Marital split-up and widowhood in old age: Differential impact on psychological and social well-being

Marital split-up and spousal loss are among the most stressful critical life events. Numerous studies have documented their detrimental effects on well-being, yet the large individual differences in psychological adaptation are still not well understood. Whereas in old age bereavement is normative and can be anticipated, divorce is an “off-time” transition for this age group. In contrast to bereavement which has been amply studied, research on later life divorce is still missing despite the increasing relevance of the topic due to the significant increase of divorces in older age. Based on a modified and extended view of Amato’s divorce-stress-adjustment model (2000), the aim of this contribution is to explore the differential impact of marital split-up and widowhood in older age on psychological (life satisfaction) and social well-being (social loneliness), and the adaptation to these critical life events. Our analyses are based on data gathered in a questionnaire study, which is part of the Swiss National Centre of Competence in Research LIVES. In a first step we compared three groups of individuals aged 60 to 75 years: a sample of 251 persons with a marital split-up (127 women; 123 men), a sample of 270 widowed persons (170 women; 100 men), and a group of 221 continuously married people (110 women; 111 men), which served as control group. In a second step, we investigated the role of socio-demographic variables, intrapersonal and interpersonal resources and variables of the context of loss as predictors for the psychological adaptation to a marital break-up and loss in old age. First results by ANCOVA indicate significant differences with regard to life satisfaction among the three groups, with divorced persons with the lowest scores, followed by the bereaved ones, and the married controls with the highest. Regarding social loneliness, divorced individuals report higher social loneliness than the bereaved group and the married controls (no significant difference between widowed and the married). In both loss groups, financial and intrapersonal resources, as well as the emotional valence of the loss are the most important predictors for the psychological and social adaptation. However, happiness in the past relationship is an important resource regarding the indicators for adaptation for the widowers, but not for individuals with a marital dissolution.

Factors that trigger emergency physicians to contact a poison centre: findings from a Swiss study.

OBJECTIVE Poison centres offer rapid and comprehensive support for emergency physicians managing poisoned patients. This study investigates institutional, case-specific and poisoning-specific factors which influence the decision of emergency physicians to contact a poison centre. METHODS Retrospective, consecutive review of all poisoning-related admissions to the emergency departments (EDs) of a primary care hospital and a university hospital-based tertiary referral centre during 2007. Corresponding poison centre consultations were extracted from the poison centre database. Data were matched and analysed by logistic regression and generalised linear mixed models. RESULTS 545 poisonings were treated in the participating EDs (350 (64.2%) in the tertiary care centre, 195 (35.8%) in the primary care hospital). The poison centre was consulted in 62 (11.4%) cases (38 (61.3%) by the tertiary care centre and 24 (38.7%) by the primary care hospital). Factors significantly associated with poison centre consultation included gender (female vs male) (OR 2.99; 95% CI 1.69 to 5.29; p<0.001), number of ingested substances (>1 vs 1) (OR 2.84; 95% CI 1.65 to 4.9; p<0.001) and situation (accidental vs intentional) (OR 2.76; 95% CI 1.05 to 7.25; p=0.039). In contrast, age, medical history and hospital size did not influence poison centre consultation. Poison centre consultation was significantly higher during the week, and significantly less during night shifts. The poison centre was consulted significantly more when patients were admitted to intensive care units (OR 5.81; 95% CI 3.25 to 10.37; p<0.001). Asymptomatic and severe versus mild cases were associated with more frequent consultation (OR 4.48; 95% CI 1.78 to 11.26; p=0.001 and OR 2.76; 95% CI 1.42 to 5.38; p=0.003). CONCLUSIONS We found low rates of poison centre consultation by emergency physicians. It appears that intensive care unit admission and other factors reflecting either complexity or uncertainty of the clinical situation are the strongest predictors for poison centre consultation. Hospital size did not influence referral behaviour.

Cleverer than we thought: the change in discourse of the Georgian Orthodox Church

This paper will focus on three episodes of contemporary church-state relations in Georgia, in particular, the conflicting interaction between law and religion in the public space. The first episode will be an open confrontation between the church and the state over the law on Registration of Religious Minority organizations (2011) which allowed the religious minorities to freely register; second: the Law on Self-governance (2013) which Georgian Orthodox Church considered “a threat to territorial integrity of Georgia”; and lastly: the Law on Anti-discrimination (2014) which was deemed “legitimization of Sodomic sin”. By reflecting on the three examples where for the first time after the collapse of Soviet Union, the Georgian state openly confronted the church and made a decision notwithstanding its position, I will attempt to argue that the role of the Orthodox Church in influencing the law making process is in gradual decline. However, on the other hand, by presenting the results of an ethnographic study conducted in 23 eparchies and perishes in 7 regions of Georgia in 2014, I will also show that church has adapted to its declining role over policy making, and to regain its political influence it gradually started to employ a civic rather than ethno nationalist discourse on matters of religious freedom while engaging with government. The paper will suggest that both unilateral decision-making of the state and civic shift in the discourse of the church constitute an important change in understanding church-state dynamics in the post-communist Orthodox Christianity dominated society.

The Lord of Heaven in the Inner Chambers: Jesuits, Women, and Domestic Christianity (ca. 1580-1690)

The study focuses on gender norms and practices in Chinese Christian communities established by Jesuit missionary activity during the long seventeenth century. It analyzes how European and Chinese gender norms and practices affected each other in the context of the Sino-Western cultural contact initiated by the missionaries. The thesis consists of two parts. First, it analyzes the ways in which European Jesuits engaged with Chinese gender relations in the course of their mission in China. The study demonstrates that the Jesuits’ adoption of the Chinese scholar-gentry’s habitus entailed a partial adaptation to Confucian gender norms. The latter placed great emphasis on gender segregation and therefore discouraged direct communication between missionaries and Chinese women. This resulted in the emergence of organizational and devotional arrangements of Christian communities specific to China. Second, the study discusses Chinese Christian women's religious culture that emerged in the absence of a strong missionary presence among female devotees. It points out that Chinese Christian women created their own ritual culture and religious sociability in the domestic context, and that they actively took part in shaping Chinese Christianity as masters of domestic rituals.

Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

Towards a new balance of trade in agriculture

Trade in agriculture is linked to a whole range of economic, environmental, societal and future interests. For this reason, international regulation of trade in agricultural goods is highly contentious. While mainly directed towards an opening of markets, the WTO Agreement on Agriculture also has some entry points for ‘non trade concerns’. However, the agreement still looks like a casual patchwork that allows rather unsystematic ally for exemptions, without explicitly exposing the grounds that allow for them. The question arises of how the agreement could be drafted in a more structured way, in order to make sure that the economic objectives are efficiently pursued, and at the same time that human rights and environmental concerns are adequately taken account of? The concept of sustainable development provides for a methodical ‘seven step’ framework that gives guidance on integrated decision making processes. In this paper, this framework is partially applied to the Agreement on Agriculture. This working paper served as an introductory note to a brainstorming workshop on the subject that took place on 27 March 2009 at the World Trade Institute, University of Bern.

Immigration (Political science - International relations)

This entry discusses ‘immigration,’ which is the permanent movement of people across states, seen from the perspective of the receiving (rather than sending) states. The focus is on the relationship between immigration and states, a neglected topic in classic immigration research, but receiving more attention in recent scholarly literature. The entry discusses, in particular, some explanatory models of immigration policy and how the immigration experience has changed or reconfirmed the institution of citizenship.

Hemodynamic changes associated with manual and automated lateral rotation in mechanically ventilated intensive care patients

Objective: To investigate hemodynamic responses to lateral rotation. ^ Design: Time-series within a randomized controlled trial pilot study. ^ Setting: A medical intensive care unit (ICU) and a medical-surgical ICU in two tertiary care hospitals. ^ Patients: Adult patients receiving mechanical ventilation. ^ Interventions: Two-hourly manual or continuous automated lateral rotation. ^ Measurements and Main Results: Heart rate (HR) and arterial pressure were sampled every 6 seconds for > 24 hours, and pulse pressure (PP) was computed. Turn data were obtained from a turning flow sheet (manual turn) or with an angle sensor (automated turn). Within-subject ensemble averages were computed for HR, mean arterial pressure (MAP), and PP across turns. Sixteen patients were randomized to either the manual (n = 8) or automated (n = 8) turn. Three patients did not complete the study due to hemodynamic instability, bed malfunction or extubation, leaving 13 patients (n = 6 manual turn and n = 7 automated turn) for analysis. Seven patients (54%) had an arterial line. Changes in hemodynamic variables were statistically significant increases ( p < .05), but few changes were clinically important, defined as ≥ 10 bpm (HR) or ≥ 10 mmHg (MAP and PP), and were observed only in the manual-turn group. All manual-turn patients had prolonged recovery to baseline in HR, MAP and PP of up to 45 minutes (p ≤ .05). No significant turning-related periodicities were found for HR, MAP, or PP. Cross-correlations between variables showed variable lead-lag relations in both groups. A statistically, but not clinically, significant increase in HR of 3 bpm was found for the manual-turn group in the back compared with the right lateral position ( F = 14.37, df = 1, 11, p = .003). ^ Conclusions: Mechanically ventilated critically ill patients experience modest hemodynamic changes with manual lateral rotation. A clinically inconsequential increase in HR, MAP, and PP may persist for up to 45 minutes. Automated lateral rotation has negligible hemodynamic effects. ^

La economía y el ambiente : Ortodoxias y heterodoxias para la aplicación al territorio

El objetivo de este trabajo es discutir los enfoques principales del debate sobre el tratamiento que debe dar la economía al impacto ambiental. El tema se relaciona con toda la discusión sobre el desarrollo y sobre la relación entre territorio y desarrollo, y atraviesa la problemática de la geografía económica y regional en cuestiones como la planificación regional o el análisis de impacto, sobre todo en territorios con fuerte influencia de la explotación de recursos naturales. Se analiza la manera de incorporar el problema en las bases de la economía neoclásica aceptando sus principios y utilizando sus instrumentos. Luego se aborda la economía ecológica desde el trabajo de Georgescu-Roegen de 1971, el primero que intenta introducir en el razonamiento económico las leyes de la irreversibilidad de los procesos, por fuera de la visión neoclásica y fundando una corriente heterodoxa. Más allá de estas posiciones, están las visiones que analizan la relación entre ambiente y desarrollo manteniendo el concepto de centro-periferia o asumiendo la necesidad de construir discursos contra-hegemónicos, enmarcando la cuestión ambiental en esa lógica: se mencionan la postura del marxismo y el aporte del poscolonialismo -este último, fundamental, por la importancia que asigna a la necesidad de reconstruir la perspectiva ambiental desde las identidades y el territorio-. Las conclusiones plantean el desafío de retomar este tipo de puntos de vista -lo que limita enormemente el uso del herramental de la economía ambiental- y también algunas propuestas neoinstitucionalistas de la economía ecológica

Estudio de algunas problemáticas políticas a partir de parámetros de análisis de la geografía actual

El presente artículo intenta abordar el estudio de algunos de los principales problemas que nos presenta, a diversas escalas, la política actual, ateniéndonos a sus implicancias espaciales y a partir de diversos parámetros ofrecidos en los últimos tiempos por la ciencia geográfica. La propuesta se apoya en bases teóricas desarrolladas a partir de los enunciados de Emmanuel Wallerstein y Peter Taylor acerca de un sistema mundial estructurado como una economía-mundo, basada en el modo de producción capitalista. Por otra parte, intenta formular una explicación teórica acerca de la dinámica experimentada por los territorios sobre la base de la mecánica de dicho sistema mundial. A partir de estos postulados, se propone el análisis de algunos de los principales fenómenos emanados del estudio anterior y sus implicancias espaciales, como las actuales relaciones de poder en el sistema, la subsistencia de factores de poder tradicionales (el Estado-nación, las configuraciones culturales de base étnica) y la aparición de nuevos (la constitución de bloques y asociaciones supranacionales, los nuevos movimientos sociales, las nuevas formas de participación local), la importancia de los discursos hegemónicos y contrahegemónicos en la construcción de las representaciones simbólicas y de los medios de información en dichos procesos o el nuevo cuadro de las identidades e hibridaciones culturales a partir de la movilidad de la población.

La economía y el ambiente : Ortodoxias y heterodoxias para la aplicación al territorio

El objetivo de este trabajo es discutir los enfoques principales del debate sobre el tratamiento que debe dar la economía al impacto ambiental. El tema se relaciona con toda la discusión sobre el desarrollo y sobre la relación entre territorio y desarrollo, y atraviesa la problemática de la geografía económica y regional en cuestiones como la planificación regional o el análisis de impacto, sobre todo en territorios con fuerte influencia de la explotación de recursos naturales. Se analiza la manera de incorporar el problema en las bases de la economía neoclásica aceptando sus principios y utilizando sus instrumentos. Luego se aborda la economía ecológica desde el trabajo de Georgescu-Roegen de 1971, el primero que intenta introducir en el razonamiento económico las leyes de la irreversibilidad de los procesos, por fuera de la visión neoclásica y fundando una corriente heterodoxa. Más allá de estas posiciones, están las visiones que analizan la relación entre ambiente y desarrollo manteniendo el concepto de centro-periferia o asumiendo la necesidad de construir discursos contra-hegemónicos, enmarcando la cuestión ambiental en esa lógica: se mencionan la postura del marxismo y el aporte del poscolonialismo -este último, fundamental, por la importancia que asigna a la necesidad de reconstruir la perspectiva ambiental desde las identidades y el territorio-. Las conclusiones plantean el desafío de retomar este tipo de puntos de vista -lo que limita enormemente el uso del herramental de la economía ambiental- y también algunas propuestas neoinstitucionalistas de la economía ecológica

Estudio de algunas problemáticas políticas a partir de parámetros de análisis de la geografía actual

El presente artículo intenta abordar el estudio de algunos de los principales problemas que nos presenta, a diversas escalas, la política actual, ateniéndonos a sus implicancias espaciales y a partir de diversos parámetros ofrecidos en los últimos tiempos por la ciencia geográfica. La propuesta se apoya en bases teóricas desarrolladas a partir de los enunciados de Emmanuel Wallerstein y Peter Taylor acerca de un sistema mundial estructurado como una economía-mundo, basada en el modo de producción capitalista. Por otra parte, intenta formular una explicación teórica acerca de la dinámica experimentada por los territorios sobre la base de la mecánica de dicho sistema mundial. A partir de estos postulados, se propone el análisis de algunos de los principales fenómenos emanados del estudio anterior y sus implicancias espaciales, como las actuales relaciones de poder en el sistema, la subsistencia de factores de poder tradicionales (el Estado-nación, las configuraciones culturales de base étnica) y la aparición de nuevos (la constitución de bloques y asociaciones supranacionales, los nuevos movimientos sociales, las nuevas formas de participación local), la importancia de los discursos hegemónicos y contrahegemónicos en la construcción de las representaciones simbólicas y de los medios de información en dichos procesos o el nuevo cuadro de las identidades e hibridaciones culturales a partir de la movilidad de la población.