Konsiliardienste in den Fachgebieten „Psychiatrie und Psychotherapie“ und „Psychosomatische Medizin und Psychotherapie“ im Land Sachsen-Anhalt

Objective To assess the availability and the utilization of specialists for psychiatry, psychotherapy and psychosomatic medicine in somatic hospitals in the German state of Sachsen- Anhalt. Method The “Committee for Issues of Psychiatric Care in Sachsen- Anhalt” sent written questionnaires to the medical chairmen of the 46 hospitals with a somatic department; the return rate was 98% with some information about 48 of 55 hospital locations. Results 17 hospitals use specialists from their own clinical facilities (12 from their own psychiatric department for inpatient care and 4 from their own psychiatric day hospital as well as 9 from their own inpatient psychosomatic unit) for psychiatric consultations on somatic wards and were classified as hospitals with “internal” consultation services. 27 hospitals ask for visits from specialists from another psychiatric hospital (14) and/or call colleagues working in private practice (14) and were classified as “external consultation services”, even if they had psychologists among their own staff (3). In another 4 hospitals, no psychiatric services were offered. Only 16 houses had statistical data regarding the frequency of psychiatric consultations at hand; another 22 hospitals provided estimates. The availability of the consultation service was a strong predictor of its utilization: Hospitals with an “internal” service reported about five times more consultations than those hospitals whose consultation services depended on external specialists. Some formal psychotherapeutic qualification was available in nearly all hospitals with internal and in 37% of the hospitals with external services. Conclusions We were able to gather at least some information regarding psychiatric and/or psychosomatic consultation services in about nearly 90% of the local somatic hospitals of the whole state of Sachsen- Anhalt, which is one of the “new” federal states that emerged from the former “German Democratic Republic” and has to catch up to the standards of medical care of the Federal Republic of Germany. The quality of the data, however, left much room for improvement, as only 36% of the hospitals were able to provide the exact number of psychiatric consultations in the previous year or the last six months. The results, nevertheless, suggest considerable deficits in the care of patients with psychiatric disorders especially in those somatic hospitals with no internal psychiatric consultation service. A service “around the clock” was only available in hospitals with a psychiatric inpatient department of their own. We strongly recommend the implementation of regular reports about the utilization of psychiatric consultations in somatic hospitals as an addition to the current measures of quality assurance. Every somatic hospital should have at least one psychiatrist (with some psychotherapeutic training) on its own staff.     

The Skeleton in the Physical Anthropology Closet1

Abstract

The “new” and “newer” concepts of physical anthropology are oriented to biochemical, genetic and evolutionary studies. While theseareneededand welcome concepts, they often slight the basic tools of anthropometry and typology. Also, the new and newer physical anthropology tends to separate biological factors from their cultural contexts. The writer discusses several questions posed by this shift in emphasis and suggests that the lack of a functional approach lessens the effectiveness of both biologically and culturally oriented investigators.     

Reconciling “stress” and “health” in physical anthropology: What can bioarchaeologists learn from the other subdisciplines?

The concepts of “stress” and “health” are foundational in physical anthropology as guidelines for interpreting human behavior and biocultural adaptation in the past and present. Though related, stress and health are not coterminous, and while the term “health” encompasses some aspects of “stress,” health refers to a more holistic condition beyond just physiological disruption, and is of considerable significance in contributing to anthropologists' understanding of humanity's lived experiences. Bioarchaeological interpretations of human health generally are made from datasets consisting of skeletal markers of stress, markers that result from (chronic) physiological disruption (e.g., porotic hyperostosis; linear enamel hypoplasia). Non-specific indicators of stress may measure episodes of stress and indicate that infection, disease, or nutritional deficiencies were present in a population, but in assessing these markers, bioarchaeologists are not measuring “health” in the same way as are human biologists, medical anthropologists, or primatologists. Rather than continue to diverge on separate (albeit parallel) trajectories, bioarchaeologists are advised to pursue interlinkages with other subfields within physical anthropology toward bridging “stress” and “health.” The papers in this special symposium set include bioarchaeologists, human biologists, molecular anthropologists, and primatologists whose research develops this link between the concepts of “stress” and “health,” encouraging new avenues for bioarchaeologists to consider and reconsider health in past human populations. Am J Phys Anthropol 155:181–185, 2014. © 2014 Wiley Periodicals, Inc.     

Pukhtunwali: Ostracism and honor among the Pathan Hill tribes

The Pathan Hill tribes provide an example of the functional role of ostracism in a face- to-face, kin-based society. “Pukhtunwali,” the Code of the Pathans, regulates the uses of ostracism, as a response to the conflict between an individual's desire for freedom and the necessity of tribal unity. The most striking use of ostracism among the Pathans is the rejection by the tribe or clan of one of its own members whose behavior might lead to feud. If a member of a group has committed an act likely to provoke a reprisal, which may be directed against any individual of that group, the guilty person may be expelled. By ostracizing the person, the group is both punishing him, and withdrawing its support. In Pathan society ostracism functions simultaneously to deter behavior that violates customary legal norms, to punish specific acts that are culturally defined as improper, and to unify the primary reference group on which individuals depend for protection and economic support.     

“Ethno-microbiology” of ethnic Indian fermented foods and alcoholic beverages

The concept of “ethno-microbiology” is to understand the indigenous knowledge of the Indian people for production of culturally and organoleptically acceptable fermented foods by natural fermentation. About 1000 types of common, uncommon, rare, exotic and artisan fermented foods and beverages are prepared and consumed in different geographical regions by multi-ethnic communities in India. Indian fermented foods are mostly acidic and some are alkaline, along with various types of alcoholic beverages. A colossal diversity of microorganisms comprising bacteria mostly belongs to phylum Firmicutes, filamentous moulds and enzyme- and alcohol-producing yeasts under phyla Ascomycota and Mucoromycota, and few bacteriophages and archaea have been reported from Indian fermented foods. Some microorganisms associated with fermented foods have functionalities and health promoting benefits. “Ethno-microbiology” of ethnic Indian people has exhibited the proper utilisation of substrates either singly or in combination such as fermented cereal-legume mixture (idli, dosa and dhokla) in South and West India, sticky fermented soybean food (kinema and related foods), fermented perishable leafy vegetable (gundruk and related foods), fermented bamboo shoots (soibum and related foods) and fermented fish (ngari and others) in North East India, and fermented meat and sausage-like products in the Indian Himalayas, fermented coconut beverage (toddy) in coastal regions, and various types of naturally fermented milk products (dahi and related products) in different regions of India. This review has also highlighted the “ethno-microbiology” knowledge of the people involving the consortia of essential microorganisms in traditionally prepared amylolytic starters for production of cereal-based alcoholic beverages. The novelty of this review is the interpretation of ethno-microbiological knowledge innovated by ethnic Indian people on the use of beneficial microorganisms for food fermentation to obtain the desired fermented food products for consumption.     

Partition of thermodynamic energies of drug–DNA complexation

We report a computation methodology, which leads to the ability to partition the Gibb's free energy for the complexation reaction of aromatic drug molecules with DNA. Using this approach, it is now possible to calculate the absolute values of the energy contributions of various physical factors to the DNA binding process, whose summation gives a value that is reasonably close to the experimentally measured Gibb's free energy of binding. Application of the methodology to binding of various aromatic drugs with DNA provides an answer to the question “What forces are the main contributors to the stabilization of aromatic ligand–DNA complexes?” © 2009 Wiley Periodicals, Inc. Biopolymers 91: 773–790, 2009. This article was originally published online as an accepted preprint. The “Published Online” date corresponds to the preprint version. You can request a copy of the preprint by emailing the Biopolymers editorial office at biopolymers@wiley.com     

Collective action in culturally similar and dissimilar groups: an experiment on parochialism,conditional cooperation,and their linkages

This study examines the effects of ingroup favoritism and outgroup hostility (“parochialism”), as well as of conditionally cooperative strategies, in explaining contributions to experimental public goods games. The experimental conditions vary group composition along two culturally inheritable traits (political party preference and religious affiliation) and one trivial, “minimal” trait (birth season). We contrast ingroup, outgroup, and random group conditions and investigate the relation between the own contribution to the public good and the expectations about other group members' behavior in each one of them. We find evidence for ingroup favoritism but no support for a separate tendency towards outgroup hostility. Further, conditional cooperation and ingroup bias are, to some extent, linked. Subjects had higher expectations of the contributions of ingroup members, and their own behavior was more strongly conditioned on other group members' expected behavior in the ingroup conditions. In ingroup contexts, subjects displayed a form of “strong reciprocity” by giving more than they expected others to at high expectation levels but less at low expectation levels. Once these interactions are taken into account, we do not find a direct effect of ingroup bias anymore. We discuss these results in the light of theories of cultural group selection and conclude that too much emphasis may have been laid on direct intergroup conflict. Our results suggest that differential cooperativeness, rather than parochialism, may characterize the behavior of individuals in cultural ingroups and outgroups.     

“Only slaves climb trees”

Professional and popular publications have increasingly depicted native peoples of Amazonia as “natural” conservationists or as people with an innate “conservation ethic.” A few classic examples are cited repeatedly to advance this argument with the result that these cases tend to be generalized to all indigenous peoples. This paper explores the premise that many of these systems of resource conservation come from areas of Amazonia where human survival depends on careful management of the subsistence base and not from a culturally imbedded “conservation ethic.” Where resource constraints do not pertain, as in the case of the Yuquí of lowland Bolivia, such patterns are unknown. Finally, the negative consequences of portraying all native peoples as natural conservationists is having some negative consequences in terms of current struggles to obtain indigenous land rights.     

Pride and shame: Key components of a culturally universal status management system

We apply recent adaptationist theories about the emotions “pride” and “shame” to the domain of hierarchical status and test the hypothesis that pride and shame are distinct components of a culturally universal status-management system. Using an international dataset containing ratings of the status impacts of 240 personal characteristics within 14 nations (N = 2751), we found that (i) the status impacts of personal characteristics were strongly intercorrelated across nations (rs = 0.79–0.98); (ii) American's (N = 222) forecasts of the pride or shame they would experience if they exhibited those same personal characteristics closely tracked the status impacts across nations (|rs| = 0.74–0.98); and (iii) pride differentially tracked status gains, while shame differentially tracked status losses. These findings provide strong supporting evidence for the existence of a universal grammar of status criteria, and suggest that pride and shame are key components of a culturally universal status management system.     

Effects of Environmental Pesticides on the Health of Rural Communities in the Malwa Region of Punjab,India: A Review

The Malwa region of Punjab, India, is facing an unprecedented crisis of environmental health linked to indiscriminate, excessive, and unsafe use of pesticides, fertilizers, and poor groundwater quality. The region has been described as India's “cancer capital” due to abnormally high number of cancer cases, which have increased 3-fold in the last 10 years. Studies of this region have also highlighted a sharp increase in many other pesticide-related diseases, such as mental retardation and reproductive disorders. The most affected individuals are the agricultural workers who are directly exposed to pesticides. The Malwa region of Punjab, India, is less than 15% of the total area of Punjab (only 0.5% of the total geographical area of India), but it consumes nearly 75% of the total pesticides used in Punjab. The high use of pesticides, along with environmental and social factors, is responsible for the high concentration of pesticide residues in the food chain of this region. Moreover, many banned and restricted pesticides are still in use in this region, warranting strict periodical health checkups and other interventions. The present review describes occupational, environmental, and social factors associated with pesticide use in the Malwa region of Punjab, India, and proposes some risk reduction interventions.     

Haemonchus contortus: New data on its genetic constitution

Studies on the genetic constitution of single smooth-bodied females, appearing from time to time in the homozygous (aa) linguiform strain “C,” revealed that these worms have the constitution of the linguiform (aa) morph but the character “flap” in them has failed to develop because of the undetermined effect of some additional factors. Experiments were also performed to check the dominance to recessiveness ratios of the characters “flap,” “knob,” and “smooth.” With the Haemonchus types present in Bulgaria these ratios have persisted over seven or eight years. It is stated that they are the same in populations whose morphologic types in female specimens show different percentage distributions.     

DEVELOPMENTAL CORRELATES OF GENOME SIZE IN PLETHODONTID SALAMANDERS AND THEIR IMPLICATIONS FOR GENOME EVOLUTION

We present an analysis of the evolutionary relationship between genome size (C-value, mass of DNA per haploid nucleus) and developmental rate using observations of limb regeneration in salamanders of the family Plethodontidae. Rates of growth and differentiation of regenerating limbs are reported for 27 plethodontid species whose C-values range from 14 to 76 picograms. A phylogenetic analysis employing Felsenstein's method of independent contrasts indicates that rate of differentiation is inversely proportional to genome size, although we have not identified any statistically significant association between genome size and the growth rate of regenerating tissue. Our results are consistent with an interpretation that genome size may place a limit on the maximum rate of regeneration attainable in plethodontid salamanders. The implications of our findings for the “junk DNA,” “nucleotypic DNA,” “selfish DNA,” and “skeletal DNA” hypotheses of genome evolution are discussed.     

La crise de la psychiatrie contemporaine 2ème partie: la reconquête du singulier

The first part of this article (PSN vol. 1, No 3 : 19–24) sets out to reveal the theoretical weakness and the practical constraints which burden present-day psychiatry, which is dominated by an excessive medicalization process in the absence of conceptions of normality and disease. In this second part, the authors reply to scientific reductionism purposing the development of a philosophical anthropology. A global approach to the human reality, which takes into account the biological, psychological, social and cultural dimensions, would enable a better understanding of the individual’s experience as well as of his dependence or autonomy on the environment. The individual’s different ways to experience social rules and values form the basis of “existential types” which will play different part in social and historical processes. Owing to biological and environmental factors, individuals prone to psychiatric disorders are unbendingly dominated by a single type of relationship to values: over-identification in manic-depressive disorders (“hypernomia”); weakness in schizophrenia (“hétéronomia”); under-identification in some personality disorders (“hyponomia”); and conflict in obsessive disorders (“idionomia”).     

Moved to Dance: Remix,Rasa, and a New India

This article looks at Bollywood dance to explore the production of the commodified bodies of global consumer culture. It focuses on “embodiment” to examine how dominant sensibilities are altered through changes in dance training and technological innovations. I argue that analyzing the dancing body as a locus of experience and expression shifts the ground from culture as text or discourse (popular in postcolonial, poststructuralist or choreographic analysis) to embodiment of subjectivity. “Remix” is the term that describes both the new training techniques and the aesthetics of Indian dances. Since the older boundaries of high and low, classical and popular are fluid under globalization, “remix” is replacing traditional codes and aesthetic experiences associated with rasa. I draw on my fieldwork among the “background dancers” in Bollywood films to argue that as consumer culture creates the dominant mode of cultural expression in India, the only durable form of dance practice seems to be the practice of consumption.     

Is the “Ecological Fallacy” a Fallacy?

Ecological studies of health effects due to agent exposure are generally considered to be a blunt instrument of scientific investigation, unfit to determine the “true” exposure-effect relationship for an agent. Based on this widely accepted tenet, ecological studies of the correlation between the local air concentration of radon and the local lung cancer mortality as measured by Cohen have been criticized as being subject to the “Ecological Fallacy” and thus producing invalid risk data. Here we discuss the data that a risk assessment needs as a minimum requirement for making a valid risk estimate. The examination of these data and a “thought experiment” show that it is Cohen's raw ecological data, uncorrected for population characteristic factors, which are the proper data for a risk assessment. Consequently, the “true” exposure-effect relationship is less and less important the more population characteristic factors are identified and the larger they are. This reversal of the usual argument is due to our approach: Here, the prediction of the health effects in an exposed population is of primary importance, not the shape of the “true” exposure-effect relationship. The results derived in this paper hold for ecological studies of any agent causing any health or other effect.     

Dealing with Uncertainty in Risk Assessment

This paper is a commentary on Hattis’ three laws of risk assessment. The first law, that “application of standard statistical techniques to a single data set will nearly always reveal only a trivial proportion of the overall uncertainty in the parameter value” is illustrated both by examining the relevance of animal models to man and by a retrospective view of exposure conditions whose importance has only recently been recognized to be important. The second law, that “any estimate of the uncertainty of a parameter value will always itself be more uncertain than the estimate of the parameter value,” is examined in terms of a model addressing multiple levels of uncertainty, e.g., the “uncertainty in the uncertainty”. A argument is made that the number of terms needed for convergence of this uncertainty hierarchy depends on how far from the central tendency of the risk distribution one goes. The further out the “tail” of the distribution, the more terms in the uncertainty hierarchy are needed for convergence. The third law, that “nearly all parameter distribu tions look lognormal, as long as you don't look too closely,” is illustrated with a number of examples. Several reasons are put forward as to why risk variables appear so frequently to be lognormal. Recognition of the lognormal character of variable distributions can provide insight into the proper form for the associated uncertainty distributions.     

Who Will Manage American Patients With Diabetes? Residents’ Career Preferences and Perceptions of Diabetes Care

ObjectiveTo identify the factors that encourage or discourage internal medicine and pediatric residents regarding specializing in endocrinology with a focus on diabetes.MethodsWe conducted an electronic survey of internal medicine and pediatric residents using a $10 participation incentive. A total of 653 residents responded to the survey (estimated response rate of 9.2%)—626 from residency programs that were contacted for our survey and 27 from referrals.ResultsAmong internal medicine and pediatric residents surveyed, 39 respondents (6.0%) planned to specialize in endocrinology, and 27 of these (4.1% of total respondents) planned to focus on diabetes. “Intellectual satisfaction, ” “emotional satisfaction, ” and “work-life balance” were identified by respondents as the most important factors in their choice of a specialty, with ratings of 5.5, 5.4, and 5.3 on a 6-point Likert scale. Among these factors identified as most important to a medical career, endocrinology with a focus on diabetes scored poorly with regard to intellectual and emotional satisfaction but received high ranking with regard to lifestyle. With regard to other factors, endocrinology was rated negatively on “compensation, ” “number of procedures, ” and “patient adherence to prescribed treatment.” Exposure to diabetes during training had no major influence on the decision to enter endocrinology.ConclusionEndocrinology with a focus on diabetes care is not an attractive specialty for most internal medicine and pediatric residents. Therefore, new strategies to attract residents to the field of diabetes care are needed. (Endocr Pract. 2011;17:235-239)