Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Evaluating the Potential for Unintentional Occupational Exposure to Fentanyl and Fentanyl Analogues Among Medicolegal Death Investigators and Autopsy Technicians

Recent increases in deaths in the United States from synthetic opioids such as fentanyl and fentanyl analogues (fentanyls) have raised concerns about possible occupational exposures to these potent agents. Medicolegal death investigators and autopsy suite staff might perform job tasks involving exposure to fentanyls. The potential for exposure to fentanyls among medicolegal death investigators and autopsy technicians at a state medical examiner's office was evaluated through review of caseload characteristics, injury and illness logs, and procedures and policies and discussions with management and employee representatives. The evaluation showed that this medical examiner's office had low potential for work-related exposure to fentanyls; its standard operating procedures and personal protective equipment requirements should reduce the potential for occupational exposure. Medicolegal death investigation agencies can develop and implement guidance to control exposures and provide workforce education and training to reduce the potential for work-related exposure to fentanyls.     

Adolescents’ Educational Outcomes: Racial and Ethnic Variations in Peer Network Importance

Little attention has been paid to the role of peer social capital in the school context, especially as a predictor of adolescents’ academic outcomes. This study uses a nationally representative (N = 13,738, female = 51%), longitudinal sample and multilevel models to examine how peer networks impact educational achievement and attainment. Results reveal that, in addition to those factors typically associated with academic outcomes (e.g., school composition), two individual-level peer network measures, SES and heterogeneity, had significant effects. Although educational attainment was generally worse in low SES schools, for all ethnic groups higher attainment was associated with attending schools with higher concentrations of minority students. At the individual level, however, membership in integrated peer networks was negatively related to high school graduation for Asians, Latinos, and non-Hispanic whites, and to GPA for Asians and Latinos, as only African-American achievement increased in more racially/ethnically heterogeneous peer networks. Our results suggest that co-ethnic and co-racial peer friendship networks should not be viewed as obstacles to the educational accomplishments of today’s youth. In fact, in many cases the opposite was true, as results generally support the ethnic social capital hypothesis while providing little corroboration for oppositional culture theory. Results also suggest that co-racial and co-ethnic ties may mediate the negative effects of school choice, or more specifically of between-school socioeconomic segregation. Consequently, we conclude that school policies aimed at socioeconomic desegregation are likely to beneficially affect the academic outcomes of all race/ethnic groups.

Ebola vaccines,evidentiary charisma and the rise of global health emergency research

Abstract

The 2013–2016 West African Ebola outbreak was both a catastrophic public health disaster and a rare research opportunity. This paper analyses how the tensions between the humanitarian imperatives of disease control and the epistemic conventions of bioscientific inquiry played out in the accelerated development, testing and licensure of Ebola vaccines. Beginning with the epidemiological projections of the disease’s spread, the paper develops the notion of evidentiary charisma to capture the power of experimental designs and data packages to marshal public health salience, recruit moral legitimacy and short-circuit scientific contestation. Attention to the charismatic dimensions of Ebola vaccine R&D helps to unpick the simultaneous appeals to exception and convention in the unfolding of a global health crisis, and to trace the normative and technical contours of the emerging paradigm of emergency research.     

On scale work: evidential practices and global health interventions

Abstract

Scalability can be understood as the ability to expand without changing. Yet, expanding an intervention to a global scale, we suggest, is a significant and difficult accomplishment. In this paper we propose to explore the kind of evidential exigencies that this accomplishment involves. To do so, we focus on the field of global health and examine how child immunization against the pneumococcus bacterium has been scaled up in low-income countries. The paper first attends to initial epidemiological scrutiny that revealed the existence of a large-scale public health problem and the possibility of an expandable solution (vaccination). It then describes the set-up of a funding arrangement using overseas aid to purchase vaccine doses manufactured by pharmaceutical companies, before paying attention to various frictions that affect the widespread use of pneumococcal vaccines. In these different moments through which scalability is accomplished, always partially and temporarily, we show that a dual activity can be witnessed, a pivoting between referential work and forward projection. To conclude, we suggest that scalability is more usefully approached as a form of expansion that is always attentive to the possibilities of change.     

Just sick of it? Health and political trust in Western Europe

This article explores two theoretical possibilities for why personal health may affect political trust: the psychological‐democratic contract theory, and the role of personal experience in opinion formation. It argues that citizens with health impairments are more likely to experience the direct effects of political decisions as they are more dependent on public health services. Negative subjective evaluations of public services can lower trust levels, especially if people's expectations are high. Using European Social Survey data, the association between health and trust in 19 Western European states is analysed. The results indicate that people in poor health exhibit lower levels of trust towards the political system than people in good health. The differences in trust between those in good and poor health are accentuated among citizens with left‐leaning ideological values. The results suggest that welfare issues may constitute a rare context in which personal, rather than collective, experiences affect opinion formation.     

Public health as an agent of internal colonialism in interwar Czechoslovakia: shaping the discourse about the nation’s children

Shmidt’s text discusses the specifics of internal colonialism in the discourses and practices of the dominant group (Czechs) concerning Slovaks and Rusyns, ethnic groups from the peripheral, eastern areas of interwar Czechoslovakia. By targeting the reproductive patterns of these groups, seen as undesirable by the authorities, internal colonialism shaped the discourse about children by consistently opposing the normalized childhood inside the nation to the supposedly abnormal child development outside the civilizing process. Shmidt focuses on three interwar projects aimed at introducing new public health practices as an ‘infrastructure of dependence’ with regard to the peripheral groups. Being directly supported by the Rockefeller Foundation, these projects contributed to building the new Czechoslovak nation and securing its international legitimacy.     

A Concurrent Analysis of Three Institutions that Transform Health Technology‐Based Ventures: Economic Policy,Capital Investment,and Market Approval

Drawing on institutional theory, this article articulates qualitative insights from a program of research on Canadian health technology‐based ventures to examine the rules that characterize economic policy, capital investment, and regulatory approval as well as the way these institutions enable and constrain the development of ventures at an early stage. Our findings clarify how economic policy integrates these ventures into the entrepreneurial domain, how capital investment configures them for economic value extraction, and how regulatory approval fully releases their market value. These findings help to revisit current policy modernization initiatives by calling attention to the convergence among the three institutions. Rather than operating solely as a source of constraints, these institutions provide a highly integrated market‐oriented space for health technology‐based entrepreneurial activities to unfold.     

A Bridge over Troubled Water: Managing Parties’ Mental Illness in Mediation

One in five individuals in society has or will have a mental illness at some point in his or her lifetime. Conflict resolution theory, however, largely assumes that all individuals operate within the range of behaviors considered mentally healthy. Evidence suggests that professionals who deal with conflict, however, may have to deal with individuals who have mental health problems more frequently than would be the statistical norm. Clearly then, new theories of practice and norms of mediator behavior are needed to respond to the distinctive challenges presented by engaging with those who face mental health difficulty. This paper surveys the research on how people with mental health challenges approach and respond to conflict and provides practical advice to conflict resolution professionals on how to recognize and tailor their approach to meet the needs of these individuals.     

大学校园心理健康文化创建探讨

大学校园文化建设是学生教育工作的重要组成部分,校园文化活动是学生教育的重要载体,创建校园心理健康文化对学生心理健康教育工作有巨大的推动作用。通过对广大高校校园心理健康活动情况的调查,心理健康活动的主要方式具有不同的功能和特点,应该根据实际情况合理运用不同活动方式,创建品牌化的校园心理健康文化。