Formal pooling of health risks in sub-Saharan Africa: Reflections on the obstacles encountered

Over the past few years a number of institutional solutions to the pooling of health risks have been advanced in a great number of reform proposals for developing countries. The empirical arguments in favour of such recommendations have the full force of accumulated experience in countries that have long been industrialized. However, rural realities in Africa and Asia naturally have very little to do with past or present realities in western countries. Whereas the technical-cooperation and scientific community has relatively good knowledge of techniques, a number of recent experiences of the introduction of mutual benefit schemes in Africa seem to show that this approach is now enjoying some success. The low levels of membership in particular make it essential to tackle the problem fully. This article tries to identify the various possible explanations for this lack of enthusiasm in sub-Saharan Africa.     

Attachment-based family therapy: adherence and differentiation

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family therapy (MDFT) and cognitive-behavioral therapy (CBT). Results indicate that ABFT therapists employed essential ABFT interventions, such as focusing on vulnerable affect, highlighting attachment-related themes, and promoting adolescent-parent reattachment through in-session enactments. In accordance with the sequential nature of the treatment, these interventions were used more extensively during the early stage of treatment, when there is a greater focus on reattachment. ABFT was perfectly discriminable from CBT, with ABFT therapists using more restructuring and reattachment interventions and CBT therapists using more signature CBT interventions, such as cognitive monitoring and homework. ABFT was also discriminable from MDFT, with ABFT therapists placing a greater emphasis on reattachment. These results suggest that ABFT is a viable and differentiated treatment. Together with prior findings supporting its efficacy, ABFT should be considered a promising new approach for working with depressed adolescents and their families.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.     

Do male and female gamblers have the same burden of adversity over their life course?

The objective of this research is to investigate gender difference and the burden of adversity during the life course of people who develop gambling problems. A sample of 86 adult participants met the criteria for at-risk problem gambling over the last 5 years. Data were obtained from informants during semi-structured face-to-face interviews, using SCID I and II, SOGS, Module K and a recount of life trajectories methodology. The results showed a high level of adversity throughout the life trajectories of the men and women studied. The results indicated that the major load of mental health disorders, the presence of anxiety disorders and co-morbid mental health disorders are more significant among women. Results also indicated a significant presence of violence in the lives of both men and women during early childhood and adolescence. During adulthood, women are more likely to be victims of intimate partner or marital violence whereas men tended to cumulate difficulties in social fields and especially in their professional lives. This significant burden of adversity creates a number of difficulties which makes it complicated to isolate gambling activities. Clinicians might have difficulty detecting female gamblers during consultation, especially when they present with co-morbid mental health disorders and violence issues.     

Introduction

The present study investigates whether hypothesized cognitive mechanisms of change mediate the efficacy of cognitive-behavioral therapy (CBT) delivered online for treating depression and anxiety disorders. Articles were included by searching MEDLINE, PsychInfo and PsychArticles databases from January 1980 to March 2011. The inclusion criteria were as follows: (a) randomized clinical trials investigating the role of CBT delivered online, (b) patient sample had clinical or subclinical intensity emotional problems, (c) at least one measure of cognitions was included, (d) the inclusion of a control group, and (e) sufficient data provided to allow calculation of effect sizes. Eleven articles were selected. Results revealed a moderate overall effect size of CBT (d = .67, P < .05) on the combined cognitive and emotional outcomes. A positive impact of online CBT on cognitive factors (d = .69, P < .05) and emotional outcomes (d = .63, P < .05) was independently demonstrated. In conclusion, cognitive-behavioral therapy delivered online can be used as an efficacious treatment for patients with emotional disorders. Assuming causal effects, the data indicate that cognitive factors are an important mechanism of change in online CBT. Future online CBT focusing on changing cognitions are likely to be efficacious.