Prevalence and clinical characteristics of urinary incontinence in elderly individuals of a low income

To estimate the prevalence of urinary incontinence (UI) in elderly individuals of low income assisted by the primary health care system in Sao Paulo, Brazil. In this community-based, observational, cross-sectional study, participants assisted by the health family program in Sao Paulo, Brazil, were sampled and interviewed face to face by questionnaire. Participants (n = 388) were selected from the collaborative program developed by the 10/66 Dementia Research Group, an International Network of investigators. Demographics, health history and a detailed assessment of UI and urinary symptoms were obtained. Prevalence of UI was calculated. Other variables included age, body mass index (BMI), duration of incontinence and characteristics of the symptoms. The association between UI and the variables was estimated using the Kruskal-Wallis test, Chi-squared test and Fisher test (depending on normality of the distribution and expected frequencies). Prevalence of UI was 38.4%. UI was more common in women than in men (50% vs. 18.3%, p < 0.001). Diabetes, obesity and hypertension were associated with UI. Almost 36.2% of the cases were of mixed incontinence, 26.8% of urge incontinence and 24.2% of stress incontinence. Men were more likely to have urge-incontinence, while women were more likely to have mixed incontinence (p = 0.001). UI is prevalent in the elderly of low income living in Sao Paulo and rates are higher than most previous studies. Chronic conditions such as hypertension, diabetes and obesity were associated with UI. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Hunting in Ancient and Modern Amazonia: Rethinking Sustainability

We use a recently developed computerized modeling technique to explore the long-term impacts of indigenous Amazonian hunting in the past, present, and future. The model redefines sustainability in spatial and temporal terms, a major advance over the static "sustainability indices" currently used to study hunting in tropical forests. We validate the model's projections against actual field data from two sites in contemporary Amazonia and use the model to assess various management scenarios for the future of Manu National Park in Peru. We then apply the model to two archaeological contexts, show how its results may resolve long-standing enigmas regarding native food taboos and primate biogeography, and reflect on the ancient history and future of indigenous people in the Amazon.

A hymenopterists' guide to the Hymenoptera Anatomy Ontology: utility, clarification, and future directions

Hymenoptera exhibit an incredible diversity of phenotypes, the result of similar to 240 million years of evolution and the primary subject of more than 250 years of research. Here we describe the history, development, and utility of the Hymenoptera Anatomy Ontology (HAO) and its associated applications. These resources are designed to facilitate accessible and extensible research on hymenopteran phenotypes. Outreach with the hymenopterist community is of utmost importance to the HAO project, and this paper is a direct response to questions that arose from project workshops. In a concerted attempt to surmount barriers of understanding, especially regarding the format, utility, and development of the HAO, we discuss the roles of homology, "preferred terms", and "structural equivalency". We also outline the use of Universal Resource Identifiers (URIs) and posit that they are a key element necessary for increasing the objectivity and repeatability of science that references hymenopteran anatomy. Pragmatically, we detail a mechanism (the "URI table") by which authors can use URIs to link their published text to the HAO, and we describe an associated tool (the "Analyzer") to derive these tables. These tools, and others, are available through the HAO Portal website (http://portal.hymao.org). We conclude by discussing the future of the HAO with respect to digital publication, cross-taxon ontology alignment, the advent of semantic phenotypes, and community-based curation.

A behavioral intervention in a cohort of Japanese-Brazilians at high cardiometabolic risk

OBJECTIVE: To assess the effect of a health promotion program on cardiometabolic risk profile in Japanese-Brazilians. METHODS: A total of 466 subjects from a study on diabetes prevalence conducted in the city of Bauru, southeastern Brazil, in 2000 completed a 1-year intervention program (2005-2006) based on healthy diet counseling and physical activity. Changes in blood pressure and metabolic parameters in the 2005-2006 period were compared with annual changes in these same variables in the 2000-2005 period. RESULTS: During the intervention, there were greater annual reductions in mean (SD) waist circumference [-0.5(3.8) vs. 1.2(1.2) cm per year, p<0.001], systolic blood pressure [-4.6(17.9) vs. 1.8(4.3) mmHg per year, p<0.001], 2-hour plasma glucose [-1.2(2.1) vs. -0.2(0.6) mmol/L per year, p<0.001], LDL-cholesterol [-0.3(0.9) vs. -0.1(0.2) mmol/L per year, p<0.001] and Framingham coronary heart disease risk score [-0.25(3.03) vs. 0.11(0.66) per year, p=0.02] but not in triglycerides [0.2(1.6) vs. 0.1(0.42) mmol/L per year, p<0.001], and fasting insulin level [1.2(5.8) vs. -0.7(2.2) IU/mL per year, p<0.001] compared with the pre-intervention period. Significant reductions in the prevalence of impaired fasting glucose/impaired glucose tolerance and diabetes were seen during the intervention (from 58.4% to 35.4%, p<0.001; and from 30.1% to 21.7%, p= 0.004, respectively). CONCLUSIONS: A one-year community-based health promotion program brings cardiometabolic benefits in a high-risk population of Japanese-Brazilians.

Il contributo dell’Unione europea all’affermazione dello stato di diritto nella comunità internazionale

This thesis is aimed at analysing EU external relations from the perspective of the promotion of the rule of law in order to evaluate the effectiveness and consistency of its action within the international community. The research starts with an examination of the notion of the rule of law from a theoretical point of view. The first chapter initially describes the historical-political evolution of the establishment of the notion of the rule of law. Some of the most significant national experiences (France, the UK, Germany and Austria) are discussed. Then, the focus is put on the need to propose interpretations which explain the grounds of the rule of law, by highlighting the different formal and substantive interpretations. This philosophical-historical analysis is complemented by a reconstruction of how the notion of the rule of law was developed by the international community, with a view to searching a common notion at the international level by comparing theory and practice within the main international organisations such as the UN, OECD and the Council of Europe. Specific mention is made of the EU experience, whose configuration as a Community based on the rule of law is often debated, starting from the case law of the European Court of Justice. The second chapter deals with the conditionality policy and focuses on the development and scope of democratic conditionality according to the dominant approach of the doctrine. First, the birth of conditionality is analysed from an economic point of view, especially within international financial organisations and the different types of conditionality recreated in the scientific sector. Then an analysis is provided about the birth of democratic conditionality in the EC – in relation to its external relations – firstly as a mere political exercise to be then turned into a standardised system of clauses. Specific reference is made to the main scope of conditionality, that is to say enlargement policy and the development of the Copenhagen criteria. The third chapter provides further details about the legal questions connected to the use of democratic clauses: on the one hand, the power of the EC to include human rights clauses in international agreements, on the other, the variety and overlapping in the use of the legal basis. The chapter ends with an analysis of the measures of suspension of agreements with third countries in those rare but significant cases in which the suspension clause, included in the Lomè Convention first and in the Cotonou Agreement then, is applied. The last chapter is devoted to the analysis of democratic clauses in unilateral acts adopted by the European Union which affect third countries. The examination of this practice and the comparison with the approach analysed in the previous chapter entails a major theoretical question. It is the clear-cut distinction between conditionality and international sanction. This distinction is to be taken into account when considering the premises and consequences, in terms of legal relations, which are generated when democratic clauses are not complied with. The chapter ends with a brief analysis of what, according to the reconstruction suggested, can be rightly labelled as real democratic conditionality, that is to say the system of incentives, positive measures developed within the community GSP. The dissertation ends with a few general considerations about the difficulties experienced by the EU in promoting the rule of law. The contradictory aspects of the EU external actions are manifold, as well as its difficulties in choosing the most appropriate measures to be taken which, however, reflect all the repercussions and tension resulting from the balance of power within the international community. The thesis argues that it is difficult to grant full credibility to an entity like the EU which, although it proclaims itself as the guardian and promoter of the rule of law, in practice, is too often biased in managing its relations with third countries. However, she adds, we must acknowledge that the EU is committed and constantly strives towards identifying new spaces and strategies of action.

Display Caotico. Mutazioni nell'arte del mostrare dagli anni Sessanta ad oggi

La mostra è diventata un nuovo paradigma della cultura contemporanea. Sostenuta da proprie regole e da una grammatica complessa produce storie e narrazioni. La presente ricerca di dottorato si struttura come un ragionamento critico sulle strategie del display contemporaneo, tentando di dimostrare, con strumenti investigativi eterogenei, assumendo fonti eclettiche e molteplici approcci disciplinari - dall'arte contemporanea, alla critica d'arte, la museologia, la sociologia, l'architettura e gli studi curatoriali - come il display sia un modello discorsivo di produzione culturale con cui il curatore si esprime. La storia delle esposizioni del XX secolo è piena di tentativi di cambiamento del rapporto tra lo sviluppo di pratiche artistiche e la sperimentazione di un nuovo concetto di mostra. Nei tardi anni Sessanta l’ingresso, nella scena dell’arte, dell’area del concettuale, demolisce, con un azzeramento radicale, tutte le convenzioni della rappresentazione artistica del dopoguerra, ‘teatralizzando’ il medium della mostra come strumento di potere e introducendo un nuovo “stile di presentazione” dei lavori, un display ‘dematerializzato” che rovescia le classiche relazioni tra opera, artista, spazio e istituzione, tra un curatore che sparisce (Siegelaub) e un curatore super-artista (Szeemann), nel superamento del concetto tradizionale di mostra stessa, in cui il lavoro del curatore, in quanto autore creativo, assumeva una propria autonomia strutturale all’interno del sistema dell’arte. Lo studio delle radici di questo cambiamento, ossia l’emergere di due tipi di autorialità: il curatore indipendente e l’artista che produce installazioni, tra il 1968 e il 1972 (le mostre di Siegelaub e Szeemann, la mimesi delle pratiche artistiche e curatoriali di Broodthaers e la tensione tra i due ruoli generata dalla Critica Istituzionale) permette di inquadrare teoricamente il fenomeno. Uno degli obbiettivi della ricerca è stato anche affrontare la letteratura critica attraverso una revisione/costruzione storiografica sul display e la storia delle teorie e pratiche curatoriali - formalizzata in modo non sistematico all'inizio degli anni Novanta, a partire da una rilettura retrospettiva della esperienze delle neoavanguardie – assumendo materiali e metodologie provenienti, come già dichiarato, da ambiti differenti, come richiedeva la composizione sfaccettata e non fissata dell’oggetto di studio, con un atteggiamento che si può definire comparato e post-disciplinare. Il primo capitolo affronta gli anni Sessanta, con la successione sistematica dei primi episodi sperimentali attraverso tre direzioni: l’emergere e l’affermarsi del curatore come autore, la proliferazione di mostre alternative che sovvertivano il formato tradizionale e le innovazioni prodotte dagli artisti organizzatori di mostre della Critica Istituzionale. Esponendo la smaterializzazione concettuale, Seth Siegelaub, gallerista, critico e impresario del concettuale, ha realizzato una serie di mostre innovative; Harald Szeemann crea la posizione indipendente di exhibition maker a partire When attitudes become forms fino al display anarchico di Documenta V; gli artisti organizzatori di mostre della Critica Istituzionale, soprattutto Marcel Broodhthears col suo Musée d’Art Moderne, Départment des Aigles, analizzano la struttura della logica espositiva come opera d’arte. Nel secondo capitolo l’indagine si sposta verso la scena attivista e alternativa americana degli anni Ottanta: Martha Rosler, le pratiche community-based di Group Material, Border Art Workshop/Taller de Arte Fronterizo, Guerrilla Girls, ACT UP, Art Workers' Coalition che, con proposte diverse elaborano un nuovo modello educativo e/o partecipativo di mostra, che diventa anche terreno del confronto sociale. La mostra era uno svincolo cruciale tra l’arte e le opere rese accessibili al pubblico, in particolare le narrazioni, le idee, le storie attivate, attraverso un originale ragionamento sulle implicazioni sociali del ruolo del curatore che suggeriva punti di vista alternativi usando un forum istituzionale. Ogni modalità di display stabiliva relazioni nuove tra artisti, istituzioni e audience generando abitudini e rituali diversi per guardare la mostra. Il potere assegnato all’esposizione, creava contesti e situazioni da agire, che rovesciavano i metodi e i formati culturali tradizionali. Per Group Material, così come nelle reading-room di Martha Rosler, la mostra temporanea era un medium con cui si ‘postulavano’ le strutture di rappresentazione e i modelli sociali attraverso cui, regole, situazioni e luoghi erano spesso sovvertiti. Si propongono come artisti che stanno ridefinendo il ruolo della curatela (significativamente scartano la parola ‘curatori’ e si propongono come ‘organizzatori’). La situazione cambia nel 1989 con la caduta del muro di Berlino. Oltre agli sconvolgimenti geopolitici, la fine della guerra fredda e dell’ideologia, l’apertura ai flussi e gli scambi conseguenti al crollo delle frontiere, i profondi e drammatici cambiamenti politici che coinvolgono l’Europa, corrispondono al parallelo mutamento degli scenari culturali e delle pratiche espositive. Nel terzo capitolo si parte dall’analisi del rapporto tra esposizioni e Late Capitalist Museum - secondo la definizione di Rosalind Krauss - con due mostre cruciali: Le Magiciens de la Terre, alle origini del dibattito postcoloniale e attraverso il soggetto ineffabile di un’esposizione: Les Immatériaux, entrambe al Pompidou. Proseguendo nell’analisi dell’ampio corpus di saggi, articoli, approfondimenti dedicati alle grandi manifestazioni internazionali, e allo studio dell’espansione globale delle Biennali, avviene un cambiamento cruciale a partire da Documenta X del 1997: l’inclusione di lavori di natura interdisciplinare e la persistente integrazione di elementi discorsivi (100 days/100 guests). Nella maggior parte degli interventi in materia di esposizioni su scala globale oggi, quello che viene implicitamente o esplicitamente messo in discussione è il limite del concetto e della forma tradizionale di mostra. La sfida delle pratiche contemporanee è non essere più conformi alle tre unità classiche della modernità: unità di tempo, di spazio e di narrazione. L’episodio più emblematico viene quindi indagato nel terzo capitolo: la Documenta X di Catherine David, il cui merito maggiore è stato quello di dichiarare la mostra come format ormai insufficiente a rappresentare le nuove istanze contemporanee. Le quali avrebbero richiesto - altrimenti - una pluralità di modelli, di spazi e di tempi eterogenei per poter divenire un dispositivo culturale all’altezza dei tempi. La David decostruisce lo spazio museale come luogo esclusivo dell’estetico: dalla mostra laboratorio alla mostra come archivio, l’evento si svolge nel museo ma anche nella città, con sottili interventi di dissimulazione urbana, nel catalogo e nella piattaforma dei 100 giorni di dibattito. Il quarto capitolo affronta l’ultima declinazione di questa sperimentazione espositiva: il fenomeno della proliferazione delle Biennali nei processi di globalizzazione culturale. Dalla prima mostra postcoloniale, la Documenta 11 di Okwui Enwezor e il modello delle Platforms trans-disciplinari, al dissolvimento dei ruoli in uno scenario post-szeemanniano con gli esperimenti curatoriali su larga scala di Sogni e conflitti, alla 50° Biennale di Venezia. Sono analizzati diversi modelli espositivi (la mostra-arcipelago di Edouard Glissant; il display in crescita di Zone of Urgency come estetizzazione del disordine metropolitano; il format relazionale e performativo di Utopia Station; il modello del bric à brac; la “Scuola” di Manifesta 6). Alcune Biennali sono state sorprendentemente autoriflessive e hanno consentito un coinvolgimento più analitico con questa particolare forma espressiva. Qual è l'impatto sulla storia e il dibattito dei sistemi espositivi? Conclusioni: Cos’è la mostra oggi? Uno spazio sotto controllo, uno spazio del conflitto e del dissenso, un modello educativo e/o partecipativo? Una piattaforma, un dispositivo, un archivio? Uno spazio di negoziazione col mercato o uno spazio di riflessione e trasformazione? L’arte del display: ipotesi critiche, prospettive e sviluppi recenti.

Sviluppo e validazione di indicatori di qualità dell’assistenza nell’ambito della salute mentale in Emilia-Romagna

In Italia, il processo di de-istituzionalizzazione e di implementazione di modelli di assistenza per la salute mentale sono caratterizzati da carenza di valutazione. In particolare, non sono state intraprese iniziative per monitorare le attività relative all’assistenza dei pazienti con disturbi psichiatrici. Pertanto, l’obiettivo della tesi è effettuare una valutazione comparativa dei percorsi di cura nell’ambito della salute mentale nei Dipartimenti di Salute Mentale e Dipendenze Patologiche della regione Emilia-Romagna utilizzando indicatori ottenuti dai flussi amministrativi correnti.. I dati necessari alla costruzione degli indicatori sono stati ottenuti attraverso un data linkage dei flussi amministrativi correnti regionali delle schede di dimissione ospedaliera, delle attività territoriali dei Centri di Salute Mentale e delle prescrizioni farmaceutiche, con riferimento all’anno 2010. Gli indicatori sono stati predisposti per tutti i pazienti con diagnosi principale psichiatrica e poi suddivisi per categoria diagnostica in base al ICD9-CM. . Il set di indicatori esaminato comprende i tassi di prevalenza trattata e di incidenza dei disturbi mentali, i tassi di ospedalizzazione, la ri-ospedalizzazione a 7 e 30 giorni dalla dimissione dai reparti psichiatrici, la continuità assistenziale ospedale-territorio, l’adesione ai trattamenti ed il consumo e appropriatezza prescrittiva di farmaci. Sono state rilevate alcune problematiche nella ricostruzione della continuità assistenziale ospedale-territorio ed alcuni limiti degli indicatori relativi alle prescrizioni dei farmaci. Il calcolo degli indicatori basato sui flussi amministrativi correnti si presenta fattibile, pur con i limiti legati alla qualità, completezza ed accuratezza dei dati presenti. L’implementazione di questi indicatori su larga scala (regionale e nazionale) e su base regolare può essere una opportunità per impostare un sistema di sorveglianza, monitoraggio e valutazione dell’assistenza psichiatrica nei DSM.

Marine biodiversity survey in the Northern Red Sea: a large-scale monitoring carried out in collaboration with volunteer divers

Concerns over global change and its effect on coral reef survivorship have highlighted the need for long-term datasets and proxy records, to interpret environmental trends and inform policymakers. Citizen science programs have showed to be a valid method for collecting data, reducing financial and time costs for institutions. This study is based on the elaboration of data collected by recreational divers and its main purpose is to evaluate changes in the state of coral reef biodiversity in the Red Sea over a long term period and validate the volunteer-based monitoring method. Volunteers recreational divers completed a questionnaire after each dive, recording the presence of 72 animal taxa and negative reef conditions. Comparisons were made between records from volunteers and independent records from a marine biologist who performed the same dive at the same time. A total of 500 volunteers were tested in 78 validation trials. Relative values of accuracy, reliability and similarity seem to be comparable to those performed by volunteer divers on precise transects in other projects, or in community-based terrestrial monitoring. 9301 recreational divers participated in the monitoring program, completing 23,059 survey questionnaires in a 5-year period. The volunteer-sightings-based index showed significant differences between the geographical areas. The area of Hurghada is distinguished by a medium-low biodiversity index, heavily damaged by a not controlled anthropic exploitation. Coral reefs along the Ras Mohammed National Park at Sharm el Sheikh, conversely showed high biodiversity index. The detected pattern seems to be correlated with the conservation measures adopted. In our experience and that of other research institutes, citizen science can integrate conventional methods and significantly reduce costs and time. Involving recreational divers we were able to build a large data set, covering a wide geographic area. The main limitation remains the difficulty of obtaining an homogeneous spatial sampling distribution.

Properdin in childhood and its association with wheezing and atopy

Properdin, a serum glycoprotein, is an important component of innate immunity, the only known positive regulator of complement, acting as an initiation point for alternative pathway activation. As an X-linked protein, we hypothesized that properdin may play a modulatory role in the pathogenesis of viral wheeze in children, which tends to be more common and more severe in boys. We aimed to determine properdin levels in a community-based paediatric sample, and to assess whether levels of properdin were associated with childhood wheeze phenotypes and atopy. We studied 137 school-children aged 8-12 yrs, a nested sample from a cohort study. Properdin was measured by a commercial enzyme-linked immunoabsorbant assay. We assessed wheeze by questionnaire, validated it by a nurse-led interview and performed skin prick tests and a methacholine challenge in all children. Forty children (29%) reported current wheeze. Serum properdin levels ranged between 18 and 40 microg/ml. Properdin was not associated with age, gender, atopy, bronchial responsiveness, current wheeze (neither the viral wheeze nor multiple-trigger wheeze phenotype) or severity of wheeze, but was slightly lower in south Asian (median 21.8 microg/ml) compared with white children (23.3 microg/ml; p = 0.006). Our data make it unlikely that properdin deficiency is common in healthy children or that levels of properdin are a major risk factor for wheeze or atopy.

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views

PURPOSE: Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves. METHOD: A convenience sample of 403 participants (210 men, mean age 32.4 ± 12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9 ± 11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale. RESULTS: High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age. DISCUSSION: The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes.

How Porous are the Walls that Separate Us?: Transformative Service-Learning, Women’s Incarceration, and the Unsettled Self

In this article, we refine a politics of thinking from the margins by exploring a pedagogical model that advances transformative notions of service learning as social justice teaching. Drawing on a recent course we taught involving both incarcerated women and traditional college students, we contend that when communication among differentiated and stratified parties occurs, one possible result is not just a view of the other but also a transformation of the self and other. More specifically, we suggest that an engaged feminist praxis of teaching incarcerated women together with college students helps illuminate the porous nature of fixed markers that purport to reveal our identities (e.g., race and gender), to emplace our bodies (e.g., within institutions, prison gates, and walls), and to specify our locations (e.g., cultural, geographic, socialeconomic). One crucial theoretical insight our work makes clear is that the model of social justice teaching to which we aspired necessitates re-conceptualizing ourselves as students and professors whose subjectivities are necessarily relational and emergent.

Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment

Community-based studies suggest that cannabis products that are high in Δ⁹-tetrahydrocannabinol (THC) but low in cannabidiol (CBD) are particularly hazardous for mental health. Laboratory-based studies are ideal for clarifying this issue because THC and CBD can be administered in pure form, under controlled conditions. In a between-subjects design, we tested the hypothesis that pre-treatment with CBD inhibited THC-elicited psychosis and cognitive impairment. Healthy participants were randomised to receive oral CBD 600 mg (n=22) or placebo (n=26), 210 min ahead of intravenous (IV) THC (1.5 mg). Post-THC, there were lower PANSS positive scores in the CBD group, but this did not reach statistical significance. However, clinically significant positive psychotic symptoms (defined a priori as increases ≥ 3 points) were less likely in the CBD group compared with the placebo group, odds ratio (OR)=0.22 (χ²=4.74, p<0.05). In agreement, post-THC paranoia, as rated with the State Social Paranoia Scale (SSPS), was less in the CBD group compared with the placebo group (t=2.28, p<0.05). Episodic memory, indexed by scores on the Hopkins Verbal Learning Task-revised (HVLT-R), was poorer, relative to baseline, in the placebo pre-treated group (-10.6 ± 18.9%) compared with the CBD group (-0.4% ± 9.7 %) (t=2.39, p<0.05). These findings support the idea that high-THC/low-CBD cannabis products are associated with increased risks for mental health.

Studying the Roles of Nonprofits, Government, and Business in Providing Activities and Services to Youth in the Phoenix Metropolitan Area

The article addresses the questions, What do children in urban areas do on Saturdays? What types of organizational resources do they have access to? Does this vary by social class? Using diary data on children's activities on Saturdays in the Phoenix-Mesa-Scottsdale metropolitan area, the authors describe the different types of venues (households, businesses, public space, associations, charities, congregations, and government/tribal agencies) that served different types of children. They find that the likelihood of using a charity or business rather than a government or tribal provider increased with family income. Also, the likelihood of using a congregation or a government facility rather than a business, charity, or household increased with being Hispanic. The authors discuss the implications for the urban division of labor on Saturdays and offer research questions that need further investigation.

The Differential Usage of Services by Impaired Elderly

Why do some clients use institutional services, while other, with comparable impairment, use community based services? To answer this question, a matching procedure paired clients from the two types of service provision. Sixty-six clients, ages 62 and over, were matched for functional ability as rated on a 6-item ADL scale (Katz, et al., 1970). A discriminant function analysis was performed, with the setting of service provision as the criterion variable. The results indicated that the institutional group was more likely than their community counterparts: (a) to have had previous service contact with other service providers; (b) to have less support available within the community setting from family members or friends; (c) to be more impaired in the areas of mental health and social resources.

[Integrating psychotherapeutic treatment of severe mental illness: between desirability and clinical practice]

Psychiatric care for severe and persistent mentally ill individuals has considerably changed over the last three decades. Striving for improvement in services provision for these patients has led to the emergence of various specialized community services, suited housing and supported work offers. Moreover, community-based treatment is also offered during acute episodes of mental illness. At the same time a range of evidence-based psychotherapeutic approaches targeting treatment needs of people with severe mental illness were developed in a process independent of the rise of community psychiatry. At present, however, a sufficient level of coordination of psychiatric services and integration of evidence-based psychological treatment into psychiatric care has not been achieved. Thus, these issues represent important steps in the further development.This paper discusses recent developments in psychiatric care of people with severe mental illness and reviews the evidence-based psychotherapy approaches suited to fit the needs of patient-centered integrated care.