Human rights and mass disaster: lessons from the 2004 tsunami.

This paper describes the results of an investigation into how the December, 2004 tsunami and its aftermath affected the human rights of the survivors. Teams of researchers interviewed survivors, government officials, representatives of international and local nongovernmental organisations, UN officials, the military, police, and other key informants in India, Sri Lanka, the Maldives, Indonesia, and Thailand. We also analysed newspaper articles, reports released by governments, UN agencies, NGOs, and private humanitarian aid groups, and we examined the laws and policies related to survivors' welfare in the affected countries. We found worsening of prior human rights violations, inequities in aid distribution, lack of accountability and impunity, poor coordination of aid, lack of community participation in reconstruction, including coastal redevelopment. Corruption and preexisting conflict negatively impact humanitarian interventions. We make recommendations to international agencies, states, and local health service providers. A human rights framework offers significant protection to survivors and should play a critical role in disaster response.

The importance of healthy communities of higher education.

A framework for understanding issues that contribute to vibrant and healthy communities of higher education is presented. The focus is on how individual and community health relate to institutional missions, purposes, and goals. This framework may be applied to 2-year and 4-year colleges and universities whether they are public, private, research, teaching, sectarian, religious, residential, or computer institutions. The following questions are addressed: Why should colleges maintain healthy communities? How do we define health in colleges and universities? Why is this important for society? What are the key responsibilities in fostering healthy educational communities? Who is responsible for assuring that this happens? What added value do personal and community health yield for institutions of higher education? Readers are provided with a rationale for assessing the role and importance of individual and community health in their campus environments; engaging students, faculty, and staff in discussions about these issues; and determining whether more thorough, systematic, and intensive community health assessments or interventions are needed in their campus settings.

Principles for assuring the health of college students: a California perspective.

Given the rapidity of change in both higher education and health care, re-examining the values and precepts that undergird the profession of college health is an ongoing need. Reported in this article are the results of a structured process in which a group of college health professionals from California, along with others interested in the health of college students, examined several trends affecting higher education and health; considered possible scenarios for these sectors; created a shared vision for the future of college health; and developed strategies useful in attaining that vision. The results of these deliberations are presented as a set of principles that, if followed, should increase the likelihood that college health centers will be responsive to user needs. Although the article is based on a California-based conference, the principles discussed are almost certainly valuable for all in college health.

Torture and war trauma survivors in primary care practice.

Close to 1 million refugees from around the world have entered the United States, fleeing repression, war, terrorism, and disease. It has been estimated that among these are thousands who have experienced torture. Many refugees and immigrants will appear in the offices of health care professionals with symptoms that may be related either directly or indirectly to torture. Both physical and psychological torture may result in long-term sequelae. Physical effects may be found in every organ system, but psychological effects are most commonly manifest in the symptoms of the post-traumatic stress disorder. For physicians to recognize how torture can affect health status, it is important to understand that history taking may be difficult and that little information may emerge that would explain the origins of scars, fractures, or disabilities. Recognizing the clues to a torture history allows physicians to assist patients in describing the trauma. In addition, knowing the subacute and chronic signs and symptoms of torture enables physicians to diagnose and treat often obscure symptoms with a much clearer understanding of the sources of the difficulty. Paying special attention to the interview process will support torture survivors in detailing often horrific events.

The health of university athletes: attitudes, behaviors, and stressors.

This study examined several aspects of the health of university athletes. Five areas of concern were targeted for investigation: general health background, use of drugs and alcohol, weight and eating behaviors, stress, and use of helping resources. The authors developed a questionnaire and used it to survey 27 varsity athletic teams at a major private university. The incidence of injuries was high; one third of the 247 student athletes surveyed reported sport-related injuries. Alcohol was much more frequently used than other drugs, and use tended to decrease during the competitive season. Significant differences between men and women athletes were found in off-season alcohol and marijuana use. Anabolic steroid abuse did not appear to be a major problem for this athlete population. Issues of diet, weight, and body image were found to be significantly different for women than for men. Although the incidence of bulimia and anorexia was low for both female and male athletes, it was clear that female athletes brought to their sport heightened concern for body image. The authors discuss the psychological and interpersonal implications that these findings have for the adjustment of female athletes. Injury and academics were perceived as the most stressful factors for both men and women, whereas weight and diet issues were a major stress factor for one third of the women. Given these data, specific recommendations are made for health professionals who work with college athletes.

Sex differences in the impact of work on physical and psychological health.

This study examines the different impact of work on the physical and psychological health of women and men: how men and women in business and managerial professions perceive the pressures of their work environments and what the consequences (e.g., depression, anxiety, somatic complaints, and drug and alcohol abuse) of these stresses are for the individual. The results indicate significant differences between the working men and women studied in job tension, coping strain, role conflict, and health status but not in styles of coping.

A committee on well-being of medical students and house staff.

A committee on well-being of medical students and house staff was established in a university medical center to address some of the socioemotional aspects of medical education and training. The overall goal was to influence the learning climate in ways that would enhance positively the educational experience. Several problem areas were identified. They included poor communication, stressful effects of medical education both on self and on relationships, a need for advocacy, and a lack of support for house staff members. A series of programs were designed and implemented in response to these issues. With institutional support, a committee on well-being may serve as an effective approach in alleviating some of the stresses of the medical training process.

Guidelines for competency-based instruction in psychiatry.

This paper presents guidelines for teachers who wish to design competency-based instructional activities in psychiatry. Developed over a 3 year period, these guidelines outline the methods used by teachers to construct competency-based seminars and clinical rotations. The guidelines describe the process of stating knowledge objectives, performance objectives and experiential objectives for psychiatric trainees to attain prior to completion of training in a given area. Selection of appropriate teaching strategies as well as criteria and conditions for assessment of the residents' abilities are also reviewed. Comments regarding the authors' experience using these guidelines with teachers are offered.

Fetal trigeminal rhythm.

A case of fetal trigeminal cardiac arrhythmia in labor is presented. The literature on fetal cardiac arrhythmias is reviewed. The significance and management of abnormal fetal rhythms in labor is discussed. The majority of fetal arrhythmias in labor do not require therapy.

Effects of magnesium sulfate on toxemic patients in labor.

One hundred forty-four toxemic patients were studied by continuous electronic maternal and fetal monitoring. Ninety-seven were treated by intravenous bolus of 2 g MgSO4 every 1-2 hours, and 47 by intravenous drip MgSO4 at a rate of 1 g/hour. Clinical doses of MgSO4 do not affect maternal ECG, temperature, uterine contractions, or fetal heart rate. Intravenous bolus administration is frequently associated with slowing of maternal respirations and hypotension and occasionally with transient apnea.

Moderate fetal bradycardia.

Fetal heart rates in the range of 100 to 119 beats per minute have been defined as moderate bradycardia. Twenty-five of 1,386 patients monitored during a 1 year period have manifested persistent moderate bradycardia. Moderate bradycardia is apparently related to fetal head compression, often in situations of relative cephalopelvic disproportion. It is alleviated by rotation of the vertex and does not appear to adversely affect the newborn infant.

Competency-based psychiatric education.

The focus of training in a competency-based residency program is on ensuring that all residents attain prespecified levels of competence for particular objectives in each training activity. The authors examine the components of a competency-based program and describe the phases of development that their department went through in creating such a program. They conclude that the competency-based training model directly faces the issue of certifying competence by holding itself accountable in a demonstrable way for ensuring that its residents have mastered specific areas of knowledge, skills, and attitudes.

The application of competency-based education to consultation-liaison psychiatry: III. Implications.

In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.

The application of competency-based education to consultation-liaison psychiatry: I. Data gathering and case formulation.

In the first of three papers, the authors present a competency-based model for training in consultation-liasison psychiatry which addresses the issues of how residents are taught to collect and formulate patient data. This model emphasizes the use of behavioral statements to describe the process of how a consultation is done. By comparing the resident's performance with prestated behavioral objectives, a method for residency supervision is offered. The second paper carries this one step further with the application of the model to clinical intervention strategies. The final paper discusses the implications of this approach to some of the issues that surround residency training in this field.

The application of competency-based education to consultation-liaison psychiatry: II. intervention knowledge and skills.

Although psychological and pharmacological intervention is an important aspect of the treatment of patients seen in consultation on medical and surgical wards, little attention has been directed to the method of training psychiatric residents in these areas. In this paper, the authors continue the application of the competency-based model of training to the problems of clinical intervention. Behavioral objectives are presented as a focus for residency supervision and their application to a clinical situation is illustrated. The objectives are designed to consider the activities of the consulting psychiatrists as he relates to the patient as well as other members of the treatment milieu.