Peter Elsass

Anthropological Advocacy: A Contradiction in Terms? [and Comments]

This paper is an attempt o integrate the discussion of advocacy in anthropology, as recently propounded by Robert Paine and others, with the broader debate on anthropological practice. The point is made that it is impossible to deal with advocacy without considering the nature of anthropological representation i general. On the basis of personal experience with the Arhuacos of Colombia, we argue that the rationale for advocating a particular cause can never be anthropological. Anthropology seeks to comprehend the context of local interests, while advocacy implies the pursuit of one particular interest. We also argue, however, that anthropology may provide an important background for engaging in advocacy, which in some cases may present itself as a moral imperative.

Substandard emergency obstetric care - a confidential enquiry into maternal deaths at a regional hospital in Tanzania.

Objective  (i) To identify clinical causes of maternal deaths at a regional hospital in Tanzania and through confidential enquiry (CE) assess major substandard care and make a comparison to the findings of the internal maternal deaths audits (MDAs); (ii) to describe hospital staff reflections on causes of substandard care.

Psychopathy as a Risk Factor for Violent Recidivism: Investigating the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP) in a Forensic Psychiatric Setting

A robust relationship has been established between psychopathy and violence, and psychopathy is considered essential in the process of violence risk assessment. This study presents data on a patient sample from a forensic psychiatric unit in Denmark. All patients were assessed for psychopathy using the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP). After a follow-up period of 5.7 years, recidivism outcomes were obtained from the Danish National Crime Register. Both psychopathy measures were related to a more severe and versatile criminal career as well as to violent recidivism. Overall, the predictive accuracy of violent recidivism of the two measures was good, and no significant difference was found in terms of predictability. The newly developed CAPP could be a promising clinical risk management tool in terms of its comprehensiveness. Its validity needs to be further explored, but at least its ability to predict violence similar to the PCL:SV is supported by the present study.

Advanced Life Support in Obstetrics (ALSO) and post‐partum hemorrhage: a prospective intervention study in Tanzania

Objective. To evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of post‐partum hemorrhage (PPH) at a regional hospital in Tanzania. Design. Prospective intervention study. Setting. A regional, referral hospital. Population. A total of 510 women delivered before and 505 after the intervention. Methods. All high‐ and mid‐level providers involved in childbirth at the hospital attended a two‐day ALSO provider course. Staff management was observed and post‐partum bleeding assessed at all vaginal deliveries for seven weeks before and seven weeks after the training. Main Outcome Measures. PPH (blood loss ≥500ml), severe PPH (blood loss ≥1000ml) and staff performance to prevent, detect and manage PPH. Results. The incidence of PPH was significantly reduced from 32.9 to 18.2%[RR 0.55 (95%CI: 0.44–0.69)], severe PPH from 9.2 to 4.3%[RR 0.47 (95%CI: 0.29–0.77)]. The active management of the third stage of labor was also significantly improved. There was a significant decrease in episiotomies. By visual estimation, staff identified one in 25 of the PPH cases before the ALSO training and one in five after the training. A significantly higher proportion of women with PPH had continuous uterine massage, oxytocin infusion and bimanual compression of the uterus after the training. Conclusions. A two‐day ALSO training course can significantly improve staff performance and reduce the incidence of PPH, at least as evaluated by short‐term effects.

Risk Assessment: The Value of Structured Professional Judgments

International research suggests that using formalized risk assessment methods may improve the predictive validity of professionals’ predictions of risk of future violence. This study presents data on forensic psychiatric patients discharged from a forensic unit in Denmark in year 2001–2002 (n =107). All patients were assessed for risk of future violence utilizing a structured professional judgment model: the HCR-20 violence risk assessment scheme. After a follow-up period of 5.6 years, recidivism outcome were obtained from the Danish National Crime Register. Overall, the predictive validity of the HCR-20 was good. The structured final risk judgment had the highest predictive accuracy of violent recidivism and was superior to the HCR-20 used in an actuarial manner. At the individual item level, a higher number of the dynamic items were significantly predictive of violent recidivism compared to static items. In sum, the findings support the use of structured professional judgment models of risk assessment and in particular the HCR-20 violence risk assessment scheme. Findings regarding the importance of the (clinical) structured final risk judgment and the individual dynamic items strengthen the use of this scheme in clinical practice.

An exploratory study of associations between illness perceptions and adjustment and changes after psychosocial rehabilitation in survivors of breast cancer

Background. Although psychosocial interventions have been found to be beneficial for cancer patients, the role of the patients’ perceptions of illness in these interventions remains unclear. We examined illness perceptions and psychological adjustment (distress and QoL) among women who had survived breast cancer and attended a psychosocial rehabilitation course. Material and methods. From an ongoing longitudinal study, we used data from two sub-studies with a total of 177 survivors (145 from the descriptive study and 32 from the randomised trial). The survivors from the descriptive study and the half of the randomised survivors attended a 1-week rehabilitation course, whereas the other half of the randomised survivors only received standard care (no intervention). All survivors filled out a questionnaire 2.5 weeks before and one and six months after the course. Results and discussion. No differences in the change of illness perceptions and the level of psychological adjustment were observed between the three groups of survivors between baseline and one and six months of follow-up. Baseline analyses showed that illness perceptions were associated with distress and QoL. This study indicates that illness perceptions are associated with adjustment; however, illness perceptions did not change after participation in a one-week multi-component rehabilitation course.

Who participates in a randomized trial of mindfulness-based stress reduction (MBSR) after breast cancer? A study of factors associated with enrollment among Danish breast cancer patients.

Discussion regarding the necessity to identify patients with both the need and motivation for psychosocial intervention is ongoing. Evidence for an effect of mindfulness‐based interventions among cancer patients is based on few studies with no systematic enrollment.

Effect of mindfulness-based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: Results of a randomized controlled trial

Abstract Background. Women with breast cancer experience different symptoms related to surgical or adjuvant therapy. Previous findings and theoretical models of mind–body interactions suggest that psychological wellbeing, i.e. levels of distress, influence the subjective evaluation of symptoms, which influences or determines functioning. The eight-week mindfulness-based stress reduction (MBSR) program significantly reduced anxiety and depression in breast cancer patients in a randomized controlled trial (NCT00990977). In this study we tested the effect of MBSR on the burden of breast cancer related somatic symptoms, distress, mindfulness and spiritual wellbeing and evaluated possible effect modification by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing. Material and methods. A population-based sample of 336 women Danish women operated for breast cancer stages I–III were randomized to MBSR or usual care and were followed up for somatic symptoms, distress, mindfulness skills and spiritual wellbeing post-intervention and after six and 12 months. Effect was tested by general linear regression models post-intervention, and after six and 12 months follow-up and by mixed effects models for repeated measures of continuous outcomes. Effect size (Cohens d) was calculated to explore clinical significance of effects among intervention group. Finally, modification of effect of MBSR on burden of somatic symptoms after 12 months’ follow-up by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing were estimated. Results. General linear regression showed a significant effect of MBSR on the burden of somatic symptoms post-intervention and after 6 months’ follow-up. After 12 months’ follow-up, no significant effect of MBSR on the burden of somatic symptoms was found in mixed effect models. A statistically significant effect of MBSR on distress was found at all time-points and in the mixed effect models. Significant effects on mindfulness were seen after six and 12 months and no significant effect was observed for spiritual wellbeing. No significant modification of MBSR effect on somatic symptom burden was identified. Conclusion. This first report from a randomized clinical trial on the long-term effect of MBSR finds an effect on somatic symptom burden related to breast cancer after six but not 12 months follow-up providing support for MBSR in this patient group.

Impact of ALSO training on the management of prolonged labor and neonatal care at Kagera Regional Hospital, Tanzania

To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training.

HCR-20 violence risk assessments as a guide for treating and managing violence risk in a forensic psychiatric setting

Abstract Over the past decades there has been a vast development in the research into risk factors for violence and the development of risk assessment instruments. One instrument that has been given special attention is the HCR-20 violence risk assessment scheme. However, little attention has been paid to the clinical applicability of this tool, i.e. how does this assessment scheme perform when utilized in clinical practice as a tool to guide intervention and management in order to alleviate risk of violent behaviour? The present study was a true prospective study into the utilization of the HCR-20 as a clinical routine. Data on forensic psychiatric patients (n = 81) from a forensic unit in Denmark are presented. As part of a clinical routine all patients were assessed for risk of future violence utilizing the structured professional judgement model, the HCR-20. Outcome measures were aggressive episodes during hospitalization and new convictions post discharge. The predictive validity of the HCR-20 was lower compared with previous findings. It is argued that this does not necessarily indicate poor predictive accuracy of the HCR-20. Rather, it may indicate that the HCR-20 is suitable for guiding risk management in order to prevent violent behaviour.