A case study perspective on psychological outcomes after female genital mutilation.

Female genital mutilation (FGM) is still performed throughout Africa and in a few countries of Asia and the Middle East, affecting over 100 million females worldwide. It includes procedures that intentionally injure female external genital organs for non-medical reasons, and can have deleterious consequences for the physical, psychological and sexual lives of its victims. This paper presents three case studies illustrating the psychological and sexual consequences of FGM. Data were gathered about child and family history, employment, medical and psychiatric history, and the genital mutilation experienced. Self-report measures of self-esteem, mental health status and sexual life were also administered. The results obtained highlight the need for European professionals to develop greater knowledge about FGM and its serious consequences, especially as regards sexuality. This is particularly important given the large numbers of immigrant women now residing within EU countries.

2010: U.S. drug and alcohol policy, looking back and moving forward.

Since the early twentieth century, both moral perspectives and changing perceptions of the disease model of alcoholism and addiction have significantly influenced the formulation of U.S. domestic policy on drugs and alcohol. Some fluctuations have occurred in federal drug policy but overall a prohibitive, punitive approach has been emphasised. Racial and socioeconomic disparities have been exacerbated by the inequities of drug laws. Over the past 50 years, limited progress has been made in challenging and changing these unproductive policies. A great deal of progress has been made in research and treatment, and in the understanding of the process of recovery. For the upcoming generation to move policy in the direction shown to be effective by experienced addiction professionals will entail a wide spectrum of interdependent actions in substance abuse research, education, prevention and treatment, and continued cooperation between many stakeholders.

Abuso sexual infantil y síndorme de alienación parental: criterios diferenciales / Child sexual abuse an parental alienation syndrome. Differential criteria

El abuso sexual infantil y los denominados casos de interferencias parental son situaciones de especial gravedad para los menores que las padecen, así como de evidente dificultad para su adecuado diagnóstico y abordaje profesional. Discernir cuando el profesional se encuentra ante uno u otro caso entraña una complejidad para la que son necesarios una formación adecuada y unos criterios fiables. El presente trabajo tiene como objetivo aportar algunos de los criterios recogidos de las publicaciones al respecto, que pretenden facilitar la diferenciación entre ambas situaciones. El análisis del relato del menor, así como diferentes indicadores clínicos presentes en una parte importante de las víctimas de abuso sexual pueden ayudar al profesional a tomar una decisión al respecto. Los efectos de un error diagnóstico en cualquiera de estos casos conllevaría un gran perjuicio para el menor, su familia y el sistema social, siendo fundamental que el profesional evite participar activamente en una evaluación de este tipo si no se dispone de la adecuada formación y experiencia (AU)

Child sexual abuse and those cases of parental interferences are severe situations with negative consequences for children suffering them. Moreover, these situations are not easy to tackle regarding the diagnosis and professional approach. To distinguish when the professional is in front of one of the above mentioned situations is a complex task for which are needed a strong, solid training and trustworthy criteria. The main aim of the present work is to suggest some criteria, gathered from the publications in the field, which would be able to differentiate between actual child sexual abuse and parental interference. The analysis of the child’s report, as well as different clinical indicators that are present in many victims of sexual abuse can help the professional to take the right decision. The effects of a diagnostic mistake in any of these cases would imply harm for the child, his or her family and the social system. It is very important that the professional avoid taking part actively in an evaluation of this type if he or she does not have enough training and experience on this controversial field (AU)

The development of an educational web site for burn care: burnsurgery.org.

Advances in burn care are well documented in the literature but often do not reach health care professionals who treat burn patients. The World Wide Web provides instant access to a wide variety of information globally. We describe the development of www.burnsurgery.org, a nonprofit Web site dedicated to the education of burn care professionals. Internet-based medical education is becoming a dominant method of information transfer and we believe that it will help to standardize and improve burn care throughout the world.

Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve.

OBJECTIVES: To compare mitral annular shape and motion throughout the cardiac cycle in patients with normal hearts versus those with functional mitral regurgitation (FMR). BACKGROUND: The causes of mitral regurgitation without valvular disease are unclear, but the condition is associated with changes in annular shape and dynamics. Three-dimensional (3D) imaging provides a more comprehensive view of annular structure and allows accurate reconstructions at high spatial and temporal resolution. METHODS: Nine normal subjects and 8 patients with FMR undergoing surgery underwent rotationally scanned transesophageal echocardiography. At every video frame of 1 sinus beat, the mitral annulus was manually traced and reconstructed in 3D by Fourier series. Annular projected area, nonplanarity, eccentricity, perimeter length, and interpeak and intervalley spans were determined at 10 time points in systole and 10 points in diastole. RESULTS: The mitral annulus in patients with FMR had a larger area, perimeter, and interpeak span than in normal subjects (P <.001 for all). At mid-systole in normal annuli, area and perimeter reach a minimum, nonplanarity is greatest, and projected shape is least circular. These cyclic variations were not significant in patients with FMR. Annular area change closely paralleled perimeter change in all patients (mean r = 0.96 +/- 0.07). CONCLUSIONS: FMR is associated with annular dilation and reduced cyclic variation in annular shape and area. Normal mitral valve function may depend on normal annular 3D shape and dimensions as well as annular plasticity. These observations may have implications for design and selection of mitral annular prostheses.

An evaluation of grab bars to meet the needs of elderly people.

This paper reports the findings of a study that evaluated the ability of 66 ambulatory and 50 nonambulatory older people to toilet independently and safely. A repeated measures research design included eight test trials in which participants got on and off a toilet using four different grab bar configurations each at two different toilet seat heights. Each trial was video-taped in order to determine patterns of grab bar use for each toilet height/grab bar configuration. In addition, pretrial and posttrial interviews were conducted to determine participant preferences and perceived safety. Results of this study indicate that some grab bar configurations that were not code-compliant were preferred and were used more often than configurations that were designed to meet Americans with Disabilities Act Accessibility Guidelines. These findings raise questions as to whether legally mandated grab bar requirements are appropriate for older individuals.

Work satisfaction, unionism and militancy amongst nurses.

In recent years there has been a substantial increase in attitudinal and industrial militancy amongst nurses. This paper examines some of the factors associated with this change, in the context of the 50-day strike by Victorian nurses in late 1986. Using data collected from 125 nurses in a large public hospital in Melbourne, it is shown that dissatisfaction with the levels of autonomy, pay and intrinsic work rewards were of greatest concern to nurses at that time, and contributed to their growing unrest and attitudinal militancy. This suggests that measures such as professionalisation and salary restructuring may help to alleviate some of the grievances of nurses, but are unlikely to resolve other important issues that contribute to their discontent.

Task force report: sociophysical settings and mental health: opportunities for mental health services planning.

President Kennedy's "bold new approach" remains compelling 15 years after it was first announced. Mental health services at the community level have come a long way since the community mental health center program's establishment in 1963. Mental health manpower, advances in treatment technology, and volumes of service all have grown remarkably; but much still remains to be done to integrate community mental health services into the communities they serve in the planning of human services generally, and particularly in emphasis on preventive care. The National Council of Community Mental Health Centers Environmental Assessment Task Force has two closely related charges in these latter areas. First, to inquire into the "environmental" aspects of mental health at the community level; and, second, to explore environmental perspectives for the establishment of prevention initiatives in the delivery of services. This paper explores that charge by seeking a perspective on environment that traces the intersection of the built environment and social-interpersonal behavior with special attention to the implications for mental well-being. Implications of this perspective for community mental health center roles in community planning are considered, with reference to the establishment of preventive services.