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Political repression and children in South Africa: the social construction of damaging effects.

This article discusses some dilemmas facing mental health and social service workers studying and providing services for children affected by political repression in South Africa. We argue that it is almost inevitable that progressive care providers are affected by an image of childhood as one of passive innocence and vulnerability, an image which is both outmoded in terms of modern developmental psychology and potentially destructive if the aim of intervention is empowerment. Practical experience with children affected by repression has led us to question commonly held views on the nature of psychological damage, and to recognise that our views on stress tend to be class-bound. Questions of partiality and credibility affect both practical work and the way that social service workers conceive of their role. Without an approach to the understanding of repression which takes account of underlying ideological factors, the social construction of illness and symptoms, and the historical antecedents of current abuses of children in South Africa, we are unable adequately to situate and evaluate critically the work we are doing. Even the focus on children as particular victims of apartheid needs to be thoroughly examined.

Child↗

Coping with political violence in Northern Ireland.

Recent community based research, employing a self-assessed measure of psychological distress, has suggested that people in Northern Ireland may be coping relatively well with the stress of continuing political violence. This paper reports a first direct investigation of coping in Northern Ireland. Using two scales from the Folkman and Lazarus Ways of Coping Questionnaire--Distancing and seeking Social Support--an attempt was made to investigate the role of coping in relation to local levels of violence, the appraisal of violence, gender and trait neutoticism. The results indicated that trait neuroticism was not related to the appraisal of levels of violence, but that appraisal was related to both types of coping. In particular, those who perceived the violence to be more serious reported using less distancing, while they also reported seeking the most social support. In addition more women reported seeking social support compared to men. Finally those who lived in a high violence area were more likely to report using distancing than were those from a less violence prone area. These results were taken to support the contention that some form of denial may be the main form of coping in Northern Ireland, and that coping is related more to the appraisal of violence than to actual violence levels, while the appraisal of violence is in turn not related to trait neuroticism.

Adaptation, Psychological↗

Ethical, methodological and political issues of AIDS research in Central Africa.

AIDS represents research challenges for anthropology as well as for biomedicine. In many ways the dilemmas of anthropologists appear to be of lesser magnitude than those confronting biomedical researchers charged with the responsibility for treating patients and searching for cures and vaccines. Yet anthropological research is both politically sensitive and policy-relevant. Ethical practice in anthropology is linked to questions of methodology and theory which this article explores based on the author's leadership of CONNAISSIDA, a collaborative action-research team studying the medical anthropology of AIDS in Zaire from 1985 to 1990. The need for a broad approach to social research in support of AIDS prevention is argued.

Acquired Immunodeficiency Syndrome↗

U.S. apartheid and the spread of AIDS to the suburbs: a multi-city analysis of the political economy of spatial epidemic threshold.

We compare mechanisms of AIDS diffusion at the county level from five U.S. central city epicenters into their associated metropolitan regions. Four of the five show an expanding 'hollowed out' center of physically and socially devastated, politically and economically abandoned high density minority neighborhoods, surrounded by rings of relatively affluent majority suburban populations. From these centers AIDS diffuses into the suburbs as a single, spatially extended disease ecosystem. The exception, San Francisco, has not yet experienced the 'hollowing out' process and is, we conclude, a major AIDS epicenter markedly less coupled to its suburbs because of that fact. This may constitute one of the few empirical observations of spatial threshold in epidemiology. Our empirical results contradict the conclusions of a recent National Research Council report that AIDS will be largely confined within marginalized urban populations. In reality U.S. urban apartheid, particularly its continuing disruption of minority social structures, has markedly accelerated the diffusion of AIDS into suburban communities. A widespread program of reform, which rebuilds minority physical and social community structures within both city and suburb, is an essential, but largely unrecognized, component to any serious strategy for the control of AIDS in the United States.

Acquired Immunodeficiency Syndrome↗

Origins of the Children's Vaccine Initiative: the political foundations.

The Children's Vaccine Initiative (CVI) was founded in 1990-91 as a means to revolutionize the way that vaccines were developed for the South. The system for the creation of vaccines was a dis-articulated one in which basic research, product development and delivery were handled by different, often insufficiently linked groups. The public sector was deeply involved in research and delivery but not the vital product development area. That area was left to the private sector which was increasingly driven by the needs to maximize profits. Potential vaccines for diseases found in the South, where a hard currency market was limited, were often left undeveloped. The CVI was designed to change that situation. The CVI hoped to exploit the discoveries of biotechnology and produce not only new and improved vaccines, but ultimately to work towards a single multi-antigen vaccine given near birth that would immunize children for life. This article deals with the events that directly led to the creation of the CVI, and to the political problems caused by organizational and national rivalries that the new venture faced from its inception.

Child↗

Alcoholism, politics, and bureaucracy: the consensus against controlled-drinking therapy in America.

Controlled drinking has long been rejected as a therapeutic goal in traditional American alcoholism treatment. More striking has been the adoption of this position by behaviorists who once fostered controlled-drinking (CD) therapy, such as Peter Nathan, former director of the Rutgers Center of Alcohol Studies. This shift has occurred even while the evidence for rejecting the value of moderation training is unclear. Rather than being justified empirically, this rejection must instead be understood as a strategy behaviorists have used to jettison a politically explosive element in the behavioral package in order to gain overall acceptance for the behavioral approach to treating alcoholism. However, this strategy entails significant scientific, clinical, social, and ethical costs.

Alcohol Drinking↗

HIV serosurveillance of newborns. A clinician's perspective on legislative, political, and ethical issues.

This article reviews the complex issues surrounding the anonymous HIV testing of newborns to monitor the prevalence of HIV infection in women of childbearing age. This serosurveillance of newborns has become a topic of legislative debate focusing on disclosure of currently anonymous results of HIV antibody tests of newborns, thus revealing the serostatus of the mother. This, in effect, would mandatorily test women without their consent. The discussion includes the following topics: (a) the historical demographics of incidence rates of AIDS, (b) current political and legislative issues raised by serosurveillance, (c) professional and ethical issues confronting health care providers, and (d) why HIV testing of newborns is a mandatory testing of all women of childbearing age. It is recommended that principles of patients right of self-determination be respected, that mandatory testing would be counterproductive and would disproportionately impact on minorities. The integration of education, counseling, and voluntary testing will result in the most effective way to get both women and children into the health care system.

AIDS Serodiagnosis↗

Women's health: science and politics.

The scientific community, in particular the NIH, as well as the political communities of governments and advocates, have formidable goals to achieve in integrating women's health research firmly within the context of biomedical science, securing rights for women to be included in clinical studies and fostering the development and advancement of women in biomedical sciences. No one group or organization can accomplish such a task alone, nor should they. This effort requires the cooperation and collaboration of many individuals and organizations if we are to meet our ultimate goal--health for all our citizens.

Clinical Trials as Topic↗

Political issues in internal medicine in Europe. A position paper.

What will be the future of internal medicine in Europe? Because of rapidly growing concerns regarding the position of internal medicine in many European countries, the European Federation of Internal Medicine (EFIM) has established a working group to analyze the situation. Being well aware of the variation in working practices in the different countries, the members of the group used an "all-European" approach to answer the following questions: Internal medicine is the modern, clinical, and scientific medical discipline that is responsible for the care of adult patients with one or more complex, acute, or chronic illnesses. Internal medicine is the cornerstone of an integrated health care delivery service that is needed today. Decision-makers in politics and hospitals, insurers, journalists, and the general public need a better understanding of what internal medicine can offer to the health care system and to the individual patient.

Journal Article↗

The political ecology of health: perceptions of environment, economy, health and well-being among 'Namgis First Nation.

Informed by Mayer's (Progr. Hum. Geogr 20 (1996) 441) political ecology of disease framework, this paper investigates First Nation's perceptions of the links between environment, economy and health and well-being. A case study of 'Namgis First Nation (Alert Bay, British Columbia, Canada) is used to explore the risks and benefits of salmon aquaculture for British Columbia's First Nations. Analysis of interview data (n = 23) indicates strong links between reduced access to environmental resources, marginal participation in the economy, and declining community health and well being. Results suggest that aquaculture development has further decreased the community's access to environmental resources, thereby restricting those economic, social, and cultural activities that determine good health and well-being for this community.

Animals↗

Uganda AIDS prevention: A,B,C and politics.

Uganda is one of the few countries in the world that has experienced a significant reduction in Human Immunodeficiency Virus (HIV) prevalence over the past decade. In contrast to many of its neighbors, Uganda has had an explicit national policy that includes: Abstinence, Be faithful, and Condoms. This strategy, known as "A,B,C," has garnered wide attention in the United States as the efficacy of abstinence-based sex education is debated. This commentary is based on published and unpublished data together with personal observations derived from a Department of Health and Human Services (DHHS)-led delegation to Uganda in December 2002. The empirical bases for both an abstinence-only and a combined (A,B,C) strategy is reviewed; and the political consequences of the debate for both Africa and the United States are explored.

Adolescent↗

Executive deficits in chronic PTSD related to political violence.

UNLABELLED: Twenty-two subjects with chronic PTSD were compared to 23 subjects with no diagnoses (NPD) on tests of executive functioning (EF) that are assumed to have clinical significance after exposure to political violence. METHOD: The three cognitive components of EF, intentionality, inhibition and executive memory [Burgess, P. W., Alderman, N., Evans, J., Emslie, H., Wilson, B. A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547-58], were measured using the Tower of London, Stroop Color-Word Test and Wisconsin Card Sorting Test (WCST), respectively. RESULTS: The PTSD group was impaired on tasks measuring automatic processing and executive memory. Executive memory problems were related to elevated posttraumatic symptoms, but the executive components intentionality and inhibition did not differentiate the groups. Arousal and intrusive symptoms had no impact on intentionality. CONCLUSION: Posttraumatic symptoms are related to automatic processing problems and impairment in executive memory. Observed dysfunctions in mental flexibility could have a negative impact on the cognitive processing of traumatic memory, thus preventing from recovery.

Adolescent↗

Meta-analysis: Methods, strengths, weaknesses, and political uses.

The general methodology, strengths and weaknesses, and political uses of meta-analysis are examined. As a systematic study of all studies that have been conducted to answer a specific question or hypothesis, meta-analysis is strong in revealing structural flaws and sources of bias in primary research and in posing promising research questions for future study. It cannot exceed, however, the limits of what is reported by primary researchers. Meta-analysis is particularly challenged to quantify the size of a common effect of treatment across reported trials because of (1) the clinical diversity of the trials and (2) the myriad of potential differences among patients with varying characteristics within the trials. Without access to the original data of reported trials, meta-analysis cannot overcome the bias of underpowered trials toward overstatement of the size of main treatment effects, nor the tendency for such trials to falsely conclude there were no statistically significant adverse events. Although severely compromised by ghost-written or honorary-authored reports of primary research, meta-analysis can make use of its methods to focus on the conflicts of interest and likely sources of bias of such research and make known what precautions should be taken by would-be consumers. Examples show how meta-analysis has clarified thinking about the off-label use of selective serotonin reuptake inhibitors for treating child and adolescent depression, use of low-tidal volume respirator assistance for acute lung injury and acute respiratory distress syndrome patients, and the long-term use of COX-2 inhibitors for relieving arthritic pain. Recommendations are made for Congressional action.

Clinical Trials as Topic↗

Privacy, privatization, and the politics of patronage: ethnographic challenges to penetrating the secret world of Middle Eastern, hospital-based in vitro fertilization.

In recent years, in vitro fertilization (IVF) has spread around the globe, including to the Middle East. Privacy, privatization, and the politics of patronage are all key issues affecting anthropological research in Middle Eastern hospital-based IVF clinics. IVF-seeking patients generally desire privacy, even total secrecy, when pursuing these treatments, due to cultural issues of stigmatization, particularly regarding male infertility. Thus, ethical issues surrounding the informed consent process are of prime importance. Furthermore, privatization of medical services in the Middle East has left patients--and anthropologists--with few choices other than private IVF clinic settings in which to pursue treatment and research. Both the ethos of patient privacy and medical privatization affect the ability of anthropologists to "penetrate" the secret world of IVF. Permission to conduct ethnography in private hospital IVF clinics may be difficult to obtain without the help of highly motivated physician patrons, who are willing to recruit their private IVF patients for ethnographic interviewing. This article provides a personal account of some of these challenges as faced by a medical anthropologist during a 15-year career of hospital-based IVF research in the Middle East.

Anthropology, Cultural↗

Viagra's rise above women's health issues: an analysis of the social and political influences on drug approvals in the United States and Japan.

In the United States, Viagra was approved in less than 6 months of its application to the Food and Drug Administration, while the medical abortion pill was approved 4 years after its application, and 17 years after research was first permitted. Congruently, the Ministry of Health in Japan legalized Viagra in 6 months, while oral contraceptives were approved 35 years after the ministry received initial applications. The pharmaceutical review agencies in each country are founded on safety and efficacy standards, in which objective decisions arise from science and clinical investigations. Analyses of these recent drug approvals demonstrate that conclusions may not have been based simply on science and health concerns. Instead, agency actions and application of pharmaceutical law appear to have been influenced by social and political pressures surrounding the products under scrutiny. Pharmaceutical regulations were effectively ignored or manipulated in the United States during the review process for medical abortion, and were applied inconsistently in Japan--ultimately yielding results that happened to conform to contemporary sociopolitical beliefs. Such disregard of legislation holds serious ramifications for public health, national consumer trust and the pharmaceutical industry. It is imperative that external pressures remain outside the scope of drug approval processes.

Attitude to Health↗

Health technology adoption and the politics of governance in the UK.

The manner in which clinical and cost-effectiveness data are used to inform decisions about the funding and availability of drugs, therapies and medical devices is inherently politicised within collectively financed systems of health care. The National Institute for Health and Clinical Excellence (NICE) was established by the British government in 1999 to reach evidence-based decisions on whether selected health technologies should be made available by the National Health Service in England and Wales. But NICE is also required to involve a broad range of interested parties in the decision-making process, provide detailed rationales for its rulings and defend appeals from aggrieved parties. Debates about the emergence of "deliberative" forms of policy governance--based upon participation by a broad range of stakeholders rather than reliance on scientific, bureaucratic or political expertise alone--are thus particularly apposite. This article draws on a study of decision-making within NICE by focusing upon the tenor and orientation of deliberation about the adoption of health technologies. Does such deliberation take place upon a level playing field for different interests? Or do implicit parameters and understandings in the deliberative process tend to privilege some interests by structuring debate and attendant outcomes? Findings suggest that deliberative assumptions and parameters pertaining to fluid and contestable ideas of transparent reasoning and domain competence both reflect and shape relationships of influence and marginality among participants. Broader analytical implications centre on a distinction between "deliberative democracy" and "democratic deliberation". The extent to which this distinction is acknowledged and addressed in policy and practise will have marked implications for the substantive nature of attempts to broaden involvement in decision-making within public sector bodies such as NICE.

Decision Making↗

The changing political economy of sex in South Africa: the significance of unemployment and inequalities to the scale of the AIDS pandemic.

Between 1990 and 2005, HIV prevalence rates in South Africa jumped from less than 1% to around 29%. Important scholarship has demonstrated how racialized structures entrenched by colonialism and apartheid set the scene for the rapid unfolding of the AIDS pandemic, like other causes of ill-health before it. Of particular relevance is the legacy of circular male-migration, an institution that for much of the 20th century helped to propel the transmission of sexually transmitted infections among black South Africans denied permanent urban residence. But while the deep-rooted antecedents of AIDS have been noted, less attention has been given to more recent changes in the political economy of sex, including those resulting from the post-apartheid government's adoption of broadly neo-liberal policies. As an unintentional consequence, male migration and apartheid can be seen as almost inevitably resulting in AIDS, a view that can disconnect the pandemic from contemporary social and economic debates. Combining ethnographic, historical, and demographic approaches, and focusing on sexuality in the late apartheid and early post-apartheid periods, this article outlines three interlinked dynamics critical to understanding the scale of the AIDS pandemic: (1) rising unemployment and social inequalities that leave some groups, especially poor women, extremely vulnerable; (2) greatly reduced marital rates and the subsequent increase of one person households; and (3) rising levels of women's migration, especially through circular movements between rural areas and informal settlements/urban areas. As a window into these changes, the article gives primary attention to the country's burgeoning informal settlements--spaces in which HIV rates are reported to be twice the national average--and to connections between poverty and money/sex exchanges.

Adult↗

The panopticon re-visited?: an exploration of the social and political dimensions of contemporary health care and nursing practice.

Insights from critical and postmodern perspectives are used to explore some of the aspects of contemporary nursing practice and health care which are taken for granted. Such an exploration begins to deconstruct the power relations implicit within the socio-political context of the health care arena in which nursing operates. In particular, the work of the French philosopher Michel Foucault is used to explore the discourses of the various health care "experts". Aspects of women's health and nursing practice are used as exemplars of the limiting effects of such discourses.

Delivery of Health Care↗