Functional MRI correlates of the recall of unresolved life events in borderline personality disorder

BACKGROUND: Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls. METHOD: Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories. RESULTS: When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2 x 2 factorial analysis (DeltaBPD - Deltacontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition. CONCLUSIONS: The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.     

Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, in spite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.     

Stärkung von Gemeinschaften: Partizipative Forschung zu HIV-Prävention mit Migrant/innen

Background

Communities play a key role in health promotion, in the concept of structural prevention and also in participatory health research. Community-Based Participatory Research (CBPR) aims to equitably involve community partners in investigating problems, identifying resources and developing solutions in order to improve community health. The participating communities are supposed to benefit from the research collaboration. However, whether this aim is actually realized in practice is only rarely analyzed.

Aim

This article explores how the community partners benefited from participating in a CBPR study on HIV prevention with migrant communities in Germany (PaKoMi).

Methods

The PaKoMi-Project was a 3-year participatory research project which aimed to improve the involvement of migrant communities in HIV research and prevention services. It was conducted by the national association of community-based AIDS service organisations (Deutsche AIDS-Hilfe e. V.) in collaboration with partners from different immigrant communities, AIDS service providers and researchers from the Social Science Research Center Berlin (WZB). Community members were trained as peer researchers and supported to conduct local CBPR-projects (case studies) in four cities. In the final evaluation, the partners stated what they gained from collaborating in the project. The current analysis focuses on the benefits for the participating partners, their communities and the field of HIV prevention.

Results

Competences were developed by the participating individuals and community capacities were strengthened, for example by developing networks, peer-based initiatives and migrant self organisations. Concepts, tools and recommendations for improving HIV prevention services for migrants were developed.

Conclusions

The PaKoMi-project shows how communities can benefit from participatory research.     

Faculty development in general practice in Germany: experiences, evaluations, perspectives

From 1999 to 2001, the German Society of General Practice and Family Medicine (DEGAM) pioneered a faculty development programme to help general practitioners (GPs) interested in an academic career to develop their skills in teaching, primary care, quality assurance and research. The programme involves five weekend-training sessions over 18 months and applies a learner-centred approach. Participants choose the learning formats and switch between the roles of learners, teachers, chair persons and programme organizers. This article evaluates the acceptability and feasibility of the programme. Data were collected over a two-year period from the 16 participants who completed the first training programme. The evaluation involved a focus group, telephone interviews and email questionnaires. Participants appreciated the learner centred format of the programme and gained new teaching and research skills. They also learned to better assess and critically reflect on their professional work as GPs and reported improved academic 'survival skills' due to collaborative networks with colleagues. The faculty development programme proved advantageous for the personal and professional development of the participating GPs. It constitutes a promising tool for the further development of General Practice as an academic discipline that is still in the process of establishing itself at medical schools in Germany.     

Die pathologische Anatomie der Influenza 1918/19

Ohne ZusammenfassungAus dem pathologisch-anatomischen Institut des Allgemeinen Krankenhauses Barmbek. Prosektor Professor Dr. Fahr.Mit 8 Textabbildungen.