter-organisational context may be viewed from a similar perspective. The work of J. D. Thompson indicates that organisations can possess positions of power relative to other organisations in their task environment. In the public sector such power may be used to influence the policy programs of dependent departments. The paper then suggests that in the public sector intra- and inter-organisational theories of power may be combined to explain how subgroups can evolve into organisations in their own right and, in so doing, succeed in considerably changing the stated direction of government policy. To show how such a situation can occur, a case study of the evolution of Queensland's institutes of technology is included. The paper concludes that theories of organisational power can be of value to policy implementation theorists but require some modification to accommodate the particular characteristics of the public sector environment.