Reflechi twòp—Thinking Too Much: Description of a Cultural Syndrome in Haiti’s Central Plateau

A rich Haitian ethnopsychology has been described, detailing concepts of personhood, explanatory models of illness, and links between mind and body. However, little research has engaged explicitly with mental illness, and that which does focuses on the Kreyòl term fou (madness), a term that psychiatrists associate with schizophrenia and other psychoses. More work is needed to characterize potential forms of mild-to-moderate mental illness. Idioms of distress provide a promising avenue for exploring common mental disorders. Working in Haiti’s Central Plateau, we aimed to identify idioms of distress that represent cultural syndromes. We used ethnographic and epidemiologic methods to explore the idiom of distress reflechi twòp (thinking too much). This syndrome is characterized by troubled rumination at the intersection of sadness, severe mental disorder, suicide, and social and structural hardship. Persons with “thinking too much” have greater scores on the Beck Depression Inventory and Beck Anxiety Inventory. “Thinking too much” is associated with 8 times greater odds of suicidal ideation. Untreated “thinking too much” is sometimes perceived to lead to psychosis. Recognizing and understanding “thinking too much” may allow early clinical recognition and interventions to reduce long-term psychosocial suffering in Haiti’s Central Plateau.     

围术期体温监测及保温的现状分析

体温是人体重要的生命体征,其过低或过高都会对患者的预后造成不利影响,在临床中最常见也最容易被忽视的是围术期低体温。围术期长时间的体温过低会引起麻醉苏醒延迟、心律失常、影响切口愈合等多种并发症,增加死亡率,延迟出院时间。体温监测及相应的保温措施对于防治低体温至关重要,围术期及时有效地体温监测能反映病人术中病情的变化,但目前临床中对于体温的监控却普遍重视不足。本文对近年来临床常用的体温监测方法及保温手段做一综述。     

Perceived Impeding Factors for Return-to-Work after Long-Term Sickness Absence Due to Major Depressive Disorder: A Concept Mapping Approach

Objective

The purpose of the present study was to explore various stakeholder perspectives regarding factors that impede return-to-work (RTW) after long-term sickness absence related to major depressive disorder (MDD).

Methods

Concept mapping was used to explore employees'', supervisors'' and occupational physicians'' perspectives on these impeding factors.

Results

Nine perceived themes, grouped in three meta-clusters were found that might impede RTW: Person, (personality / coping problems, symptoms of depression and comorbid (health) problems, employee feels misunderstood, and resuming work too soon), Work (troublesome work situation, too little support at work, and too little guidance at work) and Healthcare (insufficient mental healthcare and insufficient care from occupational physician). All stakeholders regarded personality/coping problems and symptoms of depression as the most important impeding theme. In addition, supervisors emphasized the importance of mental healthcare underestimating the importance of the work environment, while occupational physicians stressed the importance of the lack of safety and support in the work environment.

Conclusions

In addition to the reduction of symptoms, more attention is needed on coping with depressive symptoms and personality problems in the work environment support in the work environment and for RTW in mental healthcare, to prevent long term sickness absence.     

What Are Fair Study Benefits in International Health Research? Consulting Community Members in Kenya

Background

Planning study benefits and payments for participants in international health research in low- income settings can be a difficult and controversial process, with particular challenges in balancing risks of undue inducement and exploitation and understanding how researchers should take account of background inequities. At an international health research programme in Kenya, this study aimed to map local residents'' informed and reasoned views on the effects of different levels of study benefits and payments to inform local policy and wider debates in international research.

Methods and Findings

Using a relatively novel two-stage process community consultation approach, five participatory workshops involving 90 local residents from diverse constituencies were followed by 15 small group discussions, with components of information-sharing, deliberation and reflection to situate normative reasoning within debates. Framework Analysis drew inductively and deductively on voice- recorded discussions and field notes supported by Nvivo 10 software, and the international research ethics literature. Community members'' views on study benefits and payments were diverse, with complex contextual influences and interplay between risks of giving ‘too many’ and ‘too few’ benefits, including the role of cash. While recognising important risks for free choice, research relationships and community values in giving ‘too many’, the greatest concerns were risks of unfairness in giving ‘too few’ benefits, given difficulties in assessing indirect costs of participation and the serious consequences for families of underestimation, related to perceptions of researchers'' responsibilities.

Conclusions

Providing benefits and payments to participants in international research in low-income settings is an essential means by which researchers meet individual-level and structural forms of ethical responsibilities, but understanding how this can be achieved requires a careful account of social realities and local judgment. Concerns about undue inducement in low-income communities may often be misplaced; we argue that greater attention should be placed on avoiding unfairness, particularly for the most-poor.     

How Much Overtesting Is Needed to Safely Exclude a Diagnosis? A Different Perspective on Triage Testing Using Bayes' Theorem

Ruling out disease often requires expensive or potentially harmful confirmation testing. For such testing, a less invasive triage test is often used. Intuitively, few negative confirmatory tests suggest success of this approach. However, if negative confirmation tests become too rare, too many disease cases could have been missed. It is therefore important to know how many negative tests are needed to safely exclude a diagnosis. We quantified this relationship using Bayes’ theorem, and applied this to the example of pulmonary embolism (PE), for which triage is done with a Clinical Decision Rule (CDR) and D-dimer testing, and CT-angiography (CTA) is the confirmation test. For a maximum proportion of missed PEs of 1% in triage-negative patients, we calculate a 67% ''mandatory minimum'' proportion of negative CTA scans. To achieve this, the proportion of patients with PE undergoing triage testing should be appropriately low, in this case no higher than 24%. Pre-test probability, triage test characteristics, the proportion of negative confirmation tests, and the number of missed diagnoses are mathematically entangled. The proportion of negative confirmation tests—not too high, but definitely not too low either—could be a quality benchmark for diagnostic processes.     

Review article: Polonia studies and the collapse of Communism

This paper asks to what extent Suriname's consociational democracy still rests on its historically shaped meta-ideology of ethnic essentialism. Based on ethnographic data of the country's national elections in 2010, I suggest that the ‘ethnic taboo’ of ethnic mobilization by politicians was present to a certain extent. However, this taboo was challenged by the nationalist turn of Desi Bouterse's National Democratic Party. Furthermore, when considering voting behaviour and that of ethnically mixed Doglas in particular, we see that Surinamese politics is more complex. I will argue that while we have been thinking about Surinamese politics as being on a par with ethnic groupings, these 2010 elections were not simply about ethnicity. Ethnicity may have informed but did not fully explain people's political choices, because people are too complex to be captured in an exclusively ethnic category, and because the Surinamese political system is too complex to maintain clear ethnic categories.     

Aborigines and Tin Mining in North Queensland: A Case Study in the Anthropology of Contact History

Much of the 'new history'of Aboriginal contact with Europeans in Australia lacks an adequate socio-cultural understanding of Aboriginal society and its diversity. Attempts to produce overall models of contact have obscured, too, the diversity of European activity and its impact. The outcome has been too hollow and passive a view of Aboriginal responses to Australian colonial situations. The aim of the present paper is to examine, from an anthropological perspective, a particular contact relationship: tin-mining and Kuku-Nyungkul Aborigines in southeast Cape York Peninsula, north Queensland, between 1885 and 1940. Iargue that it is only through such case studies that we can gain adequate insight into Aboriginal perspective' on colonial history.     

The World Health Organisation. The regions--too much power,too little effect.

WHO''s regional offices make it structurally one of the most decentralised of all United Nations agencies. But at what cost and to what effect? This article argues that too often the regions give only the illusion of decentralisation while wresting power from WHO''s governing body and prolonging the time taken for resources to reach the point of need.     

On the origins of birds: the sequence of character acquisition in the evolution of avian flight

Assessment of competing theories for the evolution of avian flight is problematic, and tends to rest too heavily on reconstruction of the mode of life of one or a few specimens representing still fewer species. A more powerful method is to compare the sequence of character acquisition predicted by the various theories with the empirical sequence provided by cladistic phylogeny. Arboreal and cursorial theories incorrectly predict the sequence of character acquisition for several key features of avian evolution. We propose an alternative ''pouncing proavis'' model for the evolution of flight. As well as being both biologically and evolutionarily plausible, the pouncing proavis model correctly predicts the evolutionary sequence of all five key features marking the evolution of birds.     

Nest site preference by Greylag Geese Anser anser in reedbeds of different harvest age

Maintenance of reedbeds and their associated avifauna requires intervention management to modify natural succession by means of, for example, reed cutting. Nest site density of Greylag Geese Anser anser in relation to time since reedbeds were last harvested was studied at Vejlerne nature reserve, Denmark (57°00–07'N, 8°50'–9°10'E). Low nest densities were found in areas in the first four years after cutting followed by high densities in areas unharvested for five or six years. Subsequently, nest density remained high for four to seven years (depending on site) before declining to low levels again. Areas cut in the year of study and areas cut more than 16 years before contained virtually no nests. The increase in nest density with time since last harvest seemed to be related to an increase in vegetation cover (reed stem density). Areas harvested more than 16 years before probably became too dense for the geese, and newly harvested areas had too low a shoot density, hence their low nest density. However, more detailed studies are needed to establish causal relationships.     

Prosocial primates: selfish and unselfish motivations

Non-human primates are marked by well-developed prosocial and cooperative tendencies as reflected in the way they support each other in fights, hunt together, share food and console victims of aggression. The proximate motivation behind such behaviour is not to be confused with the ultimate reasons for its evolution. Even if a behaviour is ultimately self-serving, the motivation behind it may be genuinely unselfish. A sharp distinction needs to be drawn, therefore, between (i) altruistic and cooperative behaviour with knowable benefits to the actor, which may lead actors aware of these benefits to seek them by acting cooperatively or altruistically and (ii) altruistic behaviour that offers the actor no knowable rewards. The latter is the case if return benefits occur too unpredictably, too distantly in time or are of an indirect nature, such as increased inclusive fitness. The second category of behaviour can be explained only by assuming an altruistic impulse, which—as in humans—may be born from empathy with the recipient''s need, pain or distress. Empathy, a proximate mechanism for prosocial behaviour that makes one individual share another''s emotional state, is biased the way one would predict from evolutionary theories of cooperation (i.e. by kinship, social closeness and reciprocation). There is increasing evidence in non-human primates (and other mammals) for this proximate mechanism as well as for the unselfish, spontaneous nature of the resulting prosocial tendencies. This paper further reviews observational and experimental evidence for the reciprocity mechanisms that underlie cooperation among non-relatives, for inequity aversion as a constraint on cooperation and on the way defection is dealt with.     

Fate of biomedical research protocols and publication bias in France: retrospective cohort study

Objectives To describe the fate of protocols approved by the French research ethics committees, a national system created by the French 1988 Huriet-Sérusclat Act; to assess publication bias at a national level.Design Retrospective cohort study.Setting Representative sample of 25/48 French research ethics committees in 1994.Protocols 649 research protocols approved by committees, with follow-up information.Main outcome measures Protocols'' initial characteristics (design, study size, investigator) abstracted from committees'' archives; follow-up information (rates of initiation, completion, and publication) obtained from mailed questionnaire to principal investigators.Results Completed questionnaires were available for 649/976 (69%) protocols. Of these, 581 (90%) studies were initiated, 501/581 (86%) were completed, and 190/501 (38%) were published. Studies with confirmatory results were more likely to be published as scientific papers than were studies with inconclusive results (adjusted odds ratio 4.59, 95% confidence interval 2.21 to 9.54). Moreover, studies with confirmatory results were published more quickly than studies with inconclusive results (hazard ratio 2.48, 1.36 to 4.55).Conclusion At a national level, too many research studies are not completed, and among those completed too many are not published. We suggest capitalising on research ethics committees to register and follow all authorised research on human participants on a systematic and prospective basis.     

Absenteeism among hospital staff during an influenza epidemic: implications for immunoprophylaxis.

The 1980-81 epidemic of influenza A/Bangkok 79 was responsible for increased absenteeism (1.7 times the rate for the corresponding period of the subsequent nonepidemic year) among selected hospital staff in Winnipeg''s Health Sciences Centre. Retrospective study of employment records for 25 of the centre''s largest departments showed excess sick-leave costs of about $24 500 during the 2-week period of peak absenteeism that included the epidemic. Although the centre was sampling prospectively for the virus the first positive results became available too late for chemoprophylactic measures to have been effective. The greater increase in absenteeism among nursing staff caring for patients with chronic respiratory disease and nurses working on general medical or pediatric acute infection/isolation wards suggested that these groups be targeted for influenza vaccination in hospitals.     

Respiratory Sinus Arrhythmia as an Index of Vagal Activity during Stress in Infants: Respiratory Influences and Their Control

Respiratory sinus arrhythmia (RSA) is related to cardiac vagal outflow and the respiratory pattern. Prior infant studies have not systematically examined respiration rate and tidal volume influences on infant RSA or the extent to which infants'' breathing is too fast to extract a valid RSA. We therefore monitored cardiac activity, respiration, and physical activity in 23 six-month old infants during a standardized laboratory stressor protocol. On average, 12.6% (range 0–58.2%) of analyzed breaths were too short for RSA extraction. Higher respiration rate was associated with lower RSA amplitude in most infants, and lower tidal volume was associated with lower RSA amplitude in some infants. RSA amplitude corrected for respiration rate and tidal volume influences showed theoretically expected strong reductions during stress, whereas performance of uncorrected RSA was less consistent. We conclude that stress-induced changes of peak-valley RSA and effects of variations in breathing patterns on RSA can be determined for a representative percentage of infant breaths. As expected, breathing substantially affects infant RSA and needs to be considered in studies of infant psychophysiology.     

基于系统演化视角的可持续性评价方法

可持续发展水平的衡量是可持续发展研究的重要内容,它可以为政府的可持续发展决策提供重要的科学依据。现有的可持续性评价方法可分为指标列举法、流量分析法和系统分析法。前两类方法应用广泛,但理论基础较为薄弱,在指标的选取、标准化和赋权等方面存在一定的缺陷。基于系统运行机理的系统分析法尚不多见,但能弥补前两种方法的部分不足,Ulanowicz于2009年提出的演化模型是此类方法的代表。该模型从系统演化角度出发,以网络流为研究对象,以信息论为手段,指出系统的可持续性是系统上升性(效率)和恢复力平衡的结果,并提出了可持续性评价指标R。回顾了现有研究方法的优缺点。介绍了从演化视角分析可持续性的原理和数学模型,可持续发展的阈值范围以及该方法的应用案例。总结了该方法的应用步骤及尚需解决的问题。     

Too much money wasted on frivolous applications for CPP disability benefits

Family physician Samuel Shortt discusses Canada Pension Plan disability-benefit applications from the doctor''s perspective. He thinks physicians are being forced to complete too many of the forms that have little if any chance of being approved.     

Relationship between Plasma Level and Therapeutic Effect of Nortriptyline

The relationship between plasma concentration of nortriptyline and therapeutic effect after two weeks'' treatment with the drug was investigated in 29 psychiatric inpatients. Endogenous depression was diagnosed in all patients. Amelioration of depressive symptoms was estimated as reduction in score on a rating scale, based on a psychiatric interview. Amelioration was not correlated to the patient''s sex or age. There was a curved relationship between plasma level of nortriptyline and therapeutic effect. Amelioration was most pronounced in the intermediate plasma level range (50-139 ng nortriptyline/ml plasma) and was slight both at lower and at higher plasma levels. This type of relationship may be due to the dual action of tricyclic antidepressants which has been found in animal experiments. On larger dosages a phenothiazine-like blockade of the monoaminergic receptor is added to the blockade of monoamine reuptake thought to be related to the antidepressant action of the drugs.This study thus suggests two possible reasons for a therapeutic failure with nortriptyline: a too low or a too high plasma level. The large individual variation in the pharmacokinetics of the tricyclic antidepressants makes prediction of plasma level from dosage in a given individual virtually impossible without knowledge of rate of elimination and apparent volume of distribution. Hence monitoring plasma levels may be a way to increase the efficacy of treatment with these drugs.     

Rupture of a Duodenal Ulcer During Cortical Extract Therapy for Serum Sickness

Newer techniques of exercise which rely on a static or isometric muscle contraction of six seconds'' duration once daily offer great possibilities in the treatment of patients incapacitated by low cardiac reserve, joints that are painful on movement or debility too severe to permit a conventional exercise program for general conditioning. Increments of strength of up to two per cent per day can be thus achieved in normal muscles. Muscles deconditioned by immobilization respond at a faster rate. However, no significant muscle hypertrophy can be achieved by this technique.This form of exercise can also be used by persons who are “too busy to exercise” but who may be willing to give two minutes a day to an exercise program designed to increase and maintain muscle tone and strength.A considerable number of medical conditions could be treated more effectively and with less resultant disability if therapeutic exercises—passive, active and progressive—were accurately prescribed and supervised by a physician as part of the treatment program. Among the many conditions to be considered are poliomyelitis, peripheral nerve injuries, the neuritides, postural defects and cardiac diseases.     

Endpiece: The noble profession

ObjectivesTo assess whether bacterial vaginosis or chlamydial infection before 10 weeks'' gestation is associated with miscarriage before 16 weeks.DesignProspective cohort study.Setting32 general practices and five family planning clinics in south London.Participants1216 pregnant women, mean age 31, presenting before 10 weeks'' gestation.Results121 of 1214 women (10.0%, 95% confidence interval 8.3% to 11.7%) miscarried before 16 weeks. 174 of 1201 women (14.5%, 12.5% to 16.5%) had bacterial vaginosis. Compared with women who were negative for bacterial vaginosis those who were positive had a relative risk of miscarriage before 16 weeks'' gestation of 1.2 (0.7 to 1.9). Bacterial vaginosis was, however, associated with miscarriage in the second trimester at 13-15 weeks (3.5, 1.2 to 10.3). Only 29 women (2.4%, 1.5% to 3.3%) had chlamydial infection, of whom one miscarried (0.32, 0.04 to 2.30).ConclusionBacterial vaginosis is not strongly predictive of early miscarriage but may be a predictor after 13 weeks'' gestation. The prevalence of Chlamydia was too low to assess the risk, but it is unlikely to be a major risk factor in pregnant women.

What is already known on this topic

Miscarriages are common and associated with considerable morbidity and costsBacterial vaginosis is associated with miscarriage after 16 weeks'' gestation and preterm birth but the role of chlamydial infection is uncertain

What this study adds

Bacterial vaginosis is not a strong predictor of miscarriage before 16 weeks'' gestation but may be associated with miscarriage at 13-15 weeks'' gestationThe prevalence of chlamydial infection was too low for it to be a major risk factor for miscarriage in this population of healthy pregnant womenNon-invasive screening for bacterial vaginosis and chlamydial infection by using self administered vaginal swabs is feasible in pregnant women in the community