Social science & medicine
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Social science & medicine · Sep 2009
Randomized Controlled TrialExplosive anger as a response to human rights violations in post-conflict Timor-Leste.
Over several decades, clinicians have documented a pattern of explosive anger amongst survivors of gross human rights violations. Yet there is a dearth of epidemiological research investigating explosive anger in post-conflict countries. In the present study undertaken in Timor-Leste between March and November 2004, we identified an indigenous descriptor for explosive anger, including this index in the East Timor Mental Health Epidemiological Needs Study, a small area total population survey of 1544 adults living in an urban and a rural area. ⋯ Latent class analysis identified three sub-groups with explosive anger: young trauma-affected adults living in the capital city who were unemployed; an older group, predominantly men, who had experienced extensive violence, including combat, assault and torture; and a less well characterized group of women. The findings offer support for a sequential model of explosive anger in which experiences of past persecution are compounded by frustrations in the post-conflict environment. The data provide a foundation for exploring further the role of trauma-induced anger in the cycles of violence that are prevalent in post-conflict countries.
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Social science & medicine · Sep 2009
The good, the bad, and the severely mentally ill: Official and informal labels as organizational resources in community mental health services.
Research on labeling mental illness has focused relatively little attention on practical organizational concerns in the process of labeling in community mental health services. This paper examines this issue through an ethnographic study of two multi-service community mental health services organizations for people labeled severely and persistently mentally ill in the Midwest United States. The findings show that the labeling process is structured by cultural and policy environments in which mental health services are able to provide resources otherwise difficult to obtain. ⋯ Informal organizational labels regarding client mental illness are not tethered to the bureaucratic apparatus granting access to and paying for services. Instead, they reflect workers' real assessments of clients, which can differ from official ones. These informal labels determine how organizations deal with clients when rules and routines are violated.
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Social science & medicine · Jul 2009
The desire for hastened death in individuals with advanced cancer: a longitudinal qualitative study.
Research is needed on the desire for hastened death (DHD) in the context of advanced cancer in order to address the clinical, ethical, and legal questions that it raises. The goal of the present qualitative study was to understand the experience of the DHD as expressed by individuals with advanced cancer, and to understand how it evolves over time. Participants were 27 ambulatory patients aged 45-82 years with advanced lung or gastrointestinal cancer. ⋯ The experience of the DHD in the context of advanced cancer was found to be subsumed under three distinct categories: i) DHD as a hypothetical exit plan; ii) DHD as an expression of despair; and iii) DHD as a manifestation of letting go. Each category had unique temporal and qualitative characteristics. The identification of these categories may be important to inform future research on the DHD, the criteria for clinical intervention in individuals who express this desire, and the public debate about physician-assisted suicide and euthanasia for individuals with advanced disease.
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Social science & medicine · Jun 2009
It's not just what you say, it's also how you say it: opening the 'black box' of informed consent appointments in randomised controlled trials.
Randomised controlled trials (RCTs) represent the gold standard methodology for determining effectiveness of healthcare interventions. Poor recruitment to RCTs can threaten external validity and waste resources. An inherent tension exists between safeguarding informed decision-making by participants and maximising numbers enrolled. ⋯ We conclude that the current focus on content to be provided to achieve informed consent should be broadened to encompass consideration of how information is best conveyed to potential participants. A model of tailored information provision using the communication techniques identified and centred on eliciting and addressing participants' concerns is proposed. Use of these techniques is necessary to make potential participants' understanding of key issues and their position regarding equipoise explicit in order to facilitate truly informed consent.
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Social science & medicine · May 2009
Historical ArticleDo conditions in early life affect old-age mortality directly and indirectly? Evidence from 19th-century rural Sweden.
Previous research has shown that the disease load experienced during the birth year, measured as the infant mortality rate, had a significant influence on old-age mortality in nineteenth-century rural Sweden. We know that children born in years with very high rates of infant mortality, due to outbreaks of smallpox or whooping cough, and who still survived to adulthood and married, faced a life length several years shorter than others. We do not know, however, whether this is a direct effect, caused by permanent physical damage leading to fatal outcomes later in life, or an indirect effect, via its influence on accumulation of wealth and obtained socio-economic status. ⋯ While the result is interesting per se, constituting a debatable issue, it means that the argument that early-life conditions indirectly affect old-age mortality is not supported. Instead, we find support for the conclusion that the effect of the disease load in early-life is direct or, in other words, that physiological damage from severe infections at the start of life leads to higher mortality at older ages. Taking random effects at family level into account did not alter this conclusion.