The forsaken mental health of the Indigenous Peoples - a moral case of outrageous exclusion in Latin America

<p>Abstract</p> <p>Background</p> <p>Mental health is neglected in most parts of the world. For the Indigenous Peoples of Latin America, the plight is even more severe as there are no specific mental health services designed for them altogether. Given the high importance of mental health for general health, the status quo is unacceptable. Lack of research on the subject of Indigenous Peoples' mental health means that statistics are virtually unavailable. To illustrate their mental health status, one can nonetheless point to the high rates of poverty and extreme poverty in their communities, overcrowded housing, illiteracy, and lack of basic sanitary services such as water, electricity and sewage. At the dawn of the XXI century, they remain poor, powerless, and voiceless. They remain severely excluded from mainstream society despite being the first inhabitants of this continent and being an estimated of 48 million people. This paper comments, specifically, on the limited impact of the Pan American Health Organization's mental health initiative on the Indigenous Peoples of Latin America.</p> <p>Discussion</p> <p>The Pan American Health Organization's sponsored workshop "Programas y Servicios de Salud Mental en Communidades Indígenas" [Mental Health Programs and Services for the Indigenous Communities] in the city of Santa Cruz, Bolivia on July16 - 18, 1998, appeared promising. However, eleven years later, no specific mental health program has been designed nor developed for the Indigenous Peoples in Latin America. This paper makes four specific recommendations for improvements in the approach of the Pan American Health Organization: (1) focus activities on what can be done; (2) build partnerships with the Indigenous Peoples; (3) consider traditional healers as essential partners in any mental health effort; and (4) conduct basic research on the mental health status of the Indigenous Peoples prior to the programming of any mental health service.</p> <p>Summary</p> <p>The persistent neglect of the Indigenous Peoples' mental health in Latin America raises serious concerns of moral and human rights violations. Since the Pan American Health Organization' Health of the Indigenous Peoples Initiative 16 years ago, no mental health service designed for them has yet been created.</p

Capacité en matière de prise de décisions chez des récidivistes de conduite avec capacités affaiblies par l’alcool

Thomas G. Brown, Ph.D., co-directeur de rechercheObjectifs : La capacité en matière de prise de décisions des récidivistes de conduite avec capacités affaiblies (CCA) semble les distinguer des non-contrevenants, particulièrement dans des situations ambiguës à haut risque, telles que la CCA. Cette étude exploratoire vise à vérifier l’hypothèse selon laquelle les récidivistes de CCA (R) auraient une moins bonne capacité de prise de décisions et une plus faible réponse de conductibilité électrodermale par anticipation à la tâche Iowa Gambling Task (IGT) que les non-contrevenants (C). Méthode : Vingt-trois récidivistes et 24 non-contrevenants ont été recrutés. Leur âge moyen (± É.T.) était 44.17(10.03) et 37.29 (10.60) ans respectivement. Les participants devaient être âgés de 18 ans ou plus, et avoir eu deux condamnations pour CCA ou plus pour le groupe R, et zéro CCA et un permis de conduire pour le groupe C. Les participants ont effectué I’IGT, une tâche neurocognitive de prise de décisions comprenant 100 sélections de cartes divisées en cinq blocs pour les analyses. On a comparé la performance du groupe R versus le groupe C à l’aide d’une ANOVA à mesures répétées [2 (groupe) x 5 (blocs)]. On a évalué la performance durant les blocs 1 & 2 (décisions dans l’ambiguïté) et blocs 3-5 (décisions sous haut risque) en utilisant des tests t post-hoc. Finalement, on a mesuré leur réponse de conductibilité électrodermale (RCEA) durant l’IGT. Résultats : L’ANOVA à mesures répétées des blocs 1 à 5 a révélé un effet significatif de l’interaction groupe par bloc, F(1,45)=5.28, p=.03, état carré =.11. Les tests t post hoc ont révélé une différence significative entre les groupes pour la combinaison des blocs 3 à 5, t(45) = 3.38, p = .002. Un effet d’interaction significatif a été détecté pour la RCEA des récidivistes de CCA versus celle des non-contrevenants, F(8,160)=2.33, p=.02, état carré =.10. Conclusion : Les récidivistes de CCA performent moins bien que les non-contrevenants à l’IGT. Ils persistent à prendre des décisions basées sur le potentiel de gains immédiats et négligent donc les risques de pertes. Ceci suggère qu’ils ont des déficits en matière de prise de décision, ce qui, en tant que groupe, les différencie des non-contrevenants. Une difficulté en matière de prise de décisions pourrait expliquer en partie le comportement impulsif fréquemment associé au récidivisme de CCA. Finalement, puisque les analyses de RCEA manquaient de puissance statistique, il est possible que de plus grands échantillons puissent permettre d’observer des différences entre les groupes de participants dans l’analyse de RCEA.Objectives: Poor decision making in ambiguous high-risk situations, such as driving while impaired (DWI) by alcohol, may differentiate DWI recidivists from non-offenders. In this study, we test the hypothesis that DWI recidivists (R) will exhibit poorer decision-making performance on the Iowa Gambling Task (IGT), and in line with the Somatic Marker Hypothesis, weaker anticipatory somatic activation (using skin conductance response as index) than non-offenders (C, comparison group). Methods: DWI recidivists and non-DWI control drivers were recruited, [R (n=23) and C (n=24), mean ages (± SD) 44.17(10.03) and 37.29 (10.60) years respectively]. Participant selection criteria included ≥ 18 years old and ≥2 DWI convictions for group R and 0 DWI convictions lifetime and a driver’s license for group C. The participants performed the IGT, a decision-making neurocognitive task containing 100 card selection trials that we divided into 5 blocks for analyses. A 2 (group) x 5 (blocks) repeated measures ANOVA was used to compare group R performance on the IGT versus group C, followed by post hoc independent t-tests on aggregated blocks 1-2 (decision under ambiguity) & 3-5 (decision under high risk) to identify the source of group X block significant interactions. Two 3 (group) x 5 (blocks) repeated measures ANOVAs (for good decks and for bad decks) were used to compare the aSCR of groups C and R. Results: ANOVA repeated measures on blocks 1 to 5 produced a significant effect of group by block interaction F(1,45)=5.28, p=.03, partial ƞ2 =.11. Post hoc t-tests on aggregated blocks 3 to 5 were statistically significant, t(45) = 3.38, p = .002. A significant group x block interaction effect was found for good decks aSCR, F(8,160)=2.33, p=.02, partial ƞ2 =.10 . Conclusion: DWI recidivists performed more poorly than controls on the IGT, persistently making decisions based on potential immediate gains and neglecting associated loss risks and long-term outcome. This suggests they have reduced neurocognitive decision-making capacities distinguishable from the general population. While DWI recidivists’ behaviour appears as impulsive, these results suggest that their behaviour pattern involves decision-making difficulties. Larger sample sizes may be needed to detect a between-group effect in the aSCR analyses, as they were considerably underpowered

Psychological Stress as a Modulator of Functional Recovery Following Spinal Cord Injury

There is strong evidence indicating that the social environment triggers changes to the psychological stress response and glucocorticoid receptor function. Considerable literature links the subsequent changes in stress resiliency to physical health. Here, converging evidence for the modulatory role of chronic psychological stress in the recovery process following spinal cord injury (SCI) is presented. Despite the considerable advances in spinal cord injury research, we are still unable to identify the causes of variability in patients’ recovery following injury. We propose that individuals’ past and present life experiences (in the form of stress exposure) may significantly modulate patients’ outcome post SCI. We propose a theoretical model to explain the negative impact of chronic psychological stress on physical and psychological recovery. The stress experienced in life prior to SCI and also as a result of the traumatic injury, could compromise glucocorticoid receptor sensitivity and function, and contribute to high levels of inflammation and apoptosis post SCI, decreasing the tissue remaining at the injury site and undermining recovery of function. Both stress induced glucocorticoid resistance and stress induced epigenetic changes to the glucocorticoid receptor can modulate the NF-кB regulated inflammatory pathways and the Bcl-2 regulated apoptosis pathways. This model not only contributes to the theoretical understanding of the recovery process following injury, but also provides concrete testable hypotheses for future studies