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PubMed1997

Integrating space into a reactive theory of the asylum: evidence from post-Civil War Georgia.

Absent from the geographical literature on the 19th century asylum is a reactive theory of social control. Such an approach focuses on the importance that families and communities of the insane played in guiding institutionalization. Thus far, reactive theory has emphasized how social distance within communities shaped public reaction to mental illness and hence the admission decision. Unfortunately, it ignores the importance of spatial distance from the asylum in molding utilization patterns. Using evidence from asylum admissions in post-Civil War Georgia, this paper explores the necessity of adopting a reactive theory and the even greater necessity of integrating space into reactive theory. Such a project requires going beyond traditional treatments of spatial distance as a geometric barrier and examining the politics of distance, that is, how the meaning of journey to the asylum was open to competing and conflicting constructions.

Georgia↗

PubMed2004

Post-civil war adaptation and need in Managua, Nicaragua.

Within seven years after the end of the Nicaraguan civil war in 1990, forced migrants, whose lives had been most disrupted by the conflict, were self-settled in a squatter community in the capital city of Managua and lived in extreme poverty with minimal health, education, security and social service supports. Compared with voluntary migrant neighbours, whose lives had been less affected by the conflict, forced migrants exhibited equal clinically significant symptoms of physical and mental health and psychosocial maladaptation. These findings run counter to generally held theory and assumptions about the negative long-lasting effects of the trauma and stress of war, forced migration and resettlement. Explanations are offered to explain the discrepancies between theory and the study findings as well as the dominance of poverty and socioeconomic status. Implications are also drawn for increasing social support and other durable forms of assistance that emerge from the study as important to meeting the needs of equally poor and unhealthy forced and voluntary migrants in proliferating squatter communities throughout the Third World.

Adaptation, Psychological↗

PubMed1992

Social class and minor psychiatric disorder in British Civil Servants: a validated screening survey using the General Health Questionnaire.

Major psychiatric disorder is more common in people of lower rather than higher socioeconomic status. This is less clear for the commoner, so-called minor psychiatric disorders, but these are more affected by tendency to report symptoms. To examine this the distribution of minor psychiatric disorder by employment grade measured by the 30-item General Health Questionnaire is reported from the first cross-sectional phase of the Whitehall II Study of 10,314 London-based civil servants, men and women between 35 and 55 years. Validation of the GHQ in a random subsample stratified by grade and sex (N = 201) suggested that people in lower employment grades tend to under-report minor psychiatric disorder on the GHQ relative to those in higher employment grades. The prevalence of minor psychiatric disorder corrected by the coefficients from the validity study was greater in the lower employment grades than the higher employment grades particularly for men. This was echoed in grade differences in well-being measured by the Affect Balance Scale, and in symptoms and recurrent health problems. Overall, for women there were few clear-cut differences in minor psychiatric disorder by employment grade. The lack of social class gradient in women suggests that further exploration should examine women's role at work and their personal lives for the aetiology of minor psychiatric disorder.

Adult↗

PubMed1997

Social support and psychiatric sickness absence: a prospective study of British civil servants.

BACKGROUND: Studies on the direct and buffering effects of social support have not examined psychiatric sickness absence and few studies have considered support both at home and at work. This study addresses prospectively the effects of chronic stressors and social supports, at home and at work, on psychiatric sickness absence rates. METHODS: Sociodemographic factors, health and social support were measured at baseline, and short and long spells of sickness absence were measured prospectively over a 5-year period. The participants were a subsample of 4202 male and female civil servants, aged 35-55 years at baseline, from an occupational cohort, the Whitehall II Study, who completed detailed social support questions. RESULTS: Support from colleagues and supervisors at work is related to lower risk of short spells of psychiatric sickness absence, particularly for those also receiving high levels of negative aspects of close relationships from their closest person outside work. Negative aspects of close relationships from the closest person increase the risk of taking long spells of psychiatric sickness absence in men. High levels of material problems increase the risk of short spells of sickness absence. CONCLUSIONS: Negative aspects of close relationships may have an aetiological role in non-psychotic psychiatric disorder. Social support at work appears to protect against short spells of psychiatric sickness absence. This potentially implies that levels of short spells of absence might be reduced by increasing support at work. Conversely, emotional support at home may influenced absence-related behaviour and encourage a person to take absence at a time of illness.

Absenteeism↗

PubMed1998

Types of social support as predictors of psychiatric morbidity in a cohort of British Civil Servants (Whitehall II Study).

BACKGROUND: Few studies have examined prospectively both the direct and buffering effects of types of social support and social networks on mental health. This paper reports longitudinal associations between types of social support and psychiatric morbidity from the Whitehall II study. METHODS: Social support was measured by the Close Persons Questionnaire and psychiatric morbidity by the General Health Questionnaire at baseline (1985-1988) and at first follow-up (1989) in 7697 male and female London-based civil servants aged 35-55 years at baseline. The cohort was followed up and baseline measures were used to predict psychiatric disorder measured by the General Health Questionnaire at second follow-up (1991-1993). RESULTS: Longitudinal analyses showed that low confiding/emotional support in men and high negative aspects of close relationships in men and women were associated with greater risk of psychiatric morbidity even after adjustment for baseline General Health Questionnaire score. There was no evidence of a buffering effect among men or women who experienced life events or chronic stressors. Controlling for a personality measure of hostility did not affect the observed relations. CONCLUSIONS: The present findings illustrate that different types of support are risk factors for psychological distress and that they operate in different ways for men and women. Direct effects of emotional support are predictive of good mental health in men and negative aspects of close relations predict poor mental health in both men and women. Emotional support is predictive of good mental health in women whereas, confiding alone is not.

Adult↗

PubMed2002

The Great War, the Russian Civil War, and the invention of big science.

The revolutionary transformation in Russian science toward the Soviet model of research started even before the revolution of 1917. It was triggered by the crisis of World War I, in response to which Russian academics proposed radical changes in the goals and infrastructure of the country's scientific effort. Their drafts envisioned the recognition of science as a profession separate from teaching, the creation of research institutes, and the turn toward practical, applied research linked to the military and industrial needs of the nation. The political revolution and especially the Bolshevik government that shared or appropriated many of the same views on science, helped these reforms materialize during the subsequent Civil War. By 1921, the foundation of a novel system of research and development became established, which in its most essential characteristics was similar to the U. S. later phenomenon known as "big science."

History, 20th Century↗

PubMed2002

Spatial and temporal patterns in civil violence: Guatemala, 1977-1986.

Civil violence is a complex and often horrific phenomenon whose characteristics have varied by era, setting, and circumstance. Its objective analysis has rarely been feasible at spatial and temporal scales great enough and resolutions fine enough to reveal patterns useful in prevention, intervention, or adjudication. An extraordinary data set simultaneously meeting scale and resolution criteria was collected during conflict in Guatemala from 1977 through 1986. Reported here is its spatial-temporal analysis; reported as well is a putatively novel method for estimating power-law exponents from aggregate data. Analysis showed that the relationship between ethnic mix and killing was smooth yet highly nonlinear, that the temporal texture of killings was rough, and that the distribution of killing-event sizes was dichotomous, with nongenocidal and genocidal conflict periods displaying Zipf and non-Zipf distributions, respectively. These results add statistical support to claims that the Guatemalan military operated under at least two directives with respect to killing and that one of these effected a genocidal campaign against an indigenous people, the Mayans. Implications for group-behavioral modeling, conflict prevention, peace-keeping intervention, human-rights monitoring, and transitional justice are noted.

Journal Article↗

PubMed2000

What's half a lung worth? Civil jurors' accounts of their award decision making.

Jury awards are often criticized as being arbitrary and excessive. This paper speaks to that controversy, reporting data from interviews with civil jurors' accounts of the strategies that juries use and the factors that they consider in arriving at a collective award. Jurors reported difficulty in deciding on awards, describing it as "the hardest part" of jury service and were surprised the court did not provide more guidance to them. Relatively few jurors entered the jury deliberation room with a specific award figure in mind. Once in the deliberation room, however, they reported discussing a variety of relevant factors such as the seriousness of the injury, the plaintiff's age, and occasionally even more esoteric items such as the impact of inflation. Two frequent topics of discussion, attorneys' fees and insurance, suggest that jurors attempt to estimate the actual impact of an award on both defendant and plaintiff. This descriptive account may help to inform the debate about whether jurors require additional guidance or information in the award process.

California↗

PubMed2002

The emergence of modern genetics in Spain and the effects of the Spanish Civil War (1936-1939) on its development.

The aim of this paper is to show how modern genetics reached Spain through the Junta para la Amplición de Estudios e Investigaciones Científicas (JAE) during the decade of 1920s, the role played by key persons, and the level of development this discipline achieved from its different points of inception and under the conditions of financial scarcity and political turmoil that prevailed during the Spanish Civil War (1936-1939). In addition, the effect of the war on the continuity of the lines of research already began is outlined, identifying the main area in which genetics first reappeared: agronomy.

Genetics↗

PubMed2002

Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients.

Individuals with psychopathy typically are viewed as incurable cases that should be diverted from treatment settings to environments where their behavior can be monitored and controlled. The prevailing clinical conviction that psychopaths are untreatable has crucial implications, given the scarcity of mental health care resources, the number of legal contexts that call for assessment of treatability, and the explosion of research on psychopathy and violence risk over recent years. Based on a sample of 871 civil psychiatric patients (including 195 "potentially psychopathic" and 72 "psychopathic" patients), this study explores the relations among psychopathy, receipt of outpatient mental health services in real-world settings, and subsequent violence in the community. The results suggest that psychopathic traits do not moderate the effect of treatment involvement on violence, even after controlling statistically for the treatment assignment process. Psychopathic patients appear as likely as non-psychopathic patients to benefit from adequate doses of treatment, in terms of violence reduction. We interpret these results in light of prior research with offenders and analyze their implications for future research, policy, and practice.

Adult↗

PubMed2004

A descriptive study of urban rabies during the civil war in Sierra Leone: 1995-2001.

A study was conducted to assess the effects of the breakdown in internal infrastructure on the incidence of canine-transmitted human rabies in urban areas of Sierra Leone during the course of the civil war between 1995 and 2001. Data from provincial hospitals in the Western Area and Southern Province indicated that there was a significant increase in the incidence of canine-transmitted urban human rabies chi2 = 39.63, p < 0.0001, particularly among children chi2 = 23.73, p < 0.0001, over the course of the war. In the Western Area in 2001, towards the end of the war, there was a significant increase in adult cases, which was reflected in the observed versus the expected chi2 ratio (70 versus 53). Interview-based questionnaire surveys in Freetown administered between 2001 and 2002 indicated that dogs were commonly kept for security reasons, and were largely unrestrained and unlicensed, regardless of the socioeconomic status of the owner. Virtually all dogs were unvaccinated and were mainly living in close proximity with humans. This study indicated that there is an urgent requirement for appropriate mass rabies vaccination campaigns for pet dogs and for campaigns to manipulate the urban habitat to control free-roaming and wandering but owned dog populations in Freetown and other urban areas in the provinces of Sierra Leone. Interview-based questionnaires administered in three districts of Freetown indicated a relatively high degree of uniformity in dog husbandry and veterinary care habits across a wide range of socioeconomic status categories in dog owners.

Adolescent↗

PubMed1998

Euthanasia and the terminally ill: can the civil killing of others be eroded?

The present paper assesses attitudes towards the ending of life among a sample of 100 terminally ill hospice patients. Such a sample best provides an insight into the demand for euthanasia in this most extreme of circumstances. Of the completed interviews (64), 43 patients were fully aware of the implications of their condition; 35 expressed a definite opinion regarding euthanasia, 22 of whom favored the individual's right to choose the timing of death. Only 6 of these 22 were fully competent at the time of the interview and were not suffering from any depressive disorder. The implications of these results point to the need to consider the prevalence of depression, anxiety, and related disorders among those who seek an end to life. A failure to do so is likely to affect legislation worldwide, and, in turn, civilization itself.

Attitude to Death↗

PubMed2002

The effects of jury size, evidence complexity, and note taking on jury process and performance in a civil trial.

A total of 567 jury-eligible men and women who were assigned to 6- or 12-person juries saw a videotaped civil trial that contained either I or 4 plaintiffs. Half the juries took notes, whereas the remainder did not. Six-person juries that did not take notes awarded multiple plaintiffs the highest amounts of compensation. Six-person juries also gave the highest punitive damages when they did not take notes and judged multiple plaintiffs. The punitive awards of 6-person juries were highly variable compared with 12-person juries. Multiple plaintiffs also increased the unpredictability of jury punitive awards. Twelve-person juries deliberated longer, recalled more probative information, and relied less than 6-person juries on evaluative statements and nonprobative evidence. Limitations and implications are discussed.

Adult↗

PubMed2000

Malaria outbreak in a malaria-free region in Oman 1998: unknown impact of civil war in Africa.

Beginning in April 1998, the surveillance system in Dhofar region, Oman, detected malaria cases among individuals who had no risk factors for the acquisition of malaria. An investigation was conducted to describe the outbreak and to identify its possible causes. A malaria case was defined as an unexplained fever (>38 degrees C) in a resident of the Dhofar region from April to September 1998. The investigation consisted of enhanced passive case detection, active case finding through contact screening, mass blood survey and school survey. Also an entomological survey was conducted and meteorological data was reviewed. Over a period of seven months, 1279 patients with fever were examined for malaria parasites. Sixty-five cases were positive; 60 (92%) males and 5 (8%) females. Cases occurred in all age groups (range: 2-63 years, median 25 years). Most cases were among illegal Somali immigrants (28, 43%) followed by Omanis (20, 31%). Out of the 2323 slides collected from the community and 2487 from school children, 21 slides were positive. All of them were from illegal immigrants. The entomological survey detected three vectors, previously found in the region: A. d'thali, A. sergenti and A. stephensi. Although the region is classified as a malaria-free region, it has the potential for malaria introduction. This outbreak most likely occurred due to the influx of hundreds of illegal Somali immigrants due to the civil war into the Dhofar region, providing a sufficient number of gametocyte carriers for local anopheline mosquitoes to feed on.

Adolescent↗

PubMed1998

The "improved" public house, 1870-1950: the key to civilized drinking or the primrose path to drunkenness?

The Victorian temperance movement aimed to eliminate, not reform, public houses, but from 1870 interest began to be taken in promoting an "improved" public house which could promote counter-attractions to drink. Disinterested management, based upon public ownership or a trust company, was advocated as the best means of achieving this. There was, however, an ambiguity about the nature of the "improved" public house. Was the goal an austere establishment where the drinking could be controlled in the public interest, or was it a comfortable leisure centre which would promote civilized drinking? This ambiguity lay unresolved during the period of the Carlisle experiment in state control in the period after 1915. Increasingly during the inter-war years the policies of the state-run Carlisle scheme and the more go-ahead brewers converged. The issue was originally conceptualized as a moral one, then as one of national efficiency and finally as a commercial one.

Alcohol Drinking↗

PubMed2000

Assessment of psychiatric patients' competency to give informed consent: legal safeguard of civil right to autonomous decision-making.

Amendment of the Mental Health and Welfare Law in Japan will limit admission for medical care and protection only for those individuals who are incapable of giving consent to admission. This is a first in the history of the Japanese mental health legislation. By reviewing the law and psychiatric literature, it is argued that: (i) informed consent is a legal transaction that embodies the idea of an individual's right to autonomous decision-making in medical settings; (ii) health professionals have a duty to protect those individuals who cannot decide medical matters because of lack of capacity to do so; (iii) some patients are marginally incompetent so assessment of their competency is essential in protecting patients' civil rights; (iv) in order for a competency assessment to be reliable (and hence fair) the method should be psychometrically sound; (v) at the same time, in order for a competency assessment to be valid, the structure of a competency assessment should match the patient's psychological, cultural, and social background; and (vi) because informed consent is a process rather than a cross-sectional event, a competency assessment should be performed in everyday practice. The use of a brief and semistructured interview to assess patients' competency to give informed consent may meet all of the requirements described.

Decision Making↗

PubMed1995

[The civil law liability in radiology. An analysis of the administration of justice].

This study comprises 76 published judgments by German and Austrian civil courts between 1966 and 1993 concerning liability in the field of radiology. There has been a marked increase in the number of legal proceedings in the 1980's and even more so in the second half of this decade. This is due to an increased tendency to sue doctors without any legal cause in the hope of possible compensation. In 40.8% of the cases the doctor was held liable and required to compensate the patient for personal injury and suffering pain. Most of the cases were related to complications during the examination procedure. The reason most frequently cited by the courts for sentencing doctors was the fact that they did not previously inform the patient adequately about the examination and its possible consequences.

Austria↗

PubMed2006

Social determinants, political contexts and civil society action: a historical perspective on the Commission on Social Determinants of Health.

ISSUES ADDRESSED: To evaluate opportunities for action on social determinants of health (SDH) requires a historical perspective. Plans for addressing SDH should be developed with an awareness of past similar efforts and factors that contributed to their success or failure. METHODS: Review of published historical literature on analysis and action on SDH, in particular from the Latin American social medicine movement. RESULTS: In the period since World War II, global public health has oscillated between a social vision of health and a more individualistic, technological and medicalised model. Action on SDH was central to comprehensive primary health care as promulgated at the 1978 Alma-Ata conference and championed by the movement for 'Health for All by the Year 2000'. Subsequently, commitment to addressing SDH declined under the impact of restrictive interpretations of 'selective primary health care' and the pressure of neo-liberal economic and health policies. CONCLUSIONS: Through its critique of politically naive medical and public health approaches and of neo-liberal ideology, the Latin American social medicine tradition offers important lessons for today's efforts to advance action on SDH. Key lessons concern: (1) the model of praxis, consciously uniting reflection and action for political change; and (2) the importance of civil society and community participation in action on SDH.

Africa↗