Cermes

The assertive case management (ACT) study by Bond and colleagues illustrates the problems of evaluating new mental health service modalities applied to multi-dimensional problems. Both characteristics of large urban areas and increasing consumer self-awareness affect implementation of random assignment and follow-up studies. In the study reviewed here, possible lack o f fit between study subjects and the control condition, a drop-in center, may have contributed to a high attrition rate. As most of the controls never received the treatment, neither ACT nor the drop-in center were adequately tested. And without explication of how the control condition relates to other peer-oriented interventions, study findings cannot be generalized to self-help. The authors' conclusions concerning self-help are therefore not supported by their findings.

Background. -People with severe mental disorders tend to be seen as authors rather than as victims of violence, while mental illness is associated with violence and danger. French policy focuses on individuals with mental illness as authors of violence, to the detriment of evidencebased public health regarding such individuals when they are victims.

In Louisiana's unique, populist-derived charity health system, the self-designation Charity Hospital Baby expresses situational identity anchored in the life cycle and the inversion of racist and authoritative connotations. This article draws on theoretical perspectives of stratified reproduction and the politics of time to examine the controversy in which Babies advocate reopening the Katrina-damaged New Orleans Charity Hospital, and administrators and planners support a new state-of-the-art biosciences district, GNOBED. Babies evoke the present, ethical urgency (kairos) of responding to sickness and disability; GNOBED implies prolonging or saving future lives through biotechnologies under development in accelerated time (chronos). As preservationists and residents threatened with displacement join "re-open Charity" proponents, planners symbolically engage in prolepsis, rhetorically precluding opposing arguments with flash forward of supposedly "done deals." At stake is nothing less than social death for a segment of this ethnically diverse city. [public

Although syringe exchange and other harm reduction interventions have generally been effective in reducing bloodborne pathogen incidence among injection drug users (IDUs), in some cases a minority of IDUs continues to engage in risky injection behavior. Building on emerging perspectives in social epidemiology and research on drug use in anthropology that point to the importance of examining fundamental social causes of risk behavior, or what puts individuals at risk for risk, this study used a multilevel perspective to explore whether forms of capital, social network characteristics, and other contextual factors influence continued risky injection behavior. Quantitative and qualitative data were collected on IDUs in the city of Marseilles, France, where sterile injection equipment has been legal and officially promoted since 1995. In multivariate analysis on data concerning active users, location in the densest part of a large, interconnected network of IDUs greatly increased the likelihood of risky injection practices, while there was a non-significant tendency for low Acquired Cultural and Economic Capital to predict this behavior. Among the strongest individual-level characteristics to predict this outcome were illicit use of prescribed medication, generally high dose buprenorphine, and unprotected sex. Parental abuse of psychoactive drugs during the subject's childhood, on the other hand, greatly decreased the chances of engaging in risky injection behavior. Additionally, qualitative data analysis suggests that risky injection may be linked to lack of resources to procure drugs, and not simply to inadequate sterile injection equipment. Further research, including ecological models, is needed to better understand how fundamental social conditions are related to ''risk for risk''. However, public health interventions can already address the need for community-level interventions, while rethinking the consequences of inaccessible drugs and unintended ''leakage'' from the introduction of buprenorphine and other medicalized treatments for opiate dependency. r

This paper focuses on the relatively late emergence of psychiatric epidemiology as an international discipline, through local-global exchanges during the first 15 years of the World Health Organization (WHO). Building an epidemiological canon within WHO's Mental Health Programme faced numerous obstacles. First, an idealist notion of mental health inherent in WHO's own definition of health contributed to tensions around the object of psychiatric epidemiology. Second, the transfer of methods from medical epidemiology to research on mental disorders required mobilizing conceptual justifications, including a 'contagion argument'. Third, epidemiological research at WHO was stymied by other public health needs, resource scarcity and cultural barriers. This history partly recapitulates the development of psychiatric epidemiology in North America and Europe, but is also shaped by concerns in the developing world, translated through first-world 'experts'. Resolving th...

... of rights) and the type of subjects it produces (eg, lacking in self-esteem, experiencing ... of mental health bureaucracies) of those who embrace it (McLean 1995; Lovell 1991).3 ... views into action, versus capacity to determine options; provider-run programs that help clients better ...