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[Managing self determination and sexual violence in homes for young adults with mental handicap--report from an ongoing German model project].

This report is based upon a model project financially assisted by a grant from the German Federal Ministry for Families, Senior Citizens, Women and Youth, starting in 1999 and ending at the end of 2003. In cooperation with two disability care residential institutions, a conceptual approach and method to the questions of sexual self-determination and sexualized violence is being developed. Through qualitative methods of research e.g. focus groups, professional helpers of all hierarchies of the institution, including management, and the residents themselves, all had the chance to contribute their own opinions and experiences to the research topic. Specifically, to ensure their voice was heard, the people with mental retardation had an important impact on the questionnaire themselves. All aspects of sexuality were discussed--with notable difficulty arising in particular over the subject of sexual violence. It turned out that nonverbal communication and the interaction between the group members in the residents group were most indicative of their concerns. The staff at the nursing and living areas discussed the following topics: distance and closeness in the interaction between staff and residents, standards, reflections of their own professional attitudes, questions of legality as well as the tense topic of individual needs and tasks of the group. How those questioned described their solutions and ways of coping, and the impressions of the researchers forms the starting point for the compiled work. The initial ideas for the topics and the design of the concept are now laid out.

Adolescent↗

[The Beverly Lewis House--report on development of a safe facility for mentally handicapped women with abuse histories].

This contribution introduces a battered women shelter in London, Great Britain which exclusively provides refuge to women with learning disabilities who experienced sexualized violence. In the case of sexual abuse in early childhood psychotherapy is provided. Beverly Lewis House is the only institution of its kind and is lead by the author of this article. The contribution gives an insight into the significance and the structures of such an institution. Six components will be described that are important for implementing a battered women shelter specified on serving women with a learning disability: the architecture and the structures of the institution, the funding, the team, the variety of offers, the establishment of a therapeutic climate and the further progress of the women after leaving the Beverly Lewis House. Furthermore, the staff are being instructed how to deal with behaviours resulting from abuse experiences such as eating disorders, self-harming behaviour and depressions. The contribution is predominantly written in "simple language" in order to make it accessible to people with learning disabilities.

Adolescent↗

[The outriggers of personality].

The authors analyze the self-esteem, their components and his intervention on personality protection and the methods that person has to obtain a good self-esteem. The authors finish marking the strongest support of self-esteem.

Adult↗

Philosophical anthropology and psychiatry: typus melancholicus as a human disposition.

Key ideas of philosophical anthropology furnish the framework for a description of the personality type, typus melancholicus. These key ideas are: (1) all living beings are related to and interact with their environments, (2) all living beings must maintain their identities in distinction from their environments, (3) the biological constitution of human beings leaves them instinct-deficient, (4) the human-world relationship must therefore be partially determined by cultural shaping, and (5) social roles and norms determine the consciousness and behavior of human beings. "Dispositional vectors" are basic tendencies within human beings that move them toward particular forms of world-relatedness. These dispositional vectors are: over-identification with social norms (hypernomia), struggle with social norms (agonomia), under-identification with social norms (hyponomia), and over-identification with personal norms (idionomia). When the dispositional vector of hypernomia moves in a pathological direction, it becomes the personality type, typus melancholicus. The two fundamental features of typus melancholicus are hypernomia and intolerance of ambiguity.

Animals↗

Surrogacy: is there a case for legal prohibition?

Surrogacy arrangements are a complex and challenging issue for legal regulation. On the one hand, if we wish to promote personal autonomy and enable the infertile to experience parenthood, there is a case for allowing these arrangements to proceed. However, objections to legal sanctioning of surrogacy include concerns for the surrogate and the child born through the surrogacy arrangement. Legally sanctioning surrogacy may also adversely affect social conceptions of women's roles or may be considered a form of commodifying women's reproductive capacities. This article examines these challenges to allowing surrogacy, but concludes that surrogacy should not be legally prohibited.

Child↗

Why do children resist or obey their foster parents? The inner logic of children's behavior during discipline.

This article discusses a study of children's perspectives on disciplinary conflicts with their foster parents. Most children accept parental authority, but they also defend their personal autonomy and loyalties to peers. In this study, only birthchildren told real-life stories about fierce resistance to get their own way. Fierce resistance among foster children was motivated by inner conflicts and confusion. Obedience among foster children often derived from fear of punishment or a feeling of impotence. The authors discuss the theoretical and pedagogical implications of these findings.

Adolescent↗

Depression in nursing home residents.

Although their extent remains unclear, major and minor depressions are widespread in the nursing home population. This statement appears intuitively to be correct when consideration is given to the inactivity, decline in functional competence, loss of personal autonomy, and unavoidable confrontation with the process of death and dying that are associated with nursing home placement. In addition, some nursing home residents have had previous episodes of depression or are admitted to the facility already dysthymic or with other chronic forms of the illness. Such circumstances provide a favorable culture for the development and persistence of depressive illness. When the high frequency of other psychiatric disorders among nursing home residents is factored in, it is not surprising that long-term health care facilities have come to be regarded as de facto psychiatric hospitals. Nursing homes largely lack the treatment resources of psychiatric hospitals, however. Nursing home physicians are often unprepared to make psychiatric diagnoses, and a perfunctory annual psychiatric evaluation is insufficient to manage the complex depression syndromes of nursing home residents. Because nursing home psychiatrists typically work on a consultation basis, recommendations are not necessarily acted upon by the primary physicians. The consequences of undiagnosed and untreated depression are substantial. From the psychiatric perspective, the possibility that depression increases the risk for eventual development of permanent dementia highlights the importance of early identification for cases of reversible dementia. From the rehabilitation point of view, persistent depression among individuals with physical dependency following a catastrophic illness is associated with failure to improve in physical functioning. Depression can probably be linked to increased medical morbidity in nursing home residents, a relationship that also has been suggested for elderly medical inpatients. If so, the use of nursing time and other health-care facility services would be greater for depressed than nondepressed residents, and financial costs would be higher as well. Finally, recent data point to increased mortality in nursing home residents with major depressive disorder. It is apparent that depression in long-term care facilities is a condition with doubtful prognosis and negative medical, social, and financial consequences. The highest costs of all may be paid by nursing home residents who experience the unrelieved suffering of depressive illness. Only epidemiologic research using standard diagnostic criteria and direct resident assessment will adequately establish the magnitude of the need for intervention among depressed residents in long-term care.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

Morbidity and mortality in the city of Zagreb, Croatia--health needs and demands.

The aim of the study was to assess health indicators in the city of Zagreb in order to evaluate the population health status and health needs. A descriptive method was used to analyze data from regular health statistics. In the population of Zagreb, the life expectancy at birth is longer than the European average but shorter than that recorded in Austria and Slovenia. The standardized mortalitay rates of tracheal, bronchial and lung cancer, and of malignant diseases in the Zagreb population exceed the European average, whereas those of ischemic heart disease, cerebrovascular disease, uterine cervix carcinoma and breast cancer are lower than the European average. Circulatory diseases and neoplasms, the two most important groups of death causes, showed a constant rise during the 30-year period (1971-2001). The highest index of primary health care utilization (98.8%) was recorded for the > or = 65 age group, with a mean of 7.5 primary health care visits per capita. The prevalence of hypertensive disorders and of intervertebral disk diseases and other dorsopathies was significantly higher in the oldest population group (chi2 = 27.3 and chi2 = 13.43, respectively, p < 0.05 both). Considering the predominance of chronic widespread diseases that substantially influence the patient's quality of life, public health actions should primarily be focused on preserving personal autonomy of the old and sick man for as long as possible. As the standardized mortality rates of ischemic heart disease, cerebrovascular diseases, tracheal, bronchial and lung cancer, and malignant diseases exceed those reported from some neighboring countries, the highest priority and needs are now related to coping with unhealthy behavior of the population such as smoking, physical inactivity, and dietary issues that should be modified and controlled through implementation of preventive programs, along with appropriate organization and management of public health services.

Adolescent↗

Psychiatric advance directives among public mental health consumers in five U.S. cities: prevalence, demand, and correlates.

Psychiatric advance directives (PADs) are legal instruments that allow competent persons to document their preferences regarding future mental health treatment and to designate a surrogate decisionmaker in the event they lose capacity to make reliable treatment decisions during an acute episode of psychiatric illness. This study reports the findings of a survey of 1,011 psychiatric outpatients in five U.S. cities about their interest in, and completion of, PADs. Across the sites, only 4 to 13 percent of participants had completed a PAD; however, between 66 and 77 percent reported wanting to complete one if given assistance. Significantly higher demand for PADs was found among participants who were female; were nonwhite; had a history of self-harm, arrest, and decreased personal autonomy; and those who felt pressured to take medication. Actual completion of PADs was more likely among participants with higher insight, those reporting leverage by a representative payee, and those who felt external pressure to keep outpatient appointments for mental health treatment.

Adult↗

[The hemodialysed patient and his/her family caregiver. Comparison of perceptions of the chronic illness].

BACKGROUND: According to health psychology, the family caregiver (fc), i.e. the person who takes care of a hemodialysed patient, plays a pivotal role in coping with dialysis. This study explored and compared the lifestyle and the main needs of a cohort of hemodialysis patients, with reduced personal autonomy, to their fc, evaluating some psychological functional parameters, such as the perception of familial and social support, the psychological quality of life, the disability due to chronic illness, and the communication style. METHODS: An anonymous multiple versions questionnaire, administered according to the caregiver's family relationship, was given for self assessment to 54 couples of patients and related fc (spouse, son/daughter and brother/sister), mean age 66 and 60, respectively; mean dialytic patients' age: 8 years and 6 months. The questionnaire consisted of three different sections, demographics, renal disease and psychological evaluation, with 4 standard scales (Social Support Satisfaction, Marital Communication, Psychological General Well-Being Index and Evaluation of Needs). A multivariate variance analysis (MANOVA) was subsequently performed. RESULTS: Women have a higher perception of their lifestyle change after dialysis, and, in general, patients communicate more easily with their fc than vice versa. Communication problems are more common in patients with a recent diagnosis. Patients and fc mostly need a better dialogue with their nephrologists and urge some psychological help. CONCLUSIONS: The quality of the relationship between physicians, patients and their families is a key element in the process of healing.

Adult↗

[Neurologist regarding the dependence law].

INTRODUCTION: The approval of the "project of promotion of personal autonomy and care to people on dependence" situation law now opens the parliamentary process to the approval of the mentioned law around October- November 2006. Should the neurologist know its content and express his/her opinion about it? DEVELOPMENT: We analyze the role of neurological disorders as a cause of dependence, the law principles, the involvement of the neurologist in the social-health care coordination, the health administrations involved in the law development and the role of Spanish Neurological Society and regional societies as mediators with the different health administration, the involvement of the neurologist in accreditation, education, research and development, independence promotion, and dependence evaluation. CONCLUSION: Given that the project will be modified in the course of its parliamentary process, and the relevance of its reglamentary development, the door has been left open for the role of the neurologist to be accepted at the moment when the law is developed and applied. In any case, the well-being and quality of life of our patients should not be overlooked. We think that the Spanish Neurological Society will have an important role in this process.

Dependency, Psychological↗

The limitations of the Dutch concept of euthanasia.

Why has the law on euthanasia in the Netherlands caused such an upheaval both at home and abroad? In this paper I explore some bioethical issues in the decriminalisation of euthanasia in the Netherlands. The regulatory role of legal and state institutions in the process of decision-making by patients, physicians and other people concerned plays a central role in these discussions. I argue, first, that the limited scope of the Dutch legislation on euthanasia cannot be a solution to end-of-life issues in general, and, second, that it is inadequate as a model for dealing with problems related to 'death-on-request' abroad. Moreover, the confusion around the meaning of the term euthanasia would make its adaptation in other institutional environments capricious. Legal changes in the Netherlands was accompanied by cultural changes, expressed in the use of terms such as individual autonomy and personal choice. In the last section of this article I argue that the social and political environment may be crucial in defining the meaning of free choice. The contending views on the decriminalisation of euthanasia seem to develop as a reaction to change in medical technology in a particular socio-political environment rather than from a unique cultural ethic.

Coercion↗

[Prevalence of cognitive deterioration in a geriatric urban population].

A descriptive study was carried out in Salt (Gerona) to evaluate the prevalence of cognitive impairment in a geriatric urban population and its relation with several variables which might have an influence on it. The cognitive status was evaluated with the score in the Mini-Mental State Examination (MMSE). A representative sample of 392 individuals was obtained out of an overall population of 2,394 registered persons above 65 years of age; 354 of them were interviewed. The overall rate of intellectual deterioration (MMSE less than 24) was 26.5%, and it was 8% for the important deterioration (MMSE less than 18). The presence of cognitive impairment was significantly correlated in multivariate analysis with advanced age, low educational level and limited personal autonomy.

Aged↗

Future trends in the legal rights of patients in nursing homes.

The author discusses the demographic aging of Canada and outlines how the Canadian Constitution and the Charter of Rights and Freedoms are likely to affect the care and treatment of nursing home residents. Because physical freedom and personal autonomy have been given such a high value in the constitution, civil and legal rights will be protected for all residents in nursing homes, and procedural safeguards will become mandatory in the next few years for patients who refuse treatment and for those who are deemed to be incompetent. Physicians and other caregivers will increasingly be removed from the role of substitute decision-maker for incompetent patients, and patient representatives, court-appointed guardians and courts will assume this responsibility. Judicial safeguards such as impartial hearings, appeals to the court and the principles of natural justice will become commonplace in nursing homes.

Aged↗