Modernisation,smoking and chronic disease: Of temporality and spatiality in global health

This article explores the spatio-temporal logics at work in global health. Influenced by ideas of time–space compression, the global health literature argues that the world is characterised by a convergence of disease patterns and biomedical knowledge. While not denying the influence of these temporalities and spatialities of globalisation within the global health and chronic disease field, the article argues that they sit alongside other, often-conflicting notions of time and space. To do so, it explores the spatio-temporal logics that underpin a highly influential epidemiological model of the smoking epidemic. Unlike the temporalities and spatialities of sameness described in much of the global health literature, the article shows that this model is articulated around temporalities and spatialities of difference. This is not the difference celebrated by postmoderns, but the difference of modernisation theorists built around nations, sequential stages and progress. Indeed, the model, in stark contrast to the ‘one world, one time, one health’ globalisation mantra, divides the world into nation–states and orders them along epidemiological, geographical and development lines.     

Traverser l’institution de soins au temps fragile de l’adolescence

By exposing on the institutional level the sufferings of his present, the adolescent talks to us about his history, the damaged, destroyed or uninhabited links which mark out his life trajectory and arise in this “meantime” of his existence in so many painful shards in the internal world of his psyche and in the body. During their journey through the care institution, we work with these adolescents and their families, in this space-time, on what could help to reduce the internal breaking lines so that they can again start moving their subjective capacities to think and act in the world. Our work ethic is based on the specific capacity of each institutional actor to deploy his/her containing psychic envelopes around young patients; symbolized deployment of the containing function by the time to think about the care for the caregiver, the time to consent to it in a safe way for the adolescent, then for the latter the time once again acceptable to explore the field of possibilities.     

Differences in the Temporal Typology of Alcohol Hangover

Background

At a group level, hangover severity during the day has been described to follow an inverted U‐shaped curve, with gradually increasing severity scores that, after reaching a peak, gradually decrease toward zero. The aim of this study was to examine if and how individual drinkers' hangover severity scores vary during the day.

Methods

Data from a survey (Penning et al., 2012 ) in which 727 drinkers reported on their latest alcohol hangover were reanalyzed. The temporal pattern of each individual's hangover was first categorized as belonging to 1 of 6 types based on predefined temporal characteristics.

Results

Three dominant hangover patterns emerged as comprising more than 95% of the sample: (i) a continuous decline hangover (Severity Type 1 hangover, 54.5%), (ii) a steady state hangover (Severity Type 2 hangover, 19.1%), and (iii) an inverted U‐shaped curve hangover (Severity Type 3 hangover, 21.8%). Of these 3 patterns, Severity Type 2 hangovers are associated with significantly less alcohol consumption and with having the lowest severity scores of individual hangover symptoms. Severity Type 1 hangovers are associated with having the highest severity of individual hangover symptoms. In line with significantly lower levels of alcohol consumption, Severity Type 2 hangovers were significantly more often observed in women when compared to men. Severity Type 1 hangovers were significantly more common in men than in women. Severity Type 3 hangovers, characterized by the increased presence of gastrointestinal complaints, were equally commonly experienced in men and women.

Conclusions

This study revealed that the temporal pattern of hangover severity can follow marked interindividual variability. Three common temporal patterns were identified, which are uniquely related to the amount of alcohol consumed and the presence and severity of different individual hangover symptoms. Better understanding of individual differences in hangover typology may help to delineate mechanisms underlying alcohol hangover.     

Les choix moraux du psychopathe sous le prisme de la théorie de l’identité morale

GoalsContrary to the hypothesis that psychopaths do not possess the moral discernment required to think about their actions on the basis of certain moral reasons, several studies suggest the presence of a gap between what these individuals evaluate, judge, or recognize and what they actually choose to do. While theories of moral motivation designed to account for this discordance generally favor either rationalist or emotivist positions, recent work in experimental philosophy as well as in moral psychology tends to give an increasingly central place to the notion of moral identity, which would constitute an additional – and ultimately truly decisive – source of moral motivation, drawing on norms that are not objective and impersonal, but subjective and personal.MethodAfter having shown that our moral reasoning and our affects are not in themselves sufficient to shed light on the origin – and the intra- and inter-individual variability – of our moral decisions, we present the personological conception of the moral self and the normative relationship to oneself that it supposes. We then discuss the nature of the relationship between psychopathic personality and moral identity.ResultsSome research with adults has shown that differences in moral judgment skills do not predict the levels of psychopathic traits assessed. However, subjects who function psychopathically would only minimally – and anecdotally – incorporate moral traits into their self-concept. They would find it difficult to perceive or conceive of themselves as moral agents shaped and defined by a series of ethical commitments.DiscussionThe motivational influence of the moral self on our moral choices rests on a self-referential process that resembles a third-order reflection consisting in questioning – and then conforming to – the kind of person I want to be, that I have to be; to evaluate the degree of conformity of my momentary desires with what I wish to desire on the moral domain. This presupposes, as we will see, a kind of extraction, of detachment from the present, in order to identify – and thus identify with – past moral resolutions.ConclusionWe finish by defending the thesis according to which psychopathy could, in some cases at least, result from the subject's inability to mentally “time travel,” thus compromising the capacity to distance or to disengage oneself from a present desire, or to situate it in the competitive “space” of previously (self)contracted normative requirements. Such temporal inefficiency disrupts the movements of identification with particular moral commitments; paralyzes the prospective impulses projecting the person we will be if we make such and such a choice; and, moreover, neutralizes the narrative process that contributes to the construction of our moral identity by assigning us moral dispositions or tendencies to which we ultimately refer when it comes to making moral decisions.     

晚期青光眼术前含服心痛定预防球后麻醉致一过性黑矇

目的评价晚期青光眼患者抗青光眼手术中用心痛定预防球后麻醉后发生一过性黑目蒙的效果。方法对102例(114眼)晚期青光眼患者于麻醉前10 min舌下含服心痛定10 mg,并与未含服心痛定的对照组268例(302眼)进行对照研究。结果发现麻醉前含服心痛定组无1例发生一过性黑朦,而对照组却有10例(3.31%)发生一过性黑目蒙。结论心痛定能预防晚期青光眼患者术中球后麻醉后一过性黑目蒙并发症的发生。     

Dying at life׳s beginning: Experiences of parents and health professionals in Switzerland when an ‘in utero ’ diagnosis incompatible with life is made

ObjectiveThe disclosure of a diagnosis during pregnancy of a fetal malformation, which is incompatible with life, normally comes completely unexpectedly to the parents. Although a body of international literature has considered the topic, most of it comes from the United States and little has been generated from Europe. This study aims to illuminate the contemporary treatment associated with such diagnoses, regardless of whether parents decide to terminate or continue the pregnancy.Designa qualitative design was used with data collected by semi-structured interviews and subjected to a thematic analysis.Settingthe research was conducted in the German speaking areas of Switzerland with data collected from participants in places of their choice.Participants61 interviews were conducted with 32 parents and 29 health professionals.Findingsthe theme of ‘temporality’ identified four main time points from the professionals: diagnosis, decision, birth/death, and afterwards. However, in contrast to these, six major themes in this study, primarily generated from parents and extended from receiving the diagnosis until the interview, were identified: shock, choices and dilemmas, taking responsibility, still being pregnant, forming a relationship with the baby, letting go. Although there was concurrence on many aspects of care at the point of contact, parents expressed major issues as gaps between the points of contact.Conclusionscare varied regionally but was as sensitive as possible, attempting to give parents the space to accept their loss but fulfil legal requirements. A gap exists between diagnosis and decision with parents feeling pressured to make decisions regarding continuing or terminating their pregnancies although health professionals’ testimonies indicated otherwise. A major gap manifested following the decision with no palliative care packages offered. During the birth/death of the baby, care was sensitive but another gap manifested following discharge from hospital.     

“Old friend and powerful cadre”: Doctor-patient relationships and multi-dimensional therapeutic landscapes in China's primary hospitals

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes.     

The functioning of social support in long-term prevention after spinal cord injury. A qualitative study

BackgroundThe impact of social support on the long-term condition after a spinal cord injury (SCI) varies across studies mainly involving self-report questionnaires.ObjectiveWe aimed to establish the common factors associated with social support leading individuals with an SCI to the effective prevention of secondary complications, including via adherence to medical follow-up.MethodsInclusion criteria were a history of acquired SCI of any etiology, wheelchair use, and age ≥ 18 years at the time of the study. Participants should have completed their initial rehabilitation program in France ≥ 1 year earlier and were also enrolled according to 2 related study variables: routine medical follow-up (patients were or were not followed up) and the medically supervised reporting of a pressure ulcer after the initial rehabilitation session (0 or ≥ 1 pressure ulcers). We performed a preparatory quantitative and qualitative literature review to identify factors affecting long-term follow-up after SCI, then adopted a narrative design with semi-structured interviews, transcribed and analyzed progressively by using qualitative analysis software.ResultsWe included 32 participants. We categorized our results based on the knowledge, attitudes, beliefs and practices of participants with respect to pressure ulcer prevention and long-term medical follow-up. Our narrative approach allowed us to identify 3 main domains relevant to social support: reciprocity, self-management and timing related to social support.ConclusionsOur study showed social support as a dynamic process, a reciprocal phenomenon evolving in variations over time. These findings should be central to short- and long-term therapeutic education programs for patients and for people providing social support. Effective changes should also be implemented through the concept of the Learning Health System.     

Prendre le temps de la tendresse. Ateliers en recherche-action avec des adolescents polyhandicapés

This article shows us two projects developed in a medical-educational centre for severe disability persons. Workshops adapted to teenagers with brain injuries have been created through music and dance-based methods. To ensure this work, it is necessary for efforts to be undertaken in a systematical complementarity in a network among different partners such as workers, teenagers and their families. It is important to appoint that this complementarity, everyday very closely observations and kindness stances expressions, are a strength of this work.