Alcohol use and problem drinking in South Africa: Results from a national-population-based survey 2014-2015

The aim of this study was to estimate the pattern of alcohol use among South African adults by their socio-demographic and health status indicators. We analysed data from a 2014–2015 South African national population-based survey which sampled 22 752 adults (mean age 37.1 years, SD?=?17.6, age range of 15–109 years). Results indicate 3.9% were hazardous or harmful alcohol users. In adjusted logistic regression analysis, both men and women who self-reported to use tobacco, and women to have hypertension, were at higher risk for harmful alcohol use. Age and socioeconomic status moderated harmful alcohol use among men so that those in middle age (35–49 years) and with above average household income were at lower risk for hazardous or harmful alcohol use. Socio-demographic factors appear to primarily influence risk for hazardous or harmful alcohol use among South African adults.     

Estimating the population size of transgender women in San Francisco using multiple methods, 2013

Purpose: To estimate the number of adult transgender women (TGW) in San Francisco and to provide an example of how estimation can be conducted.

Methods: Using nine different services accessed by the TGW population, the service multiplier, integrated into a respondent-driven sampling (RDS) survey of TGW, was used to calculate nine estimates of the TGW population in San Francisco. Both the successive sampling method, also integrated into the RDS survey of TGW, and a population proportion from the literature each calculated an additional estimate of the TGW population. The median of all 11 estimates was calculated to present a single estimate of the TGW population in San Francisco.

Results: The median of estimates was 978 TGW in San Francisco (plausibility bounds 635 – 1,400). This estimate is consistent with known cases of HIV among TGW and surveys on the prevalence of infection in the TGW population.

Conclusion: Using multiple methods, we estimate the TGW population size to be 0.13% of the San Francisco population. Despite small numbers, TGW bear a disproportionate burden of HIV infection in San Francisco. TGW are a priority for HIV care and prevention services.     

IMPLEMENTATION OF AN EVIDENCED‐BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING

The process of mental health intervention implementation with vulnerable populations is not well‐described in the literature. The authors worked as a community‐partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low‐income community. We used qualitative ethnographic methods to document the adaption of an evidence‐based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0‐ to 84‐month‐old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.     

The structure of the Beck Hopelessness Scale: A confirmatory factor analysis in UK students

The aim of this paper was to confirm the factor structure of the 20-item Beck Hopelessness Scale in a non-clinical population. Previous research has highlighted a lack of clarity in its construct validity with regards to this population.Based on previous factor analytic findings from both clinical and non-clinical studies, 13 separate confirmatory factor models were specified and estimated using LISREL 8.72 to test the one, two and three-factor models.Psychology and medical students at Queen’s University, Belfast (n = 581) completed both the BHS and the Beck Depression Inventory (BDI).All models showed reasonable fit, but only one, a four-item single-factor model demonstrated a non-significant chi-squared statistic. These four items can be used to derive a Short-Form BHS (SBHS) in which increasing scores (0-4) corresponded with increasing scores in the BDI. The four items were also drawn from all three of Beck’s proposed triad, and included both positively and negatively scored items.This study in a UK undergraduate non-clinical population suggests that the BHS best measures a one-factor model of hopelessness. It appears that a shorter four-item scale can also measure this one-factor model.     

Some thoughts between body and mind in the light of Wilma Bucci's multiple code theory

The author proposes the usefulness of Wilma Bucci's Multiple Code Theory in clarifying some controversial issues in psychoanalytically inspired psychosomatics. Definition of a dialectic among different entities may appear difficult in an unitarian view of the organism, where body and mind are seen as having no kind of intrinsic existence, which may be differentiated from the organism as a whole, but as two categories having to do with the perspective of the observer. This aporia may find a solution in a redefinition of the body-mind relationship as that between symbolic systems and the subsymbolic system, both of which may be viewed as mind or as body depending on the point of observation. Similarly, somatic pathology, if we accept an unitary paradigm, need no longer be viewed as due to an influence of 'mind' on 'body': a definition of pathology as linked to a disconnection between different systems, as found in Bucci's theory, is proposed as a possible solution. Emergence of somatic symptoms, however, besides being witness to disconnection, may be seen as the subsymbolic first expression of an item of content, an attempt at reconnection, as already proposed, in a way, by Winnicott in 1949. This attempt has much better opportunities to succeed when it finds an adequate container, as in analysis. A clinical situation of this kind is presented.     

PLACING OURSELVES

Abstract This essay set the stage for the 2003 Star Island conversation on “Ecomorality” by remembering the cosmic, geological, and ecological context in which we live. It reflects on the immense journey that matter and life have traveled from the beginning and reminds us that, throughout that journey, all that was and is emerged from a fertile mix of individual well‐being and reciprocity. But to sense the meaning of the story and to know our place in it takes more than hearing its broad outline. We need to remember the individual actors who have gone before us; to read their stories in particular places, like the rocks and ecosystems of Star Island; and to listen carefully for the meaning to be found in those actors and those places. Those stories, actors, and places invite us to sense the sacredness of our time and place and to reconsecrate our selves and our energies to developing an ethic that honors our common ancestry.     

边缘人群社会医学：值得关注的新领域

从边缘化的概念入手,对边缘人群的内涵及范畴进行了明确界定,引出边缘人群社会医学的概念。对当前我们开展边缘人群社会医学研究的必要性进行了初步分析,就我国当前边缘人群存在的主要社会医学问题进行了深入的探讨。     

Dynamics of Religious Group Growth and Survival

We model and analyze the dynamics of religious group membership and size. A group is distinguished by its strictness, which determines how much time group members are expected to spend contributing to the group. Individuals differ in their rate of return for time spent outside of their religious group. We construct a utility function that individuals attempt to maximize, then find a Nash equilibrium for religious group participation with a heterogeneous population. We then model dynamics of group size by including birth, death, and switching of individuals between groups. Group switching depends on the strictness preferences of individuals and their probability of encountering members of other groups. We show that in the case of only two groups—one with finite strictness and the other with zero—there is a parameter combination that determines whether the nonzero strictness group can survive over time, which is more difficult at higher strictness levels. We also show that a high birth rate can allow even the strictest groups to survive. Finally, we consider cases of several groups, gaining insight into strategic choices of strictness values and displaying the rich behavior of the model.     

Clinical Ethicists Awakened: Addressing Two Generations of Clinical Ethics Issues Involving Undocumented Patients

Because the United States has failed to provide a pathway to citizenship for its long-term undocumented population, clinical ethicists have more than 20 years of addressing issues that arise in caring for this population. I illustrate that these challenges fall into two sets of issues. First-generation issues involve finding ethical ways to treat and discharge patients who are uninsured and ineligible for safety-net resources. More recently, ethicists have been invited to help address second-generation issues that involve facilitating the presentation for care of undocumented patients. In the current environment of widespread fear of deportation in the immigrant community, ethicists are working with health care providers to address patient concerns that prevent them from seeking care. I illustrate that in both generations of issues, values implicit within health care, namely, caring, efficiency, and promotion of public health, guide the strategies that are acceptable and recommended.     

Can a before-school physical activity program decrease bullying victimization in disadvantaged children? The Active-Start Study

Background/ObjectiveTo test the effectiveness of an 8-week before-school physical activity program to reduce bullying victimization among a group of socially disadvantaged children in the Active-Start study.MethodA non-blinded randomized controlled trial was conducted in three public schools classified as highly vulnerable and located in a deprived area of Santiago (Chile). A total of 5 classes participated, totaling 170 fourth grade children. The intervention was delivered before starting the first school-class (8:00–8:30 a.m.). The program lasted for 8 weeks. Primary outcome measurement on bullying victimization was assessed by the CUBE questionnaire at baseline and post-intervention.ResultsThere was a statistically significant reduction in the probability of suffering physical bullying (OR= 0.18, 95% CI, 0.04-0.82; p= .027) and verbal bullying (OR=0.13, 95% CI, 0.02-0.97; p= .046) after the 8-week program.ConclusionsParticipation in an 8-week before-school physical activity intervention implemented in schools located in a disadvantaged district in Santiago (Chile) resulted in lower levels of bullying victimization among study participants. The Active-Start program may be a feasible and potentially scalable intervention option to improve the climate and pro-sociality environment at schools.