ABSTRACT
Sudden cardiac death, mostly related to ventricular arrhythmia, is a major public health issue, with still very poor survival at hospital discharge. Although coronary artery disease remains the leading cause, other etiologies should be systematically investigated. Exhaustive and standardized exploration is required to eventually offer specific therapeutics and management to the patient as well as his/her family members in case of inherited cardiac disease. Identification and establishing direct causality of the detected cardiac anomaly may remain challenging, underlying the need for a multidisciplinary and experimented team.
Subject(s)
Death, Sudden, Cardiac/etiology , Adult , Age Factors , Algorithms , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Autopsy , Cardiomyopathies/complications , Coronary Artery Disease/complications , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/prevention & control , Female , France/epidemiology , Genetic Diseases, Inborn/complications , Genetic Diseases, Inborn/diagnosis , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Humans , Male , Middle Aged , Myocardial Infarction/complications , Registries , Risk Factors , Sex FactorsABSTRACT
No presente trabalho, analisa-se a contribuição do neurologista e neuropsiquiatra Antonio Austregésilo (1876--1960) para o estudo psicopatológico e sistematização das chamadas psicoses infecciosas, no Brasil. Baseando-se em Emil Kraepelin e lançando mão de observações clínicas em doenças infecciosas globais e tropicais, Austregésilo revela detalhado conhecimento clínico e intervém no debate sobre etiologia, especificidades de fatores causais e curso da doença, na fronteira entre as doenças físicas infecciosas e os transtornos mentais.
The present article analyzes the contribution of neurologist and neuropsychiatrist Antonio Austregésilo (1876-1960) for the psychopathological study and systematization of so-called infectious psychoses in Brazil. Based on Emil Kraepelin and using clinical observations on global and tropical infectious diseases, Austregésilo built detailed clinical knowledge and took part in the debate on etiology, specificities of causal factors and the course of the disease, which is located on the edge between infectious physical diseases and mental disorders.
Cet article analyse la contribution du neurologue et neuropsychiatre Antonio Austregésilo (1876-1960) à l'étude psychopathologique et à la systématisation des psychoses dites infectieuses au Brésil. Basé sur Emil Kraepelin et en utilisant des observations cliniques sur les maladies infectieuses mondiales et tropicales, Austregésilo construit un savoir clinique détaillé et participe au débat sur l'étiologie, les spécificités des facteurs causals et le cours de la maladie, à la frontière entre les maladies physiques infectieuses et les troubles mentaux.
En el presente trabajo, analizamos la contribución del neurólogo y neuropsiquiatra Antonio Austregésilo (1876-1960) al estudio psicopatológico y a la sistematización de las llamadas psicosis infecciosas en Brasil. Basándose en Emil Kraepelin y utilizando observaciones clínicas sobre enfermedades infecciosas globales y tropicales, Austregésilo revela conocimientos clínicos detallados e interviene en el debate sobre la etiología, las especificidades de los factores causales y el curso de la enfermedad, en la frontera entre las enfermedades físicas infecciosas y los trastornos mentales.
ABSTRACT
Epidemiology, which was initially confined to the distribution of diseases in populations (descriptive epidemiology) and the factors responsible for such distribution (analytical epidemiology), also involves the evaluation of diagnostic and therapeutic strategies, as well as prognostic factors. Epidemiology provides elements that form the basis for medical and public health decisions. Information is collected from systematic records, which include large databases, or through specific surveys. Descriptive studies utilise mortality rates, as well as incidence and prevalence figures. The aim of aetiological epidemiology is to demonstrate a causal relationship between exposure and disease. It is necessary to check that studies do not present any major bias and to seek evidence in favour of causality. The strength of a causal relationship is calculated using relative risk or odds ratio. Other measurements of risk include attributable risk and aetiological fraction. Screening and diagnostic strategies are evaluated using the concepts of sensitivity, specificity, and above all, levels of likelihood that help determine the probability of a given patient becoming ill as a result of his or her personal characteristics and of test results. Evaluation of prognostic factors enables scores to be constructed allowing the probability of a given clinical outcome to be calculated as a function of patient characteristics.
Subject(s)
Dermatology , Epidemiologic Methods , Bias , Big Data , Causality , Health Status Indicators , Humans , Mass Screening , Odds Ratio , Prognosis , Risk AssessmentABSTRACT
Neste artigo apresento alguns elementos e condições para a definição de uma teoria da transformação em psicanálise. Conjugando traços conceituais derivados das noções de causalidade, determinação e indeterminação, argumento que a lógica do encontro na experiência psicanalítica, entendida como cura, terapia e tratamento, exige uma epistemologia da prática. Uma teoria da transformação assim concebida possui uma condição ética e uma potência política que ainda está por ser discernida.
In this article we present some elements and conditions for a psychoanalitical theory of transformation. Combining conceptual aspects derived from the notion of causality, determination and indetermination, we claim that the logic encountered in the psychoanalytic experience, understood as cure, therapy and treatment, ne-eds a kind of epistemology of practice. A theory of transformation, conceived in these terms, demands an ethical condition and has a political scope that still needs to be.
En ese artículo presento elementos y condiciones para una teoría de la transformación en psicoanálisis. Ajudicando razgos conceptuales derivados de nociones como causalidad, determinación y indeterminación, plantea-se la lógica de lo encuentro en la experiencia psicoanalítica, considerada como cura, terapia y tratamiento. Una teoría de la transformación así considerada tiene la condición ética y una potencia política que aún resta establecer.
Dans cet article, je présente quelques éléments et conditions pour la définition d'une théorie de la transformation en psychanalyse.Combinant des traits conceptuels dérivés des notions de causalité, de détermination et d'indétermination, je soutiens que la logique de la rencontre dans l'expérience psychanalytique, entendue comme guérison, thérapie et traitement, nécessite une épistémologie de la pratique.Une théorie de la transformation ainsi conçue a une condition éthique et un pouvoir politique qui reste à discerner.
ABSTRACT
Research on endocrine disruptors (EDs) developed from numerous disciplines. In this concert of disciplines, epidemiology is central to inform on the relevance for humans of mechanisms and dose-response functions identified in animals, to characterize the health impact (number of attributable disease cases), the cost associated with ED exposure, and the efficiency of the measures taken to limit exposure. Here, we present epidemiological tools to draw valid inference regarding effects of potential EDs. Epidemiology is generally observational, requiring care to control confounding bias. Many potential EDs have a short biological half-life; approaches relying on repeated biospecimens sampling allow limiting exposure misclassification and the resulting bias. For non-persistent compounds, couple-child cohorts are a central study design. Cohorts can now rely on molecular biology approaches to characterize exposures and intermediate pathways, which corresponds to the advent of molecular epidemiology and allows stronger interactions between epidemiology, toxicology, and molecular epidemiology to characterize the health effects of EDs.
Subject(s)
Endocrine Disruptors/toxicity , Animals , HumansABSTRACT
In recent years, there has been a major shift in our understanding of the course of Parkinson's disease (PD) from a disease of the brain to a disease of long latency, characterized by the progressive emergence of multiple non-motor symptoms, including hyposmia, constipation, depression, anxiety, rapid eye movement (REM) sleep behavior disorder and excessive daytime sleepiness, as well as subtle motor signs, before the typical motor signs appear. Epidemiological studies have made major contributions by allowing better characterization of subsequent PD risk in relation to non-motor symptoms. Such findings have profound implications for the conduct of epidemiological studies examining risk and protective factors in PD, and the interpretation of their findings. Given the length of the prodromal period, reverse causation in particular is a major concern with many reported associations. One striking feature of PD etiology, compared with other diseases, is the presence of numerous inverse associations. If these associations are truly causal, they would have major implications for disease prevention and for slowing disease progression. However, whether these associations are truly causal remains to be demonstrated in future studies. Experimental studies play an important role by offering a better understanding of the underlying mechanisms. Well-designed epidemiological studies using innovative approaches will also be key in elucidating whether these intriguing associations are causal or a consequence of reverse causation.
Subject(s)
Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Parkinson Disease/etiology , Prodromal Symptoms , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/etiology , Constipation/diagnosis , Constipation/epidemiology , Constipation/etiology , Depression/diagnosis , Depression/epidemiology , Depression/etiology , Epidemiologic Research Design , Epidemiologic Studies , Humans , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/etiologyABSTRACT
En este trabajo se presentan algunas conclusiones del proyecto de investigación UBACyT 2012-2014: "La libertad en psicoanálisis. Su incidencia en la concepción de sujeto y la causalidad en la obra de J. Lacan. Consecuencias clínicas y éticas", y del proyecto UBACyT (2014-2017): "Articulación de las conceptualizaciones de J. Lacan sobre la libertad con los conceptos fundamentales que estructuran la dirección de la cura: interpretación, transferencia, posición del analista, asociación libre y acto analítico", ambos dirigidos por el autor. La libertad no constituye un concepto propio del psicoanálisis, no obstante, encuentra en él ciertas articulaciones con algunos conceptos que delinean una noción peculiar de la libertad, que se distingue de las concepciones filosóficas y psicológicas. En este trabajo se discute la relación libertad-causalidad en psicoanálisis...
This article presents some conclusions of the research projects UBACyT 2012-2014: Freedom in psychoanalysis. Its impact on the concepts of subject and causality in Lacan's work. Clinical and ethical implications", and UBACyT (2014-2017): "Articulation of Lacan's conceptualizations on freedom with the fundamental concepts that structure the direction of the treatment: interpretation, transference, analyst's position, free association, and analytic act" --both directed by the author. Freedom is not a psychoanalytic concept; nevertheless, it is found in certain psychoanalytic conceptualizations in relation with some concepts that delineate a peculiar notion of freedom, as distinguished from the philosophical and psychological ones. In this work we discuss the relation freedom- causality in psychoanalysis...
Ce texte présente certaines conclusions de deux projets de recherche menés par l'auteur du présent article : UBACyT 2012-2014 : ® La liberté en psychanalyse. Son incidence dans la conception de sujet et la causalité chez J. Lacan. Conséquences cliniques et éthiques ¼ ; et UBACyT (2014-2017) : ® Articulation entre les conceptualisations de J. Lacan à propos de la liberté et les concepts fondamentaux structurant la direction de la cure : interprétation, transfert, position de l'analyste, libre association et acte analytique ¼. La liberté n'est pas un concept propre à la psychanalyse. Celle-ci établit cependant une notion particulière de liberté qui se différence des conceptions philosophiques et psychologiques. Cet article examine donc la relation liberté-causalité en psychanalyse...
Subject(s)
Humans , Causality , Freedom , PsychoanalysisABSTRACT
OBJECTIVES: The first objective of this article is to summarize the history of electroconvulsive therapy (ECT) in psychiatry in order to highlight the transition from clinical level of evidence based on phenomenological descriptions to controlled trial establishing causal relationship. The second objective is to apply the criteria of causation for ECT, to focus on the dose-effect relationship criteria, and thus to analyze the conditions of application of these criteria for ECT. METHODS: A literature review exploring the use of electricity, ECT and electroencephalography (EEG) in psychiatry was conducted. The publications were identified from the Pubmed and GoogleScholar electronic databases. The scientific literature search of international articles was performed in July 2016. RESULTS: In 1784, a Royal commission established in France by King Louis XVI tested Mesmer's claims concerning animal magnetism. By doing that, the commission, including such prominent scientists as the chemist Anton Lavoisier and the scientist and researcher on electricity and therapeutics Benjamin Franklin, played a central role in establishing the criteria needed to assess the level of evidence of electrical therapeutics in psychiatry. Surprisingly, it is possible to identify the classical Bradford Hill criteria of causation in the report of the commission, except the dose-effect relationship criteria. Since then, it has been conducted blinded randomized controlled trials that confirmed the effectiveness of ECT against ECT placebos for the treatment of psychiatric disorders. At present, the dose-effect relationship criteria can be analyzed through an EEG quality assessment of ECT-induced seizures. CONCLUSIONS: EEG quality assessment includes several indices: TSLOW (time to onset of seizure activity ≤5Hz, seconds), peak mid-ictal amplitude (mm), regularity (intensity or morphology of the seizure (0-6)), stereotypy (global seizure patterning, 0-3) and post-ictal suppression (0-3). A manual rating sheet is needed to score theses indices. Such manual rating with example of EEG segments recording is proposed in this article. Additional studies are needed to validate this manual, to better establish the dose-response relationship for the ECT, and thus strengthen the position of the EEG as a central element for clinical good practice for ECT.
Subject(s)
Electroconvulsive Therapy , Evidence-Based Medicine , Seizures/therapy , Animals , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/history , Electroconvulsive Therapy/methods , Electroencephalography , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Seizures/diagnosis , Seizures/historyABSTRACT
Este texto tematiza el impasse constitutivo de la psicopatología, privilegiando en la discusión los dos abordajes clínicos que han sido prevalentes en nuestro medio, es decir, el psicoanálisis y la psiquiatría biológica. Se propone que el uso de esta aporía constitutiva, dependiendo de cómo se operacionaliza, es crucial no solo en la riqueza clínica del campo, sino que se trata de la única posibilidad viable para una acción terapéutica que sea realmente eficaz.
This text thematizes the constitutive impasse of psychopathology by focusing on the two clinical approaches which have been prevalent in our milieu, i.e. psychoanalysis and biological psychiatry. It proposes that the use of this constitutive aporia, depending on how it is operationalized, is crucial not only in the clinical richness of the field, but it is the only viable possibility for a truly effective therapeutic action.
Cet article aborde l'impasse constitutive de la psychopathologie en privilégiant les deux approches cliniques dominantes dans notre milieu, c'est-à-dire, la psychanalyse et la psychiatrie biologique. Cette aporie constitutive, selon la manière dont elle est mise en uvre, est fondamentale non seulement en ce qui concerne la richesse clinique du domaine, mais aussi car il sagit de la seule possibilité viable pour une action thérapeutique réellement efficace.
Subject(s)
Causality , Diagnostic and Statistical Manual of Mental Disorders , Psychoanalysis , PsychopathologyABSTRACT
Cases of multiple sclerosis appearing after a mass hepatitis B vaccination program can lead to claims for compensation. The legal jurisdiction under which such claims will be examined depends on whether the vaccination was carried out as part of a mandatory program (implying liability of the State or employers) or in application of recommendations (implying responsibility of the vaccine manufacturer). In the literature, there is no evidence demonstrating a statistically significant relationship between anti-hepatitis B vaccination and the onset or exacerbation of multiple sclerosis, questioning even the notion of compensation. The analysis of the jurisprudence shows that, in a first period, the scientific uncertainty of a link between vaccination and onset of multiple sclerosis precluded any compensation to victims. Subsequently, judicial and administrative courts ignored this scientific uncertainty, which enabled them to examine claims for compensation by adopting a presumptive reasoning based on specific criteria and different regulations depending on the legal jurisdiction. According to the French high courts (Cour de cassation and Conseil d'État) scientific causality and legal causality do not necessarily have to be consistent, such that medical uncertainty should not be an obstacle to compensation for victims.
Subject(s)
Compensation and Redress , Hepatitis B Vaccines/adverse effects , Multiple Sclerosis/chemically induced , Humans , Uncertainty , Vaccination/legislation & jurisprudenceABSTRACT
OBJETIVOS: Realizamos uma análise do conceito de causalidade aplicado em psiquiatria e propomos sua abordagem baseada nas ideias de influências causais fracas e de redes causais complexas. MÉTODO: Análise conceitual de artigos e livros selecionados. RESULTADOS: Identificamos o modelo de causalidade INUS, proposto pelo filósofo J. L. Mackie que contorna algumas das dificuldades relacionadas à presença de múltiplas causas interdependentes, como parece ocorrer no caso dos transtornos mentais e mostramos que tal modelo se aplica bem ao TEPT. CONCLUSÃO: Sugerimos que o fracasso na busca de causas "fortes" para os transtornos mentais talvez indique a necessidade de revisão de nossas expectativas, com a adoção de modelos alternativos de causalidade.(AU)
OBJECTIVES: We briefly analyze the concept of causality as applied to psychiatry and put forward an approach based on the notions of weak causal influences and complex causal networks. METHOD: a conceptual analysis of selected articles and books. RESULTS: We present the INUS causation model proposed by the philosopher J.L.Mackie that gets around some of the difficulties related to the presence of multiple interdependent causes, as appears to be the case in mental disorders. This model seemingly works well in PTSD, as shown. CONCLUSION: We suggest that the failure to find "strong" causes for mental disorders may indicate the need to revise our expectations by adopting alternative models of causality.(AU)
OBJECTIFS: Nous avons effectué une analyse de la notion de causalité appliquée en psychiatrie et proposons une approche basée sur les notions des influences causales faibles et des réseaux causaux complexes. MÉTHODE: Analyse conceptuelle d'articles et de livres sélectionnés. RÉSULTATS: Nous avons identifié le modèle de causalité INUS, proposé par le philosophe J. L. Mackie, qui contourne certaines des difficultés liées à la présence de multiples causes interdépendantes, comme cela semble se produire dans le cas des troubles mentaux, et nous montrons que ce modèle s'applique bien au TSPT. CONCLUSION: Nous suggérons que l'impossibilité de trouver des causes "fortes" de troubles mentaux peut indiquer le besoin d'une révision de nos attentes et l'adoption de modèles alternatifs de causalité.(AU)
OBJETIVOS: se realizó un análisis del concepto de causalidad aplicado en psiquiatría y propusimos su enfoque basado en las ideas de las influencias causales sencillas y redes sociales complejas. MÉTODO: Análisis conceptuales de artículos y libros seleccionados. RESULTADOS: Se identificó el modelo de causalidad INUS propuesto por el filósofo JL Mackie que evita algunos de los problemas relacionados con la presencia de múltiples causas interdependientes, como parece ocurrir en el caso de los trastornos mentales y mostramos que este modelo se aplica también al TEPT. CONCLUSIÓN: Se sugiere que el fracaso en encontrar las causas "complejas" para los trastornos mentales puede indicar la necesidad de revisar nuestras expectativas y la adopción de modelos alternativos de causalidad.(AU)
Subject(s)
Humans , Causality , Mental DisordersABSTRACT
OBJETIVOS: Realizamos uma análise do conceito de causalidade aplicado em psiquiatria e propomos sua abordagem baseada nas ideias de influências causais fracas e de redes causais complexas. MÉTODO: Análise conceitual de artigos e livros selecionados. RESULTADOS: Identificamos o modelo de causalidade INUS, proposto pelo filósofo J. L. Mackie que contorna algumas das dificuldades relacionadas à presença de múltiplas causas interdependentes, como parece ocorrer no caso dos transtornos mentais e mostramos que tal modelo se aplica bem ao TEPT. CONCLUSÃO: Sugerimos que o fracasso na busca de causas "fortes" para os transtornos mentais talvez indique a necessidade de revisão de nossas expectativas, com a adoção de modelos alternativos de causalidade.
OBJECTIVES: We briefly analyze the concept of causality as applied to psychiatry and put forward an approach based on the notions of weak causal influences and complex causal networks. METHOD: a conceptual analysis of selected articles and books. RESULTS: We present the INUS causation model proposed by the philosopher J.L.Mackie that gets around some of the difficulties related to the presence of multiple interdependent causes, as appears to be the case in mental disorders. This model seemingly works well in PTSD, as shown. CONCLUSION: We suggest that the failure to find "strong" causes for mental disorders may indicate the need to revise our expectations by adopting alternative models of causality.
OBJECTIFS: Nous avons effectué une analyse de la notion de causalité appliquée en psychiatrie et proposons une approche basée sur les notions des influences causales faibles et des réseaux causaux complexes. MÉTHODE: Analyse conceptuelle d'articles et de livres sélectionnés. RÉSULTATS: Nous avons identifié le modèle de causalité INUS, proposé par le philosophe J. L. Mackie, qui contourne certaines des difficultés liées à la présence de multiples causes interdépendantes, comme cela semble se produire dans le cas des troubles mentaux, et nous montrons que ce modèle s'applique bien au TSPT. CONCLUSION: Nous suggérons que l'impossibilité de trouver des causes "fortes" de troubles mentaux peut indiquer le besoin d'une révision de nos attentes et l'adoption de modèles alternatifs de causalité.
OBJETIVOS: se realizó un análisis del concepto de causalidad aplicado en psiquiatría y propusimos su enfoque basado en las ideas de las influencias causales sencillas y redes sociales complejas. MÉTODO: Análisis conceptuales de artículos y libros seleccionados. RESULTADOS: Se identificó el modelo de causalidad INUS propuesto por el filósofo JL Mackie que evita algunos de los problemas relacionados con la presencia de múltiples causas interdependientes, como parece ocurrir en el caso de los trastornos mentales y mostramos que este modelo se aplica también al TEPT. CONCLUSIÓN: Se sugiere que el fracaso en encontrar las causas "complejas" para los trastornos mentales puede indicar la necesidad de revisar nuestras expectativas y la adopción de modelos alternativos de causalidad.
Subject(s)
Humans , Causality , Mental DisordersABSTRACT
Epidemiological research is mostly based on observational studies. Whether such studies can provide evidence of causation remains discussed. Several causal analysis methods have been developed in epidemiology. This paper aims at presenting an overview of these methods: graphical models, path analysis and its extensions, and models based on the counterfactual approach, with a special emphasis on marginal structural models. Graphical approaches have been developed to allow synthetic representations of supposed causal relationships in a given problem. They serve as qualitative support in the study of causal relationships. The sufficient-component cause model has been developed to deal with the issue of multicausality raised by the emergence of chronic multifactorial diseases. Directed acyclic graphs are mostly used as a visual tool to identify possible confounding sources in a study. Structural equations models, the main extension of path analysis, combine a system of equations and a path diagram, representing a set of possible causal relationships. They allow quantifying direct and indirect effects in a general model in which several relationships can be tested simultaneously. Dynamic path analysis further takes into account the role of time. The counterfactual approach defines causality by comparing the observed event and the counterfactual event (the event that would have been observed if, contrary to the fact, the subject had received a different exposure than the one he actually received). This theoretical approach has shown limits of traditional methods to address some causality questions. In particular, in longitudinal studies, when there is time-varying confounding, classical methods (regressions) may be biased. Marginal structural models have been developed to address this issue. In conclusion, "causal models", though they were developed partly independently, are based on equivalent logical foundations. A crucial step in the application of these models is the formulation of causal hypotheses, which will be a basis for all methodological choices. Beyond this step, statistical analysis tools recently developed offer new possibilities to delineate complex relationships, in particular in life course epidemiology.
Subject(s)
Causality , Epidemiologic Studies , Models, Theoretical , Algorithms , Humans , Research DesignABSTRACT
We survey the burgeoning literature on inequality of opportunity in health. We focus on ways to tackle health inequalities. We are of the opinion that the main contribution so far of this literature is in inviting us to choose a new indicator of the relative success of the public policy, which aims at reducing health inequalities. This indicator is the part of explained health inequalities due to lifestyles. We can defend the use of this indicator on the basis of a value judgment but we will restrain us to do so here. Our argument is mainly positive. It resorts on the fact that, so far, we do not know how to tackle health inequalities coming from differences in lifestyles. These inequalities seem more irreducible than inherited health inequalities, as the Great Britain example shows us. When these inequalities are quite high in proportion of total explained inequalities, it means that we are not so far from a public health policy, which is going to reach his main objective in reducing health inequalities.
Subject(s)
Health Policy/legislation & jurisprudence , Health Status Disparities , Social Justice/legislation & jurisprudence , Age Distribution , Empirical Research , Health Policy/trends , Healthcare Disparities/legislation & jurisprudence , Healthcare Disparities/statistics & numerical data , Humans , Models, Theoretical , Socioeconomic Factors , United Kingdom/epidemiologyABSTRACT
This article uses debates regarding yellow fever causality among leading healers in 19th-century Galveston, Texas, U.S., as a means of exploring the extent to which ideas are social actors. That is, the analysis demonstrates that ideas about yellow fever causality shaped contemporaneous public health policy responses to yellow fever outbreaks in 19th-century Galveston. The article contributes to the growing literature documenting that contagionist and anticontagionist views were often assimilated, and also supports the historiography showing that the predisposing/exciting causes dichotomy is a more robust intellectual framework for understanding 19th-century attributions of disease causality.
