An analysis of the changing metaphors and concepts of mental health in psychoanalysis.

There is a strong focus on defining and classifying psychopathology within a psychoanalytic paradigm. There is less emphasis on the consideration of what it means to be mentally healthy within a psychoanalytic framework. Yet, our understandings of mental health, whether implicit or explicit, inform our choices with our patients; our decisions to begin analytically oriented therapy, our treatment plans and our evaluations that termination has become appropriate. Therefore this research explores a fundamental underlying assumption that informs our work: what it signifies to be mentally healthy from a psychoanalytic perspective. In order to explicate understandings of mental health, the research explores the thought of four psychoanalytic theorists, Freud, Klein, Bion and Winnicott. The first part of the research examines the theories of the thinkers in order to extract their essential concepts and metaphors about mental health. For each thinker, a different emphasis on mental health is derived: Freud’s structural model is essential to his apprehension of mental health, for Klein the ability to experience affects and work through the depressive position is vital, for Bion the capacity to think and tolerate suffering is highlighted, while for Winnicott what becomes important is an individual’s capacity to inhabit transitional space. Next, these four approaches are discussed, compared and contrasted and the validity, or “mental health”, of each theory is considered. Finally, some contemporary approaches to mental health within psychoanalysis are explored. It is concluded that mental health in a psychoanalytic paradigm differs from psychiatric and other psychotherapeutic approaches to mental health. Mental health is not about cure, symptom elimination or efficient functioning in the world. Therefore, it is very important that psychoanalytically oriented therapists consider what it means to be mentally healthy within the terms of our discipline. While no one single definition is offered, it becomes clear that mental health is defined more in terms of one’s internal, psychic life as opposed to external functioning, is about tolerating process as opposed to fixating on end-goals and is concerned with a certain ongoing quality of relationship rather than the foreclosed elimination of a symptom

Experiences of women who have lost young children to AIDS in KwaZulu-Natal, South Africa: a qualitative study

Background AIDS continues to be the leading cause of death in South Africa. Little is known about the experiences of mothers who have lost a young child to AIDS. The purpose of this qualitative study was to explore the attitudes and experiences of women who had lost a young child to HIV/AIDS in KwaZulu-Natal Province, South Africa. Methods In-depth interviews were conducted with 10 women who had lost a child to AIDS. The average age of the deceased children was six years. Interviews were also conducted with 12 key informants to obtain their perspectives on working with women who had lost a child to AIDS. A thematic analysis of the transcripts was performed. Results In addition to the pain of losing a child, the women in this study had to endure multiple stresses within a harsh and sometimes hostile environment. Confronted with pervasive stigma and extreme poverty, they had few people they could rely on during their child\u27s sickness and death. They were forced to keep their emotions to themselves since they were not likely to obtain much support from family members or people in the community. Throughout the period of caring for a sick child and watching the child die, they were essentially alone. The demands of caring for their child and subsequent grief, together with daily subsistence worries, took its toll. Key informants struggled to address the needs of these women due to several factors, including scarce resources, lack of training around bereavement issues, reluctance by people in the community to seek help with emotional issues, and poverty. Conclusions The present study offers one of the first perspectives on the experiences of mothers who have lost a young child to AIDS. Interventions that are tailored to the local context and address bereavement issues, as well as other issues that affect the daily lives of these mothers, are urgently needed. Further studies are needed to identify factors that promote resilience among these women

LIF-Dependent Signaling: New Pieces in the Lego

LIF, a member of the IL6 family of cytokine, displays pleiotropic effects on various cell types and organs. Its critical role in stem cell models (e.g.: murine ES, human mesenchymal cells) and its essential non redundant function during the implantation process of embryos, in eutherian mammals, put this cytokine at the core of many studies aiming to understand its mechanisms of action, which could benefit to medical applications. In addition, its conservation upon evolution raised the challenging question concerning the function of LIF in species in which there is no implantation. We present the recent knowledge about the established and potential functions of LIF in different stem cell models, (embryonic, hematopoietic, mesenchymal, muscle, neural stem cells and iPSC). We will also discuss EVO-DEVO aspects of this multifaceted cytokine

Serum-Deprived Human Multipotent Mesenchymal Stromal cells (MSCs) are Highly Angiogenic.

Recent reports have indicated that mesenchymal stromal cells (MSCs) from bone marrow have a potential in vascular remodeling and angiogenesis. Here, we report a unique phenomenon that under serum-deprived conditions MSCs survive and replicate. Secretome analysis of MSCs grown under serum-deprived conditions (SD-MSCs) identified a significant upregulation of prosurvival and angiogenic factors including VEGF-A, ANGPTs, IGF-1, and HGF. An ex vivo rat aortic assay demonstrated longer neovascular sprouts generated from rat aortic rings cultured in SD-MSC-conditioned media compared to neovascular sprouts from aortas grown in MSC-conditioned media. With prolonged serum deprivation, a subpopulation of SD-MSCs began to exhibit an endothelial phenotype. This population expressed endothelial-specific proteins including VEGFR2, Tie2/TEK, PECAM/CD31, and eNOS and also demonstrated the ability to uptake acetylated LDL. SD-MSCs also exhibited enhanced microtubule formation in an in vitro angiogenesis assay. Modified chick chorioallantoic membrane (CAM) angiogenesis assays showed significantly higher angiogenic potential for SD-MSCs compared to MSCs. Analysis of CAMs grown with SD-MSCs identified human-specific CD31-positive cells in vascular structures. We conclude that under the stress of serum deprivation MSCs are highly angiogenic and a population of these cells has the potential to differentiate into endothelial-like cells

Subcutaneous versus intramuscular administration of human chorionic gonadotropin during an in vitro fertilization cycle

Objective: To confirm that hCG levels in follicular fluid and serum would be comparable between IM and SC administration of purified hCG. Design: In a prospective study, serum and follicular fluid levels of hCG after an IM or SC injection of 10,000 IU of hCG were evaluated 36 hours after injection, that is, at the time of oocyte retrieval. Setting: This study was carried out in a university-affiliated IVF program. Patient(s): Forty women undergoing oocyte retrieval were entered into the study at the time of egg retrieval, that is, 36 hours after hCG administration. Intervention(s): SC or IM injection of hCG. Main Outcome Measure(s): Serum and follicular fluid concentrations of hCG were evaluated 36 hours after injection at the time of oocyte retrieval. Result(s): There was a significantly higher serum hCG level in the SC group (348.6 ± 98 IU/L) vs. the IM group (259.0 ± 115 IU/L) and a significantly higher follicular fluid hCG level in the SC vs. the IM group (233.5 ± 85 vs. 143.4 ± 134 IU/L). Conclusion(s): After purified hCG administration via the SC route, both serum and follicular fluid levels are greater compared with the IM route. © 2003 by American Society for Reproductive Medicine

Changing professional practice in tuberculosis care: an educational intervention.

AIM: This paper describes the development and implementation of an experiential, participatory in-service education programme focusing on patient-centeredness, problem-solving and critical reflection for primary providers delivering care to tuberculosis patients in South Africa. BACKGROUND: Tuberculosis is a major contributor to the disease burden in developing countries. In South Africa, approximately 90% of tuberculosis patients are managed by nurses at the primary level. Despite efforts to improve quality of care for these patients, many fail to complete their treatment as prescribed. Poor rapport between health care providers and patients with tuberculosis is a major reason for non-adherence to treatment. Methods of improving the quality of care delivery and communication between health care providers and patients with tuberculosis is therefore a priority. DISCUSSION: The paper outlines the stages of developing and implementing the education programme and reflects on this process. Data is drawn from an in-depth qualitative evaluation of the delivery and impacts of the intervention. The approach was acceptable to health care providers and adaptable to the needs of specific clinics. Participants evaluated the educational intervention positively, noting that it facilitated critical reflection on their work; encouraged problem-solving; and heightened their awareness of communication with patients and with colleagues. However, important structural barriers to practice change were identified, including conditions of service, relations with colleagues and support from management. CONCLUSIONS: Experiential, participatory in-service education can be implemented on a large scale in primary care settings. However, the process is resource intensive and the impacts of such education may be limited by barriers at other levels of the health system