The ethics of relationality in implementation and evaluation research in global health: reflections from the Dream-A-World program in Kingston, Jamaica.

BACKGROUND: Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice. DISCUSSION: In this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees' rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons. Global health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives.

Global mental health and its discontents: an inquiry into the making of global and local scale.

Global Mental Health's (GMH) proposition to "scale up" evidence-based mental health care worldwide has sparked a heated debate among transcultural psychiatrists, anthropologists, and GMH proponents; a debate characterized by the polarization of "global" and "local" approaches to the treatment of mental health problems. This article highlights the institutional infrastructures and underlying conceptual assumptions that are invested in the production of the "global" and the "local" as distinct, and seemingly incommensurable, scales. It traces how the conception of mental health as a "global" problem became possible through the emergence of Global Health, the population health metric DALY, and the rise of evidence-based medicine. GMH also advanced a moral argument to act globally emphasizing the notion of humanity grounded in a shared biology and the universality of human rights. However, despite the frequent criticism of GMH promoting the "bio"-medical model, we argue that novel logics have emerged which may be more important for establishing global applicability than arguments made in the name of "nature": the procedural standardization of evidence and the simplification of psychiatric expertise. Critical scholars, on the other hand, argue against GMH in the name of the "local"; a trope that underlines specificity, alterity, and resistance against global claims. These critics draw on the notions of "culture," "colonialism," the "social," and "community" to argue that mental health knowledge is locally contingent. Yet, paying attention to the divergent ways in which both sides conceptualize the "social" and "community" may point to productive spaces for an analysis of GMH beyond the "global/local" divide.

Age-related differences in associative memory depend on the types of associations that are formed.

Building on well-established findings of age-related decline in associative memory, we examined whether the magnitude of age differences depends on the types of associations that are formed. Specifically, because of predominant age-related changes in the hippocampus, we expected to find larger age differences in recognition of between-domain than within-domain associations. Twenty younger and 20 older healthy adults were given two associative recognition tests, using face-name and word-word pairs, that were matched for difficulty level. As hypothesized, a three-way interaction indicated that, relative to item recognition, age differences in associative recognition were greater for between-domain face-name associations than for within-domain word-word associations. This dissociation is consistent with the idea that the hippocampus plays a prominent role in binding information received from distal neocortical regions. The discussion focuses on the roles of recollection and familiarity in supporting associative memory as well as implications for the remediation of age-related memory decline.

Interaction between noradrenaline and corticotrophin-releasing factor in the reinstatement of cocaine seeking in the rat.

RATIONALE: Corticotropin-releasing factor (CRF) and noradrenaline (NA) have been shown in independent studies to mediate stress-induced reinstatement of drug seeking. To date, however, a functional interaction between the systems in reinstatement has not been demonstrated. OBJECTIVES: The objectives of this study were to determine whether CRF and NA systems can interact to influence reinstatement responding and, if so, in what direction the interaction occurs. MATERIALS AND METHODS: Rats were trained to self-administer cocaine (0.23 mg/kg per infusion) for 8-10 days. Subsequently, responding for drug was extinguished, and tests for reinstatement were conducted following: (1) pretreatment with the CRF receptor antagonist, D: -Phe CRF(12-41) [1 microg, intracerebroventricular (i.c.v.)], prior to i.c.v. injections of NA (10 microg; Experiment 1); (2) pretreatment with the alpha(2) adrenoceptor agonist, clonidine (40 microg/kg, i.p.), prior to i.c.v. injections of CRF (0.5 microg; Experiment 2); (3) pretreatment with D: -Phe (1, 5 microg, i.c.v.), prior to systemic injections of the alpha(2) adrenoceptor antagonist, yohimbine (1.25 mg/kg; Experiment 3A); or (4) pretreatment with clonidine (40 microg/kg, i.p.) prior to systemic injections of yohimbine (0.625 mg/kg, 1.25 mg/kg; Experiment 3B). RESULTS: NA reliably induced reinstatement, an effect that was blocked by pretreatment with D: -Phe. In contrast, CRF-induced reinstatement was not attenuated by pretreatment with clonidine. Pretreatment with neither D: -Phe nor clonidine was effective in blocking yohimbine-induced reinstatement. CONCLUSION: Together, the present findings suggest a functional interaction between NA and CRF systems in mediating stress-induced reinstatement of cocaine seeking, whereby activation of CRF receptors occurs subsequent to, and downstream of, the sites of action of NA.