Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews

Several clinical papers have provided clinical recommendations for how to provide cognitive behavioral therapy (CBT) for obsessive-compulsive symptoms among Orthodox Jewish individuals. However, no published studies have described culturally adapted CBT for anxiety or depression in this population or quantified the effectiveness of such approaches. We evaluated the effectiveness of CBT for symptoms of generalized anxiety and depression in a sample of Orthodox Jews (n = 65) and a comparison sample (n = 42) presenting to the Center for Anxiety, a private outpatient clinic with three offices in the New York area (www.centerforanxiety.org). A chart review revealed that all patients received CBT-based interventions with appropriate religious-cultural adaptations of treatment, which we present in two case studies. We observed statistically and clinically significant treatment gains from pretreatment to midtreatment (anxiety: t = 8.56, p < .001; depression: t = 8.01, p < .001), and again from midtreatment through termination (anxiety: t = 3.68, p < .001; depression: t = 3.62, p < .001). No significant differences in anxiety or depression were observed between Orthodox Jewish patients and controls at any time point or for treatment effects (anxiety: Wilks’ Lambda = .950, F = 2.65, p = .076, η_p² = .050; depression: Wilks’ Lambda = .99, F = 2.00,p = .49, η_p² = .014). This paper offers clinical insight into delivery of CBT to Orthodox Jewish patients, as well as preliminary support for the effectiveness of CBT in treating symptoms of generalized anxiety and depression within this population.     

L’affaire Lambert

In the case Lambert, the Council of State (high court of the Public law) finished a long trial. The question concerned the power of medical decision: family? doctor? judge? The European Court of Human Rights disputes its solution.     

Improved classification of mammograms following idealized training

People often make decisions by stochastically retrieving a small set of relevant memories. This limited retrieval implies that human performance can be improved by training on idealized category distributions (Giguère & Love, 2013). Here, we evaluate whether the benefits of idealized training extend to categorization of real-world stimuli, namely classifying mammograms as normal or tumorous. Participants in the idealized condition were trained exclusively on items that, according to a norming study, were relatively unambiguous. Participants in the actual condition were trained on a representative range of items. Despite being exclusively trained on easy items, idealized-condition participants were more accurate than those in the actual condition when tested on a range of item types. However, idealized participants experienced difficulties when test items were very dissimilar from training cases. The benefits of idealization, attributable to reducing noise arising from cognitive limitations in memory retrieval, suggest ways to improve real-world decision making.     

Les autorisations d’équipements lourds d’imagerie médicale : un désordre organisé

Medical imaging is essential for all medical specialties and it is natural that the government wants to create a real healthcare provision policy in this area. Medical imaging and particularly the “heavy” equipment are subject to a regulatory and legal framework. This framework results in respect of administrative authorization mechanism. These authorizations are a major tool for development of medical imaging on French territory. This mechanism is an important instrument of economic regulation in controlling health costs. However, the access to this kind of equipment raises various issues in governance and administration but also in matter of economic regulation, distribution of healthcare supply in medical imaging in health territories and respect of public health issues. The authorization mechanism raises questionings, not only at national and regional level in terms of unequal access, but also at European and international level. Indeed, France is among the last countries in the ranking of CT (computed tomography) and MRI (magnetic resonance imaging) equipment rates in comparison with many OECD (Organization for Economic Cooperation and Development) countries. Now, these authorizations will integrate much more the concepts of accessibility and quality of patient care. The legal and regulatory framework of these authorizations will have to evolve and to adapt to new technologies and practices, which today should be a source of significant cost savings.     

Déontologie et santé publique en droit constitutionnel

Ethics, even if there is a renewed interest today, has long been important in the public health domain, keeping constitutional law at a distance for the benefit of a relative autonomy of the medical field. However, the indifference between sanitary ethics and constitutional law tends to become less marked because of the appearance of a double opposite movement, consisting on the one hand of a public “déontologisation” of health law, including constitutional law and, on the other hand, in a constitutionalisation of ethics regarding public health. This evolution sets up as an arbitrator of State interventionism a Constitutional Council originally reluctant to check the intervention of public authorities in the field of health.     

Du secret médical aux dossiers de santé électroniques. Réflexions juridiques sur la protection des données de santé

Health data give rise to a plurality of qualifications. The exercise players are forced this not unusual for the legal system. In the case of health data, especially when these data are processed through folders to which several categories of actors need access, it may still be problematic. Electronic medical records, in which the authorities have in recent years invested a lot of hope and money, fail to cross the course of a generalization though it was presented as being beneficial for our public health system and financing of health spending. Without exaggerating the extent of social problems related to the interpretation and application of standards, it is reasonable to think that they are partly responsible for this fact. After presenting the two great bodies of norms which where initially protecting personal health data, this paper develops the analysis of their confrontation before highlighting the status of one of the most complex issues in this field, that is the people's consent to the various treatments that their data may be subject of.     

Implantologie orale et responsabilité : à propos du choix du dispositif implantaire

Dental implants are medical devices designed to create stable, strong, non-iatrogenic and durable anchors in the maxilla or mandible to which a removable or fixed dental prothesis fits, to replace one or more missing teeth. From the 1970s to 2000, these medical devices experienced changes in shape and materials before a consensus was reached on a type of implant that responded to the standard of care. This raises the question of the medical liability of healthcare professionals who use different implant systems in their practices. The present article proposes to highlight the choice of the dental implant by dental practitioner, its design and the materials used, on the field of the medical liability, through a retrospective study of judicial decisions in France. The “Brånemark-type” endosseous cylindrical-conical screw implant is considered as standard of care in France. The dental surgeon has the possibility to use other types of dental implants when the clinical situation strictly contraindicates the use of cylindrical-conical screw implants. In case of litigation, he must be able to justify his choices.     

Le contentieux de la régularité externe des décisions rendues par les juridictions ordinales des médecins

In the event of irregular composition of the ordinal jurisdiction or omission of certain compulsory particulars in the decision rendered, the parties may challenge the external regularity of the decision. The pleas based on the contested decisions are formal and procedural defects. If successful, these means result in the annulment of the decision ordering the doctor to be disciplined. These means constitute a separated legal cause and can only be invoked within the time limit for appeal, unless they are of public order.