Social psychiatry and psychiatric epidemiology functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study

Purpose: Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. Methods: A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing communityascertained cohort of people with SMD (n= 218), and attendees at the Butajira General Hospital psychiatric clinic (n= 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding two years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS), were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. Results: Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects and internalized stigma were associated with functional impairment across self reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. Conclusion: To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted

A simplified logic of causal inference

This paper provides a simplified method for evaluating the evidence in favour of a causal claim. It analyses the evidence bearing upon such a claim in terms of two questions: Do the putative cause and effect covary, and can alternative non-causal explanations of the relationship be ruled out? The different research designs for assessing covariation are outlined, as are the ways in which these designs permit a researcher to decide between alternative explanations of the relationship

The triumph of the null hypothesis: epidemiology in an age of change

Summary The recent confusion concerning the relation between hormone replacement therapy and cardiovascular disease has stirred a new wave of debate about the value and future of epidemiology. Opponents of epidemiology suggest an ever-diminishing role in an age of small risks and complex diseases, yet proponents are not in consensus about how to adapt their discipline to the challenges associated with ageing societies and changing disease patterns. While epidemiology is likely to be increasingly called upon to make sense of the risks involved with these changes, wading into this era with a mindset and tools that were derived from epidemiology's ‘golden era’ of tackling major risk factors, has created more confusion than understanding. Increasingly, we need to downsize epidemiology to what is testable, measurable, and relevant, based on robust methodology and public health rationale. Applying an evolutionary perspective, that views health problems of modernity as a manifestation of the mismatch between our ancient genes and hi-tech lifestyles, can provide guidance for a 21st century research agenda

Relaciones de parentesco, corporalidad y afectos en la producción de lo común: reflexiones a partir de una etnografía con trabajadores de la economía popular en Argentina

A partir de una investigación etnográfica con una cooperativa de vendedores ambulantes de la Confederación de Trabajadores de la Economía Popular (CTEP), este artículo explora los vínculos entre parentesco, corporalidad y afectos en la producción de lo común. Sostengo que esta producción implica el derecho a mantener una forma de vida que se remonta al menos a tres generaciones atrás —la posibilidad de seguir siendo—, como punto de partida de un proceso de experimentación política que permite proyectar una vida que vale la pena ser vivida para sí mismos y para las generaciones futuras al producir derechos y formas de bienestar colectivos de los que esta población ha estado históricamente desposeída. Más que pensar lo común como algo dado, este análisis busca contribuir a una perspectiva de lo común que atiende al proceso de producción y se focaliza en las prácticas y relaciones cotidianas que le dan forma.Starting from an ethnographic investigation with a cooperative of street hawkers from the Confederations of Workers of the Popular Economy (CTEP), this article explores the linkages between kinship, corporality and affections in the production of the common. I argue that this production entails the right to uphold a way of life that dates back at least three generations —the possibility of continuing to be—, as a starting point for a process of political experimentation to allow projecting a life worth living for themselves and for future generations, by producing rights and forms of collective wellbeing this population has historically been dispossessed of. More than thinking of the common as a given, this analysis seeks to contribute to a view of the common that serves the production process and focuses on the daily practices and relationships that shape it.A partir de uma pesquisa etnográfica com uma cooperativa de vendedores ambulantes da Confederação de Trabalhadores da Economia Popular (CTEP), este artigo explora os vínculos entre parentesco, corporeidade e afetos na produção do comum. Argumento que essa produção implica o direito de manter uma forma de vida que remonta, pelo menos, a três gerações — a possibilidade de continuar sendo—, como ponto de partida de um processo de experiência política que permite projetar uma vida que vale a pena ser vivida para si mesmo e para as gerações futuras ao produzir direitos e formas de bem-estar coletivos dos quais essa população tem estado historicamente destituída. Mais que pensar o comum como algo dado, esta análise busca contribuir para uma perspectiva do comum que atende ao processo de produção e está focada nas práticas e nas relações cotidianas que lhe dão forma.Fil: Fernandez Alvarez, Maria Ines. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Filosofía y Letras. Instituto de Ciencias Antropológicas; Argentin