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PubMed2006

Civil commitment in Turkey: reflections on a bill drafted by psychiatrists.

Involuntary hospitalization of the mentally ill has been an issue that still remains outside the judicial system in Turkey. Despite the new Turkish Civil Code, which includes several articles relevant to involuntary psychiatric hospital admissions, there still appears to be a need for a comprehensive mental health law to address specific issues concerning civil commitment of the mentally ill. As a result of the lack of specific statutory regulation, an insufficient number of psychiatric hospital beds and limited appreciation of the safety risks involved in untreated mental illness, involuntary hospitalization remains an underutilized option by psychiatrists and the courts alike. In response to its concerned members, the Psychiatric Association of Turkey has appointed a task force to draft a proposed mental health law, entitled the "Psychiatric Patients' Bill of Rights." Although the draft suggests a model with emphasis on the right to psychiatric treatment, it also recommends close judicial oversight to prevent potential abuses of discretion by the system. However, this might present logistic problems in a country with already overburdened courts. Authors discuss the highlights of the draft within the context of Turkey's current cultural, social and judicial structure, and compare it to similar laws of other countries.

Advisory Committees↗
PubMed2006

Incentives to improve farm management: EMS, supply-chains and civil society.

This paper focuses on impediments to environmentally sound management practices and how these might be overcome, with an emphasis on the role of environmental management systems, supply chains and civil society. It argues that: Farmers are under increased pressure to cut costs and improve production but with little opportunity to increase prices. Commonly short-term economic interest has damaging environmental implications. Current government policy, in Australia and in many other jurisdictions, relies heavily on voluntary arrangements, education and information, as the main policy instruments through which to persuade farmers to adopt better environmental farm management - e.g. the recent push to encourage the use of voluntary environmental management systems. However, there is good evidence to suggest that these can only make a valuable contribution when combined with a range of other policy instruments, including positive and negative incentives, intervention by third parties and in some cases, an underpinning of regulation. Arguably, what is needed is a strategy that builds on the strengths of voluntary environmental management arrangements while compensating for their weaknesses by combining them with other, complementary policy instruments. If so, we must engage with a range of questions that have not so far figured substantially in the policy debate. Although the principal focus has been on the role of government in bringing about on-farm change in management practices, supply chain pressure (at least in respect of agricultural chemicals and practices which threaten food safety) and civil society action are also potentially powerful mechanisms for bringing about change. Government can and should play a role in harnessing such forces in the interests of improved environmental on-farm practices.

Agriculture↗
PubMed2004

The post-war public health effects of civil conflict.

Civilian suffering from civil war extends well beyond the period of active warfare. We examine longer-term effects in a cross-national analysis of World Health Organization data on death and disability broken down by age, gender, and type of disease or condition. We find substantial long-term effects, even after controlling for several other factors. We estimate that the additional burden of death and disability incurred in 1999 alone, from the indirect and lingering effects of civil wars in the years 1991-1997, was nearly double the number incurred directly and immediately from all wars in 1999. This impact works its way through specific diseases and conditions, and disproportionately affects women and children.

Adolescent↗
PubMed1998

[Unpredictable risk and damage compensation in civil process].

UNPREDICTABLE RISK DEFINITION: Any medical or surgical action with diagnostic or therapeutic purpose involves a potential risk of complication, unrelated to the initial pathology or a technical error, but could lead to death or disability. Proof of unpredictable risk without initial fault requires a careful examination of each case by a judicial expert in order to eliminate the complications related to an unskilled surgeon or to poor postoperative care. UNPREDICTABLE RISK COMPENSATION: Conclusions of the Academy: In current French common law, damage compensation can only be obtained in cases where all possible medical means are not implemented and professional fault can be proven. It is illogical to extend the civil responsibility of the practitioner to an obligation of procedural result. In the absence of fault, damage compensation does not come under the civil responsibility of the surgeon. A special insurance system for unpredictable risk has to be created using the principles of mutual insurance.

Expert Testimony↗
PubMed2001

[Medical civil responsibility in the year 2000].

In France, during the last year, important jurisprudence was established by the French Supreme Court of Appeal concerning the physician's civil responsibility. On october 7, 1998, the Court decided that "the physician is not exempted for the obligation to provide information by the simple fact that these risks only materialize exceptionally". This means that from now, the physician must inform the patient of all risks that might influence the patient's decision, particularly information concerning life-threatening or severe consequences, but also, as in the past, concerning frequent even benign consequences. The limits of this jurisprudence and the completeness of the information, as established in 1998, are emergency, patient refusal and impossibility to inform the patient. In the decree of May 23, 2000, the Court gave its definition of impossibility to inform the patient, thus establishing the "therapeutic limits". But the judges recognized that the requirement for information delivery is independent of the necessary or unnecessary nature of the therapeutic act. However, in the decree of June 20, 2000, the Court established the conditions for awarding indemnities for defective information delivery. Defective information delivery is not sufficient in itself to constitute a civil offense. Real damage is also necessary. To be awarded with an indemnity, the patient must prove that the lack of information affected his/her decision to consent. If it appears that even if he/she had been well informed, the patient had consented to the care given, the physician would not be obliged to provide the patient with an indemnity. The judges want to find a compensation and make the proof easier for the patient. They accept the potential fault when an organ was injured in the course of an operation. But, these decisions concern the proof and they don't modify the medical responsibility. The physicians have got a duty to use reasonable skill and care and they don't have any obligation to achieve a certain result. Sometimes, the physician has got an obligation to achieve a certain result but it isn't a general rule (November 08, 2000).

Access to Information↗
PubMed1999

Prevalence and effects of child sexual abuse in a poor, rural community in El Salvador: a retrospective study of women after 12 years of civil war.

OBJECTIVE: The purpose of this retrospective study was to examine the epidemiology of child sexual abuse (CSA) among women in a poor, rural community in El Salvador, which was recovering from a 12-year civil war. METHODS: A cross-sectional, door-to-door survey was administered to 83 women. The LA Times Sexual Abuse Survey was used to determine the prevalence of CSA. The Hopkins Symptom Checklist (HCL) was used to measure long-term psychological sequelae of abuse (somatization, anxiety, depression, interpersonal sensitivity, and obsessive-compulsive traits). Information also was obtained about participation and number of relatives killed in the country's 12-year civil war. RESULTS: Of the 83 women interviewed, 14 (17%) reported a total of 21 experiences of CSA. The median age of abuse was 14 years. The majority of perpetrators (90.4%) were strangers, friends, or neighbors. None was a parent. The only significant difference between abused and non-abused women was on the depression measure, where abused women showed more pathology. After controlling for the number of relatives killed in the war, however, that difference failed to reach statistical significance. CONCLUSIONS: Differences in the epidemiology of CSA from that of other countries may be secondary to a different social structure in the rural Salvadoran community and non-disclosure by the women surveyed. The lack of difference in psychological symptoms between abused and non-abused women may be related to the different characteristics of the abuse and perpetrators. It also may be secondary to adverse social conditions such as poverty and war, which could obscure the long-term effects of CSA.

Adolescent↗
PubMed2003

Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola.

This study arises from a general proposition that different levels and types of exposure to war are crucial in shaping health outcomes in a population under war-induced duress. We analyze civil war-related regional and ethnolinguistic differentials in age-adequate immunization (complete vaccination for age) and levels of malnutrition in Angola. Our analysis is based on data from a nationally representative survey conducted in 1996, some 2 years after the end of one of the most destructive periods of hostilities in the history of Angolan civil war. The data show that despite Angola's unique mineral wealth, the nation's levels of child age-adequate immunization is lower and malnutrition rates are higher than in most of sub-Saharan Africa. To examine age-adequate immunization and chronic malnutrition we fit logistic regression models that include the regional degree of war impact and ethnolinguistic group, in addition to rural-urban differences and other conventional sociodemographic characteristics. The tests reveal a significant disadvantage of rural children relative to urban children in both immunization and chronic malnutrition. Net of the rural-urban differences, we also detect a significant disadvantage of children residing in parts of the country that had been most affected by the fighting. The tests also point to a lower level of immunization and higher level of chronic malnutrition among children from the ethnolinguistic group commonly identified with the opposition. These associations tend to be stronger among children who were born and/or grew up during war than among children who were born after peace was re-established.

Africa South of the Sahara↗
PubMed1999

The pre-hospital management of injury following mass toxic release; a comparison of military and civil approaches.

Mass release of toxic substances may occur either accidentally or deliberately in both peace and war. Different approaches to the management of casualties from such an event have been developed by civil and military emergency medical teams, and reflect the different circumstances in which they operate. The nature and classification of toxic hazards is considered and the civil and military operational and medical responses compared. Both systems have different aspects that can contribute to early casualty management in a contaminated environment.

Disaster Planning↗
PubMed2004

Capitalising on global HIV/AIDS funding: the challenge for civil society and government.

After years of passionate advocacy informed by solid policy work on the ground, the global response to HIV/AIDS is better resourced. Poor countries can absorb considerably higher levels of aid than they currently receive, but recent increases in funding have generated a number of concerns. This paper analyses the capacity of NGOs, community-based organisations and governments to ensure that the influx of funds has a significant effect on the HIV epidemic and people's lives. Limited absorptive capacity may be an obstacle to the uptake of funding. To avoid community-based organisations being over-stretched by AIDS and to ensure capacity is maintained, HIV-positive staff must be enabled to continue their work through access to antiretroviral therapy and related services. Equally challenging, given that donors are increasingly using governments as intermediaries to fund civil society organisations, is increasing the capacity of developing country governments to disburse funds effectively. If donors do not accept that governments and civil society organisations need technical support in order to accept, distribute and account for increases in funding, there is a danger that home-grown responses will be replaced with imported solutions. The community sector is the glue that holds responses to HIV/AIDS together; now it needs to adapt to new partnerships with government and other emerging HIV/AIDS service providers.

Community Networks↗
PubMed1999

Coalition building and public opinion. New reproductive technologies and Canadian civil society.

The process of technology assessment is evolving. The process of policy development for technology is the least understood in the cycle of technology assessment. The process of policy development, which should involve extensive consultation and a broad-based research and evaluation program, is often fraught with difficulties and can cause further analysis or the assessment process to come grinding to a halt. This article reviews some social, political, and ethical issues and the role of civil society in influencing the technology assessment process for new reproductive technologies in Canada. It is written from the perspective of one of the Deputy Directors of Research and Evaluation for the Royal Commission on New Reproductive Technologies and highlights the strengths and difficulties of technology assessment when civil society and technology assessment come face to face. A brief update by a policy analyst in Health Canada on the current situation of legislation on new reproductive technologies has been provided and is included at the end of this article.

Advisory Committees↗
PubMed1992

Why the gap? Practice and policy in civil commitment hearings.

The failure of civil commitment procedures to meet statutory requirements is one of the more reliable findings in the applied social sciences. Most states now require specific legal procedures and behavioral standards for involuntary hospitalization. Nonetheless, empirical studies have demonstrated that commitment hearings are rarely adversarial and clinical concerns continue to take precedence over legal issues. These findings are analyzed in the context of three related issues: the grounds for commitment that are used in civil commitment hearings, the particular difficulties of recommitment hearings, and the shortcomings of the national policy of deinstitutionalization. The authors conclude that a primary cause of the gap between legal standards and actual practice is the absence of viable, less restrictive alternatives to inpatient treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed2004

What difference does a civil union make? Changing public policies and the experiences of same-sex couples: comment on Solomon, Rothblum, and Balsam (2004).

When Vermont became the first state in the United States to legalize civil unions for same-sex couples, it marked an important milestone in lesbian and gay Americans' struggle for equal rights. Against this background, S. E. Solomon, E. D. Rothblum, and K. F. Balsam's (2004) study, the first to examine experiences of same-sex couples who have undertaken civil unions, is a significant effort. The study provides valuable data about these couples, yet much remains to be learned. Further study of the impact of changing legal landscapes on experiences of same-sex couples and their families has the potential to add significantly to knowledge about contemporary family lives.

Female↗
PubMed2004

Inscribed matter as an energy-efficient means of communication with an extraterrestrial civilization.

It is well known that electromagnetic radiation-radio waves-can in principle be used to communicate over interstellar distances. By contrast, sending physical artefacts has seemed extravagantly wasteful of energy, and imagining human travel between the stars even more so. The key consideration in earlier work, however, was the perceived need for haste. If extraterrestrial civilizations existed within a few tens of light years, radio could be used for two-way communication on timescales comparable to human lifetimes (or at least the longevities of human institutions). Here we show that if haste is unimportant, sending messages inscribed on some material can be strikingly more energy efficient than communicating by electromagnetic waves. Because messages require protection from cosmic radiation and small messages could be difficult to find among the material clutter near a recipient, 'inscribed matter' is most effective for long archival messages (as opposed to potentially short "we exist" announcements). The results suggest that our initial contact with extraterrestrial civilizations may be more likely to occur through physical artefacts-essentially messages in a bottle-than via electromagnetic communication.

Journal Article↗
PubMed2001

Medico-legal aspects of sleep disorders: sleepiness and civil liability.

Excessive sleepiness is associated with motor vehicle accidents and is responsible for enormous social and financial loss. The specific legal obligations for an individual with a sleep disorder, their employer and those health care practitioners associated with that individual are reviewed. Although there are related implications within the criminal law and in particular criminal negligence, the arguments developed in this paper will be largely confined to the context of the civil liability. The legal concepts of foreseeability and proximity are discussed in the context of sleep-related accidents. The reasoning of a recent Australian High Court judgement is discussed in view of the differences in legal and medical opinion on the extent of foreseeability of accidents as a result of sleepiness. Many countries have legislation designed to protect employees from injury at work and to protect the general public from injury. What is not clear is the extent to which an employer will be required to accept liability for an employee's sleepiness and the duty to monitor the health of their employees. Factors which influence this liability include: the extent to which the implications of the condition is known and understood generally; the extent to which the condition is suspected or identified in an individual employee; the extent of a proper screening and treatment program and the way in which risk management programs have been implemented. Although the issue of sleepiness and civil liability is examined from an Australian legal context, the principles have direct relevance to other legal systems. The authors highlight the degree of uncertainty provided by the common law and statutory provisions, and that decisions rest on the balance of public interests, which mean that many of the current dilemmas facing practitioners may only be solved in the courts.

Journal Article↗
PubMedDate not supplied

[Illness-related premature unfitness for work among civil servants in Bavaria - an evaluation in the social medical field].

In a prospective study, over a period of four years 11,528 anonymous questionnaires concerning premature unfitness for work among civil servants were evaluated. The questionnaire was devised by the investigators. The main items of interest were: age, sex, career and occupation, main diagnosis and accompanying symptoms, duration of illness, rehabilitation measures, and working capacity including medical assessment of unfitness for work. Included in this study were 9,348 investigations (excluded were reactivations); 40.9 % were from women and 58.9 % from men. The median age was 54 years (women 52, men 55). The range of illnesses among all those investigated included a large number of psychological disorders (43.3 %, n = 4,052) (diagnosis group F of ICD-10). Second place was taken by muscular/skeletal diseases (ICD-10 group M) in 17.4 % of cases (n = 1,630), and third place by cardiovascular diseases (ICD-10 group I) in 10.4 % of cases (n = 972). The median duration of the main disease was 24 months. Classified as no longer fit for work were n = 7,033 persons, corresponding to 75.2 % of those investigated. Among those unfit for work, psychological disorders were the reason in 46.2 % of cases (men 42.6 %, women 53.4 %). In this first prospective study of illness-related premature unfitness for work in civil servants, psychological and psychosomatic illnesses were found to be the 'number one' illness among persons taking early retirement. The median age at which these persons became unfit for work was 52 in women and 55 in men. In view of the high prevalence of psychological disorders, and the increasing tendency towards early retirement and the considerable jump forward in the age this happens compared to in previous studies with small collectives, a preventive strategy must be developed which takes into account the evidence gained in social-medical and occupational-medical practice.

Absenteeism↗
PubMed2003

[Evaluation of the premature unfitness for work among civil servants career--groups and morbidity].

Out of the data obtained in a prospective study over 11,528 assessments concerning premature unfitness for work among civil servant over a period of four years the collective groups of those assessed unfit for work (n = 6,861, 2,723 women i. e. 39.7 % and 4,128 men i. e. 60.2 %) were included in this study. The median age was 54 years (women 52, men 55), 4,112 were teachers, in the administration 1,644, in the technical service 386 and in activities with special request (e. g. fire-brigade or law execution service) 483. Career groups: official-legal groups of careers in lower service categories were 266, in medium categories about 29, in elevated service 2,766 and higher service 2,146 woman officials and male officials. In all fields of activity and groups of careers psychic disorders (ICD 10: F) had a prevalence between 30.8 % in lower service and 48.0 % in the elevated service as "Premature Retirement Suffering No. 1". Women in all fields of activity were clearly more frequently concerned than men (differences from 3.1 per cent points to 18.1 per cent points middle service or technical service, p < 0.01). Second place was taken by muscular/skeletal diseases (ICD 10 group M) in 17.4 % of cases (n = 1,630), and third place by cardiovascular diseases (ICD 10 group I) in 10.4 % of cases (n = 972). The altogether lower prevalence of musculoskeletale illnesses (ICD 10: I) showed a dependency on the activity request and was highest in the technical services and in lower service categories. The median of entrance into premature unfitness for health reasons was between 15 and 9 years earlier than the age limit by law and presented itself differently in the groups of careers. Although this analysis only shows the prevalence of illnesses causal for premature retirement and not the health situation of all civil servants, it can give however pointers to emphasis for a necessary prevention.

Adult↗
PubMed2002

Civil war medicine from the perspective of S. Weir Mitchell's "The case of George Dedlow".

In 1866, a year following the close of the American Civil War, an anonymous article arousing much public interest appeared in the popular magazine, The Atlantic Monthly. The real author, Silas Weir Mitchell, who became one of America's most distinguished neurologists, wrote this short story early in his career while serving as a contract army surgeon and conducting his important clinical researches in nerve injuries. This article was the first literary effort in his long and prolific career as a physician/writer. Historians citing this article have focused almost exclusively on the early descriptions of causalgia and phantom limb syndrome, appearing as it did in a popular magazine. The present author proposes to show, for the first time, that Mitchell actually intended to describe many important medical consequences of the American Civil War, which was later shown to have so profoundly affected him throughout his medical and literary career. He cleverly accomplished this through the narration of Assistant Surgeon George Dedlow, who loses all four extremities by amputation.

Amputation, Surgical↗
PubMed2006

Civil society-a leader in HIV prevention and tobacco control.

Many civil society organisations (CSOs) have been at the forefront of identifying new ideas and implementing innovative models regarding health and health systems around the world. Their activities become highly charged, however, when they engage in advocacy efforts designed to influence change in policies and systems linked with more controversial or complicated public health issues. Policies, laws and regulations regarding illicit drugs and tobacco fall directly into that category. There is no doubt that the use of both kinds of substances can have the same health consequences-including ill health and death-yet they are approached in widely different ways. Smoking is legal to some extent in every country in the world, and is generally considered a matter of personal choice. Many people believe that efforts to limit tobacco use are coercive and impede on individual rights. Those who use illicit drugs such as heroin, meanwhile, are with few exceptions considered social deviants, misfits and lawbreakers. Many CSOs support comprehensive, government-funded prevention strategies coupled with non-punitive, non-judgmental programmes designed to help users change behaviour. Such strategies are designed to reflect and respond to the medically addictive nature of both tobacco and many illegal drugs. Proponents argue that not only are the public health benefits of expansive, well-conceived interventions potentially vast, but so too are the social and economic benefits accruing from lower rates of debilitating disease and premature death. To that end, many international, national and local CSOs are identifying the direct and indirect health consequences of tobacco and illegal drug use; proposing and advocating for strategies to limit their impact; and sharing information and resources with like-minded organisations elsewhere. This leadership role has helped influence and shape policy, especially in recent years. This paper examines civil society's involvement in efforts to change drug and tobacco policy in selected countries in Central and Eastern Europe and the former Soviet Union (CEE/FSU). It concludes that in Poland and Kazakhstan, in terms of tobacco control, and increasingly in Ukraine and parts of Central Asia in terms of harm reduction, multi-sectoral approaches are the most effective way to engage citizens and to implement comprehensive strategies to change behaviour by supportive measures, not punitive ones.

Asia↗