Promoting health equity in conflict-affected fragile states

Issues around health equity in conflict-affected fragile states have received very little analysis to date. This paper examines the main factors that threaten health equity, the populations that are most vulnerable and potential strategies to improve health equity. The methods employed are a review of the published and grey literature, key informant interviews and an analysis of data on social determinants of health indicators. A new conceptual framework was developed outlining types of inequity, factors that influence equity and possible strategies to strengthen equity. Factors that affect equity include displacement, gender and financial barriers. Strategies to strengthen health equity include strengthening pro-equity policy and planning functions; building provider capacity to provide health services; and reducing access and participation barriers for excluded groups. In conclusion, conflict is a key social determinant of health. More data is needed to determine how conflict affects within-country and between-country equity, and better evaluated strategies are needed to reduce inequity.     

Le rapport de la schizophrénie au désir dans l’enseignement de Lacan

Objectives

In psychoanalytic research on psychosis, the tendency in Lacan's thinking, as well as among his readers and commentators, is to focus work on paranoia. However, it is here counterbalanced by a specific approach to schizophrenia. It is also against the current trend of positioning Desire in psychosis as a deficiency that we explore what might be the “desiring” economy of the schizophrenic.

Understanding the pathogenesis of hip fracture in the elderly,osteoporotic theory is not reflected in the outcome of prevention programmes

Hip fractures are an acute and worsening public health problem. They mainly affect elderly people, a population group that is highly vulnerable to disease and accidents, and to falls in particular. Although it has been suggested that osteoporosis is the cause of hip fractures, they mainly occur after a fall has been suffered. The underlying causes of a fall are not related to osteoporosis, although pharmaceutical companies have coined the term "osteoporotic fracture" for hip fractures in the elderly. Drug treatments for osteoporosis have not diminished the frequency of these injuries, nor have they prevented the occurrence of a subsequent fracture. Since pharmaceutical interests require osteoporosis to be considered a disease, rather than a normal condition of senescence, they go further by assuming that treatment for osteoporosis is essential, and that this policy will diminish the incidence of hip fractures. On the other hand, the origin and treatment of conditions that may be conducive to provoking falls are very difficult to elucidate. In this paper, we consider some of the medical and social problems that arise in this area, as well as conflicts of interest regarding the aetiopathogenesis and prevention of hip fracture, and propose a new paradigm for the prevention of falls.     

III: Mental health initiatives as peace initiatives in Sri Lankan schoolchildren affected by armed conflict

The Health Reach Sri Lanka project (1993–96) is described. It was a school‐based assessment of children's exposure to war‐related events and the presence of psychological distress, undertaken in six communities in parts of Sri Lanka variously affected by armed conflict. Its objectives, methods and results are presented. The research project aimed to raise national awareness of the psychosocial effects of armed conflict on children, using a community‐development approach to local capacity building, based on the ‘health initiative as peace initiative’ model. As a follow‐up to the study, a locally run programme, based on creative play and trauma‐healing, was established, initially for the children involved in the study. This was later extended to other children in the district affected by armed conflict.     

Stroop效应在冥想训练研究中的应用

目的:通过Stroop实验探讨冥想训练的神经心理学效应.方法:采用经典Stroop字色判断任务,通过e-prime2软件对4名志愿者和4名气功师进行间隔半小时的两次实验,记录被试字色判断任务的准确性和反应时间.fMRI实验采用组块设计,数据分析采用SPM8软件,对志愿者和气功师在脑内激活情况进行比较.结果:志愿者字色判断干扰任务的平均准确率略低于气功师,平均反应时较气功师为长.气功师和志愿者间fMRI实验的脑内激活存在差异,差异区域主要在左侧前额叶背外侧皮质(DLPFC)、前扣带皮质(ACC)和顶下小叶(IPL).结论:Stroop实验可以作为一种客观的手段来评价气功练习者的冲突控制能力,长期的气功练习可以提高练习者冲突控制的能力.     

Commentaire sur l’« avis d’experts français sur la prise en charge des femmes en âge de procréer et enceintes souffrant d’un trouble bipolaire traitées par valproate »

Professor Marlene Freeman of Massachusset General Hospital's answer to the question “How should I prescribe valproic acid (for psychiatric disorders) to women of childbearing age?” is “Don’t do it at all.”     

Beyond holding hands: the modern role of the professional doula

This article illustrates the five main aspects of the doula's role: providing specific labor support skills; offering guidance and encouragement; assisting mothers to cover gaps in their care; building a team relationship; and encouraging communication between patient, nursing staff, and medical caregivers. The roles of both nurses and doulas are discussed, including the complementary nature of their roles, and also strategies for preventing conflict between doulas and nurses. A modern perspective on birth plans and the doula movement are included.     

Best interests at end of life: A review of decisions made by the Consent and Capacity Board of Ontario

Purpose

When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of “best interests” when no prior expressed wishes are known.

Methods

We purposively sampled written decisions of the Ontario Consent and Capacity Board that focused on the best interests of patients at the end of life. Interpretive content analysis was performed independently by 2 reviewers, and themes that were identified by consensus as describing best interests were construed, as well as the characteristics of an end-of-life dispute that may be most appropriately handled by an application to the Consent and Capacity Board.

Results

We found that many substitute decision makers rely on an appeal to religion or God in their interpretation of best interests, whereas physicians focused narrowly on the clinical condition of the patient in their interpretations.

Conclusions

Several lessons are drawn for the benefit of health care teams engaged in end-of-life conflicts with substitute decision makers over the best interests of patients.     

注意对冲突监测事件相关电位N270的影响

目的：探讨注意对冲突监测事件相关电位N270的影响。方法：30名健康志愿者分成两组,一组人判断连续呈现的一对数字的颜色是否相同,不考虑数值（注意颜色）;另一组人判断连续呈现的一对数字的数值是否相同,不考虑颜色（注意数值）,在头皮同步记录事件相关电位。结果：颜色不同和／或数值不同的数字对均可在第二个数字呈现后引起事件相关电位N270,颜色和数值完全相同的数字对则不引起该负波。与不被主动注意状态相比,刺激特征冲突被注意时引出的N270波幅更高,持续时间更长,起始潜伏期不变。结论：冲突监测系统的启动不受注意影响,而一旦启动后则受到注意系统的调节。