Impact of Population Growth on Food Supplies and Environment

Population and Environment -     

Organizational Restructuring in European Health Systems: The Role of Primary Care

The main goal of this paper is to review the strategies developed across European health care systems during the 1990s to improve coordination among health care providers. A second goal is to provide some analytical insights in two fields. On the one hand, we attempt to clarify the relationships between pro‐coordination strategies and organizational change in health care. Our main conclusion is that the specific features of health care impede the operation of either market or hierarchical coordination mechanisms. These can, however, be selectively successful if applied as levers to promote the role and impact of the pro‐cooperative coordination strategies which are ultimately required to foster adequate inter‐professional and inter‐organizational coordination. On the other hand, we try to cast some light on the ongoing debate on convergence versus path dependency within the broader field of welfare state reform. Evidence on pro‐coordination reforms in health care apparently supports some insights from previous work on the centrality of the socio‐political structure to account for varying patterns of selective path dependency across countries. In particular, the informal power resources of specialist physicians vis‐à‐vis primary care professionals and the state are critical to explain the different rhythm and fate of pro‐coordination reforms across Europe. Against received wisdom, the evidence examined suggests that selective path dependency might apparently be compatible with a general trend towards convergence understood as hybridization.     

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

Pediatric research posing a minor increase over minimal risk and no prospect of direct benefit: challenging 45 CFR 46.406

Subpart D of the Common Rule establishes 4 categories of research that may be conducted on children. One category, 45 CFR 46.406, permits research posing a minor increase over minimal risk and no prospect of direct benefit but expected to yield vital knowledge about the subjects' disorder or condition. To include other children in research posing a minor increase over minimal risk and no prospect of direct benefit requires federal review and approval of the Secretary of Health and Human Services under 45 CFR 46.407. It is widely held that children generally should not be exposed to more than minimal risk in research without the prospect of direct benefit. To justify deviating from this norm, as 406 allows, two claims must be true: (1) When there is vital knowledge to be gained from studying children, it is permissible to expose some children to a minor increase over minimal risk with no prospect of direct benefit; (2) It is permissible for locally reviewed and approved research to expose only children with the disorder or condition under investigation to greater risk with no prospect of direct benefit. The justification for (1) appears to be grounded in the magnitude of benefit to society combined with the need to study children. This article demonstrates that, even if the necessity and magnitude of benefit to society justify exposing children to increased risk, the decision to categorically restrict participation in such research to children with the disorder or condition under investigation (unless the study is federally reviewed and approved) is not justified. Subpart D should be revised.     

Implementation and evaluation of an HIV/STD intervention in Peru

This paper presents the lessons learned through a process evaluation (PE) after 1 year of implementation of a 2-year community intervention in Lima, Peru. The intervention consisted of training and motivating community popular opinion leaders (CPOLs) for three marginal population segments to disseminate prevention messages among their peers. PE data included: observations, qualitative interviews with CPOLS, conversations and messages delivered by CPOLs, training facilitators' perceptions about implementation, and a survey of CPOLs. The PE helped to document and enhance the intervention. CPOLs were motivated to talk to their peers. CPOLs perceived that their participation had an effect on their own risk behaviors and saw their role as beneficial to their community. The PE was helpful in examining training delivery and the feasibility and acceptability of the intervention in order to assess the elements related to program success necessary to replicate the CPOL model.     

Early Intervention in Portugal: Study of Professionals’ Perceptions

Early intervention (EI) has been characterized by considerable advances in its domain, which has had great repercussions in the implementation of the family-centered approach. These changes have had implications in the practices and in the adoption and learning of new values that should be implemented in EI. This study evaluates the professional perspectives regarding family-centered practices in EI programs in Portugal. The results highlight the importance of effective collaboration and coordination between health, education, and social services and the importance of providing child and family support in a natural context. These results reinforce the need to invest in professional training to improve the quality of services offered to families in EI.     

The Role of Early Maladaptive Schemas in the Appearance of Psychological Symptomatology in Adult Women Victims of Child Abuse

ABSTRACT

Child abuse affects people’s ways of thinking, feeling, and observing the world, resulting in dysfunctional beliefs and maladaptive schemas. Thus, consequences of child abuse may persist during adulthood. Therefore, the aim of this study was to analyze the psychological consequences (anxiety, phobic anxiety, depression, and hopelessness) of different types of maltreatment (physical, sexual, and emotional abuse and physical and emotional neglect) and to study the role of early maladaptive schemas in the onset of symptomatology in adult female victims of child abuse. The sample consisted of 75 women referred by associations for treatment of abuse and maltreatment in childhood. Sexual abuse was the type of maltreatment that was most strongly related to most dysfunctional symptomatology, followed by emotional abuse and physical abuse, whereas physical neglect was the least related. Also, early maladaptive schemas were found to correlate with child abuse and dysfunctional symptomatology. Finally, early maladaptive schemas mediated the relationship between sexual abuse and dysfunctional symptomatology when the effect of other types of abuse was controlled. These results may provide important guidance for clinical intervention.     

Stuck on a Muddy Road: Frictions of Mobility amongst Urban Toba in Northern Argentina

This article explores how the Toba, an indigenous group in the North of Argentina, shape places and an urban subjectivity in the frictions of their mobility between villages, the urban barrio (neighborhood), and the periurban bush. I argue that the experience of Toba moving to the city is better understood as frictions between the Toba desire to progress in the city, the organization of difference in space, and their multiple movements “back” to the villages. In addition, I analyze their contemporary hunting trips, which take urban Toba to the nearby bush, as a mobility that shapes a form of indigeneity engaged with access to both the city center and the bush. This practice confronts them with ranch owners and police but reconnects the barrio and the bush by traversing them. If frictions emerge between forces that trigger movement and forces that slow that movement down, in the frictions of mobility the Toba have at once shaped their position in the city and overflowed its limits.     

Elder Abuse in Portugal: Findings From the First National Prevalence Study

In this study, we present findings of the Portuguese national prevalence study, “Aging and Violence,” the purpose of which was to estimate the prevalence of abuse and neglect of older people in family settings over a 12-month period and examine the relationship between abuse and sociodemographic and health characteristics. Through a telephone survey of a representative probability sample (N = 1,123), we evaluated 12 abusive behaviors and demographic data. Overall, 12.3% of older adults experienced elder abuse in family settings. The prevalence rates of specific types were as follows: psychological, 6.3%; financial, 6.3%; physical, 2.3%; neglect, 0.4%; and sexual, 0.2%. Logistic regression was employed to determine the relationship between abuse and covariates. The study suggests that education level, age, and functional status are significantly associated with abuse. Accurate estimates of the prevalence of elder abuse and understanding of victim and perpetrator characteristics are fundamental to designing effective strategies for prevention and intervention.