We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting

The present study assesses barriers to identification and referral of domestic violence (DV) victims by staff at a health care institution following a 3-hr DV training program in which 752 health care providers participated. Focus groups are conducted with staff in hospital departments that serve a high volume of women. Responses to focus group questions identify system-wide and individual hospital department barriers. These barriers have implications for health care organizations trying to implement DV screening protocols through training alone to change staff behavior in diverse clinical settings. Limitations of this study and future research recommendations are also discussed.     

Subacute fatal aluminum poisoning in dialyzed patients: post-mortem toxicological findings

The population of Cura?ao, Netherlands Antilles (133,000) shows a very high prevalence of end-stage renal disease (approximately 1 per 1,000). These patients are often treated chronically with haemodialysis. As the drinking water on the island is prepared by distillation of sea water, the haemodialysis fluid used to be prepared with tap water without further treatment. In 1996, the 27 patients of one of the dialysis centers on the island presented with nausea, vomiting, and hypercalcaemia in a short time span, which was initially diagnosed as 'hard water syndrome'. In spite of treatment with low-calcium dialysate, microcytic anaemia and neurological symptoms developed. Ten patients died of convulsions, sepsis, and coma. As aluminum (Al) intoxication was suspected, Al in serum (AlS) was measured. Ante mortem AlS was 808 microg/l (n = 7; range 359-1189); in the survivors AlS was 255 microg/l (n = 17; range 113-490). Normal AlS is < 10 microg/l, and <50 microg/l in asymptomatic dialyzed patients. The court requested post-mortem toxicological analysis of four patients. Al concentrations in liver, bone, and cerebral cortex were significantly increased as compared with background levels. Al intoxication was, therefore, considered to be the most likely cause of death in these patients. Investigations of the tap water supply revealed that a few weeks before the onset of the symptoms, a water conduit pipe to the dialysis unit had been replaced, which was lined with Al- and Ca-rich cement mortar. These ions leached into the distilled water and caused both Ca- and Al-intoxication through uptake from the dialysate into the patients' circulation. The symptoms of the latter were initially not recognized as they were masked by the symptoms of hypercalcaemia.     

My life as a community activist

The author recounts his life and how it led to a career as an activist community psychology practitioner with a focus on issues of social justice. He tells of his upbringing, family and education as the background to a series of positions in various systems. The story shows an evolution from working with individuals to working with whole communities; and from working on issues of remediation and treatment to working on prevention and finally empowerment, social change, and social justice. The story of his life parallels the social issues of the time. Throughout the accounting of his life the author raises the questions that he was struggling with. The sequence of those questions is as follows: Can I emerge as a community leader? What do I do with that leadership? Can my work in psychology have any relationship to the larger social issues? Can my politics, social action and beliefs in social justice, be integrated with my mental health job? Can I find a setting that will tolerate and permit me to do work to create social change and reduce oppression? Can we build competent helping systems with partners from many sectors? Can we mobilize whole communities around community crises? Can we use coalition building to make a difference in quality of life? And finally: How can our spirituality inform our work for social change and how can our social change work to inform our spirituality?     

Business Power and the Politics of Postneoliberalism: Relations Between Governments and Economic Elites in Bolivia and Ecuador

The article analyzes and compares the dynamics of business‐government relations in Bolivia and Ecuador during the presidencies of Evo Morales and Rafael Correa. It specifically traces the shift from confrontation to rapprochement to a fairly stable pattern of negotiation and dialogue that characterizes the two governments' interaction with core business elites. Drawing on the structural and instrumental power framework developed by Tasha Fairfield, it proposes an explanation that accounts for this overall shift as well as for the main differences between the two countries. In a nutshell, the article argues that the business elites' response to a severe loss of instrumental power and the governments' response to the persistent structural power of business combined to cause the shift toward negotiation and dialogue. The article also probes the plausibility of this power‐based explanation by briefly comparing the two cases with other left‐of‐center governments in the region.     

Succession pattern of carrion-feeding insects in Paramo, Colombia

The minimum postmortem interval can be estimated based on knowledge of the pattern of insect succession on a corpse. To use this approach requires that we take into account the rates of insect development associated with particular climatological conditions of the region. This study is the first to look at insect succession on decomposing carcasses in the high altitude plains (Paramo) in Colombia, at 3035 m above sea level. Five stages of decomposition were designated with indicator species identified for each stage: Callíphora nigribasis at the fresh stage; Compsomyiops verena at the bloated stage; Compsomyiops boliviana during active decay; Stearibia nigriceps and Hydrotaea sp. during advanced decay and Leptocera sp. for dry remains. A succession table is presented for carrion-associated species of the region, which can be used for estimating time since death in similar areas. Compsomyiops boliviana is reported for the first time in Colombia.     

Quasi-experimental designs for community-level public health violence reduction interventions: a case study in the challenges of selecting the counterfactual

Objectives

We highlight the importance of documenting the step-by-step processes used for the selection of comparison areas when evaluating a community-level intervention that targets a large-scale community.

Methods

We demonstrate the proposed method using a propensity score matching framework for an impact analysis of the Cure Violence Public Health Model in Philadelphia. To select comparison communities, propensity score models are run using different levels of aggregation to define the intervention site. We discuss the trade-offs made.

Results

We find wide variation in documentation and explanation in the extant literature of the methods used to select comparison communities. The size of the unit of analysis at which a community is measured complicates the decision processes, and in turn, can affect the validity of the counterfactual.

Conclusions

It is important to carefully consider the unit of analysis for measurement of comparison communities. Assessing the geographic clustering of matched communities to mirror that of the treated community holds conceptual appeal and represents a strategy to consider when evaluating community-level interventions taking place at a large scale. Regardless of the final decisions made in the selection of the counterfactual, the field could benefit from more systematic diagnostic tools that document and guide the steps and decisions along the way, and ask: “could there have been another way of doing each step, and what difference would this have made?” Overall, across community-level evaluations that utilize quasi-experimental designs, documentation of the counterfactual selection process will provide a more fine-grained understanding of causal inference.