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PubMed2006

Psychodynamic Trojan horses: using psychopharmacology to teach psychodynamics.

Concurrences of scientific, cultural, and economic developments in the past decade have changed psychiatric practice and psychiatric training. The explosion in neurobiological sciences has left residents with an overwhelming amount of neurobiology to master at the same time that managed care has led to a de-emphasis on psychiatrists providing psychotherapy. Consequently, many residents are left questioning the relevance of psychodynamics for psychiatry, given that the majority will function primarily as prescribers. However, the illusion, increasingly common in our culture, that medications are a simple fix leaves residents unprepared to make sense of the complex and irrational processes that happen in the acts of prescribing and taking medications (or not taking medications). Consequently, residents may feel confused, angry, hopeless, and/or abandoned in their role. These residents are often hungry for a context to explain why they feel hopeless, confused, or defeated in carrying out the "simple" task of prescribing. A psychodynamic understanding can provide such a holding context, just as it can give residents tools for backing out of futile and/or destructive enactments and turning conflicts around medications to some therapeutic good. Many psychodynamic concepts that initially may have seemed to residents part of some arcane and outmoded pseudoscience suddenly become relevant when they provide both a context for understanding the resident's distress and useful clinical tools. Those psychodynamic psychiatrists wishing to promulgate a psychodynamic understanding may need to meet psychiatric trainees at their developmental level and take seriously the current emphasis on providing effective somatic treatments. By engaging trainees at the junction of psychodynamics and psychopharmacology, psychodynamic psychiatrists may find a more receptive audience and open the door for greater interest in developing psychodynamic understanding and technical skills.

Clinical Competence↗

PubMed2000

Concepts of illness and treatment practice in a caboclo community of the Lower Amazon.

Comparatively little has been written recently about the health consequences of social change and economic development in Amazonia. This study focuses on patterns of morbidity, treatment practices, and illness beliefs among caboclos of the Lower Amazon. It suggests that for these people traditional medicine is a salient marker of ethnic identity. An understanding of beliefs concerning disease etiology is critical to an appreciation of individual treatment choices in a plural medical system such as that found within the Lower Amazon region, where traditional healers can play a pivotal role in developing effective linkages to clinical services.

Adult↗

PubMed2005

Ideologies of aid, practices of power: lessons for Medicaid managed care.

The articles in this special issue teach valuable lessons based on what happened in New Mexico with the shift to Medicaid managed care. By reframing these lessons in broader historical and cultural terms with reference to aid programs, we have the opportunity to learn a great deal more about the relationship between poverty, public policy, and ideology. Medicaid as a state and federal aid program in the United States and economic development programs as foreign aid provide useful analogies specifically because they exhibit a variety of parallel patterns. The increasing concatenation of corporate interests with state and nongovernmental interests in aid programs is ultimately producing a less centralized system of power and responsibility. This process of decentralization, however, is not undermining the sources of power behind aid efforts, although it does make the connections between intent, planning, and outcome less direct. Ultimately, the devolution of power produces many unintended consequences for aid policy. But it also reinforces the perspective that aid and the need for it are nonpolitical issues.

Altruism↗

PubMed2002

Energy, industry and nitrogen: strategies for decreasing reactive nitrogen emissions.

Nitrogen oxides are released during atmospheric combustion of fossil fuels and biomass, and during the production of certain chemicals and products. They can react with natural or man-made volatile organic compounds to produce smog, or else can be further oxidized to produce particulate haze, or acid rain that can eutrophy land and water. The reactive nitrogen that begins in the energy sector thus cascades through the atmosphere, the hydrosphere and soils before being eventually partially denitrifed to the global warming and stratospheric ozone-depleting gas nitrous oxide or molecular nitrogen. This paper will suggest how an economic analysis of the nitrogen cycle can identify the most cost-effective places to intervene. Nitrogen oxides released during fossil-fuel combustion in vehicles, power plants and heating boilers can either be controlled by add-on emission control technology, or can be eliminated by many of the same technical options that lead to carbon dioxide reduction. These integrated strategies also address sustainability, economic development and national security issues. Similarly in industrial production, it is more effective to focus on redesigning industrial processes rather than on nitrogen oxide pollution elimination from the current system. This paper will suggest which strategies might be utilized to address multiple benefits rather than focusing on single pollutants.

Acid Rain↗

PubMed2003

Distribution of deciduous stands in villages located in coniferous forest landscapes in Sweden.

Termination of fire along with active removal of deciduous trees in favor of conifers together with anthropogenic transformation of productive forest into agricultural land, have transformed northern European coniferous forests and reduced their deciduous component. Locally, however, in the villages, deciduous trees and stands were maintained, and have more recently regenerated on abandoned agricultural land. We hypothesize that the present distribution of the deciduous component is related to the village in-field/out-field zonation in different regions, which emerges from physical conditions and recent economic development expressed as land-use change. We analyzed the spatial distribution of deciduous stands in in-field and out-field zones of villages in 6 boreal/hemiboreal Swedish regions (Norrbotten, Angermanland, Jämtland, Dalarna, Bergslagen, Småland). In each region 6 individual quadrates 5 x 5 km centered on village areas were selected. We found significant regional differences in the deciduous component (DEC) in different village zones. At the scale of villages Angermanland had the highest mean proportion of DEC (17%) and Jämtland the lowest (2%). However, the amounts of the DEC varied systematically in in-field and out-field zones. DEC was highest in the in-field in the south (Småland), but generally low further north. By contrast, the amount of DEC in the out-field was highest in the north. The relative amount of DEC in the forest edge peaked in landscapes with the strongest decline in active agriculture (Angermanland, Dalarna, Bergslagen). Because former and present local villages are vital for biodiversity linked to the deciduous component, our results indicate a need for integrated management of deciduous forest within entire landscapes. This study shows that simplified satellite data are useful for estimating the spatial distribution of deciduous trees and stands at the landscape scale. However, for detailed studies better thematic resolution is needed to determine biologically relevant differences in quality of deciduous stands.

Environmental Monitoring↗

PubMed2004

Flood-risk management strategies for an uncertain future: living with Rhine River floods in The Netherlands?

Social pressure on alluvial plains and deltas is large, both from an economic point of view and from a nature conservation point of view. Gradually, flood risks increase with economic development, because the expected damage increases, and with higher dikes, because the flooding depth increases. Global change, changing social desires, but also changing views, require a revision of flood-risk management strategies for the long term. These should be based on resilience as opposed to the resistence strategy of heightening dikes. Resilience strategies for flood-risk management imply that the river is allowed to temporarily flood large areas, whereas the flood damage is minimized by adapting land use. Such strategies are thus based on risk management and 'living with floods' instead of on hazard control. For The Netherlands, one of the most densely populated deltas in the world, alternative resilience strategies have been elaborated and assessed for their hydraulic functioning and 'sustainability criteria'.

Disasters↗

PubMed1995

Rise and fall in ischemic heart disease mortality - it may have happened before.

The rise in ischemic heart disease (IHD) mortality occurring mostly during the first half of the 20th century is usually associated with economic development and its consequences for people's lifestyles. On the basis of historical evidence, it is postulated that a previous IHD epidemic cycle may have occurred in England and Wales towards the turn of the nineteenth century. The implications of this on causal theories and current etiological research on atherosclerosis are discussed.

Angina Pectoris↗

PubMed1996

[On the hypothesis of cesarean birth rate stabilization in southeastern, Brazil].

Births in S. Paulo State (Brazil) between 1987 and 1993 were studied to test the association between cesarean section rates and the social and economic development. The study used both Health Regions and hospitals as units of analysis. The cross-sectional study of secondary data adopted as variables: cesarean section rates in 1987, 1992 and 1993 by hospital and region; kind of provider; link of hospital with medical school; post-neonatal infant mortality rate; number of banks per inhabitant; and consumption potential of the regional central town per inhabitant. The C-section rates in the period studied were around 48% for the State; between 21.3 and 85.5% for the regions; between zero and 100% for the hospitals; as for kind of provider, the higher rates were found in private hospitals (56% in 1993). Medical school hospitals held stable rates throughout the period, around 39%. The multiple linear regression showed that banks per inhabitant and consumption potential by inhabitants explained 48% of the variation of the regional C-section rates. The stabilization of the State C-section rates is questioned, since the data shows a shift in the mode of hospital rates to higher values. A re-structure of the care delivered to births is imperative in S. Paulo State, since cesarean sections, besides being medical procedures, have become a consumer good, a symptom of the perverse logic that pervades the current organization of the health system.

Analysis of Variance↗

PubMed2005

[Social inequality and homicide rates in Sao Paulo City, Brazil].

OBJECTIVE: The relation between income and mortality due to violence has been studied in recent years. The Synthesis of Social Indicators of 2002 [Sintese de Indicadores Sociais, 2002], published by The Brazilian Institute of Geography and Statistics (IBGE), states that one of the most outstanding characteristic of Brazilian society is inequality. The proposal of this ecological study was to test the association between homicide rates, and some health and socioeconomic indicators. METHODS: This is an ecological cross-sectional study. Data regarding Sao Paulo City, Brazil in the year 2000 was analyzed. The association between homicide coefficients and the following five indicators were tested: infant mortality rates, monthly average income of household heads, percentage of adolescents aged 15 to 17 years not attending school, proportion of pregnant adolescent women aged 14 to 17 years and demographic density. Pearson's correlation coefficient and a multiple linear regression model were utilized to test these associations. RESULTS: The municipal homicide rate was 57.3/100,000. The correlation between homicide rates and average monthly income was strong and negative (r=-0.65). Higher homicide rates were found in the districts whose inhabitants had lower incomes and lower rates were found in those districts whose inhabitants had higher incomes. The correlation between homicide rates and proportion of adolescents not attending school was positive and strong (r=0.68). The correlation between homicide rates and the proportion of pregnant adolescent women was positive and strong (r=0.67). The correlation between homicides and the rate of infant mortality was r=0.24 (for all: p<0.05). The correlation between demographic density and homicides was not significant. Although the univariate regression was positive for four indicators, the multivariate regression test was only significant for average monthly income (negative) and proportion of adolescents not attending school (positive) (for both indicators: p<0.01). CONCLUSIONS: The findings highlight the problem of homicides and socioeconomic disparities in S. Paulo City. Economic development and reducing socioeconomic inequality may have an impact on the rates of mortality due to violence.

Adolescent↗

PubMed2005

[Household food availability in Brazil: distribution and trends (1974-2003)].

OBJECTIVE: Data from household food budget surveys were examined in order to describe the regional and socio-economic distribution of household food availability in Brazil in 2002-2003 and trends from 1974 to 2003. METHODS: The study uses data from the "Pesquisa de Orçamento Familiar 2002-2003" budget survey conducted by the Brazilian Institute for Geography and Statistics (Instituto Brasileiro de Geografia e Estatística) from July 2002 to June 2003, including a national sample of 48,470 households. In each household, during seven consecutive days, all monetary and non-monetary expenses with food and beverages for family consumption were registered. Crude weights of purchased foods were transformed into calories and nutrients with the use of food composition tables. RESULTS: Adequate protein content and a high proportion of animal protein were found in all regions and income strata. These were the most important positive aspects identified in the household food availability in Brazil. On the other hand, all regions and socio-economic strata showed excess calories from sugar and little availability of fruits and vegetables. An excessive proportion of calories came from total and saturated fat in the more economically developed regions and in the urban milieu, as well as among higher-income families. Time-trends in metropolitan areas indicated a decline in the consumption of basic, traditional foods, such as rice and beans; notable increases (up to 400%) in the consumption of processed food items, such as cookies and soft drinks; maintenance of the excessive consumption of sugar; and a continuous increase in total fat and saturated fat content in the diet. CONCLUSIONS: Patterns and trends regarding household food availability in Brazil are consistent with the increasing participation of chronic non-communicable diseases in morbidity and mortality and with the continuous increase in the prevalence of obesity.

Brazil↗

PubMedDate not supplied

[One century of experience with the control of ancylostomiasis].

In the beginning of the XX century, ancylostomiasis was considered a serious public health problem and governments started the first systematic planning for the control of an endemic disease, in large scale. Thereafter, ancylostomiasis was considered a less important subject, because efficient anti-helminthic drugs were introduced, this in combination with the economic development in rich countries, reduced undernourishment and improved housing and sanitary conditions. Consequently, the residual cases of the infection became in general asymptomatic. However, in the third world the problem is still present, and must be considered with realism and managed accordingly. Various suggestions for controling the disease are presented in this paper.

Ancylostomiasis↗

PubMedDate not supplied

Mercury exposure and malaria prevalence among gold miners in Pará, Brazil.

Economic development, including resource extraction, can cause toxic exposures that interact with endemic infectious diseases. Mercury is an immunotoxic metal used in the amalgamation of gold, resulting in both occupational exposures and environmental pollution. A cross-sectional medical survey was conducted in 1997 on 135 garimpeiros in Para, Brazil, because of their risks of both mercury exposure and malaria transmission. Mean levels of blood and urine mercury were well above non-exposed background levels. Twenty-six subjects had malaria parasitemia: Health symptoms consistent with mercury exposure were reported, but neither symptoms nor signs correlated with mercury levels in blood or urine. We did not find a dose response relationship between mercury exposure and likelihood of prevalent malaria infection, but there was a possible reduction in acquisition of immunity that may be associated with conditions in gold mining, including mercury exposure.

Adolescent↗

PubMedDate not supplied

Prevalence of Helicobacter pylori infection in a rural area of the state of Mato Grosso, Brazil.

The prevalence of Helicobacter pylori infection was evaluated by ELISA in 40 children and teenagers and in 164 adults from a rural area of the State of Mato Grosso, Brazil. Antibodies to H. pylori were detected in the serum of 31 (77.5%0 children and teenagers and in 139 (84.7%) adults. The prevalence of infection increased with age (x2 for trend, p < 0.01) even though no variations occurred in the region in the present century in terms of living conditions or sanitation, economical development and migratory influx supporting the hypothesis that the infection is also acquired during later life in developing countries. An inverse correlation was observed between the prevalence of infection and annual family income (x2 for trend, p < 0.013). There was no correlation between type of system for sewage disposal and prevalence of infection (p = 0.8). In conclusion, the prevalence of H. pylori infection in Nossa Senhora do Livramento, a rural area from Brazil, is very high and similar to that observed in other developing countries. Furthermore, the increase in the prevalence of infection with age observed in this population seems to be due to both, cohort effect and acquisition of the infection during later life.

Adolescent↗

PubMed2002

Achievements of schistosomiasis control in China.

The control of schistosomiasis has been spectacularly successful in terms of controlling endemicity and severity of the disease during the last 50 years. It can be categorized into two stages. From 1955 through 1980, the transmission-control strategy had been widely and successfully carried out. By the end of 1980, the epidemic of schistosomiasis was successfully circumscribed in certain core regions including areas at the middle and low reaches of the Yangtze River and some mountainous areas in Sichuan and Yunnan provinces, where control of schistosomiasis had been demonstrated to be very difficult to be sustained. Therefore, since 1980, schistosomiasis control in China has been modified to employ a stepwise strategy, based on which morbidity control has been given priorities and if possible transmission control has been pursued. However, since snail-ridden areas remain unchanged so far, reinfections occur frequently. This necessitates a maintenance phase to consolidate the achievements in the control of schistosomiasis. In the mean time, we are challenged with some environmental, social and economical changes in terms of controlling schistosomiasis. Successfully controlling schistosomiasis in China is still a long-term task but will be achieved without doubt along with the economic development and the promotion of living and cultural standard of people.

Adolescent↗

PubMedDate not supplied

[Rabies epizootic in the urban area of Ribeirão Preto, São Paulo, Brazil].

This report describes some epidemiological aspects of a rabies epizootic that started in 1995 in the urban area of Ribeirão Preto, SP, Brazil, and discusses its main causes. All laboratory confirmed cases were described according to a set of epidemiological variables. Simultaneously, information was raised concerning rabies vaccine coverage and epidemiological surveillance activities. In addition to one human case, 58 rabid animals were confirmed in 1995 (54 dogs, 3 cats. and 1 bat). There were 20 cases in 1996 (18 dogs and 2 cats). Geographical distribution was uneven in the city, with higher concentrations observed in the Western, Northern, and Southwestern sections, corresponding to the poorest areas. No seasonal variation was observed. The main reasons for the epizootic were low rabies vaccine coverage in animals and severe failures in epidemiological surveillance activities in the years immediately prior to 1995. This epizootic illustrates the risk of neglecting such activities, even in a city with a reasonably good health system, located in one of the most economically developed areas of the country. Vigorous preventive measures markedly reduced the number of cases.

Animals↗

PubMedDate not supplied

[Integration, exclusion and solidarity in the current social policy debate].

The current global trend involving transformation of work and the crisis in large government economic development and intervention projects in the market are raising new challenges for social policies to combat poverty. This study reconstitutes and analyzes the tensions, paradoxes, and main consequences of this process, focusing on problems concerned with combining solidarity strategies and public welfare systems.

Brazil↗

PubMed2001

An ecosystem approach to health and its applications to tropical and emerging diseases.

Disease and health outcomes occur within a complex socio-ecological context characterized by feedback loops across space and time, self-organization, holarchies, and sudden changes in organization when thresholds are reached. Disease control programs, even if they are successful, may undermine health; conversely, programs in agriculture and economic development designed to improve health may simply alter disease patterns. A research and development strategy to promote sustainable health must therefore incorporate multiple scales, multiple perspectives, and high degrees of uncertainty. The ecosystem approach developed by researchers in the Great Lakes Basin meets these criteria. This has implications for community involvement in research, development policies, and for understanding and controlling tropical and emerging diseases. Even if unsuccessful in achieving specific outcome targets, however, the requirements of this approach for open and democratic communication, negotiation, and ecological awareness make its implementation worthwhile.

Agriculture↗

PubMedDate not supplied

[Scientific research in the biosciences in São Paulo: beyond institutions].

During the first half of the twentieth century, the creation of scientific institutes was a landmark in the history of the State of São Paulo, given their innovative role and their relation to the region's industrial and economic development. These institutions encompassed a number of basic and applied areas and fostered pioneering lines of research. The transformations that occurred in the political arena during the latter half of the century, exacerbated by the lack of continuity in policies regarding scientific and technological management, brought the progressive deterioration and virtual stagnation of research in most São Paulo institutes. Under my guidance, undergraduate students of biology who were enrolled in a course in the history of science conducted interviews with researchers who had lived through these changes. This oral history approach documents the perceptions of this community of scientific researchers regarding their own achievements and the paths their institutes have followed in the last decades.

Academies and Institutes↗