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THAT USED TO BE US: HOW AMERICA FELL BEHIND IN THE WORLD IT INVENTED AND HOW WE CAN COME BACK

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Anderson reviews THAT USED TO BE US: HOW AMERICA FELL BEHIND IN THE WORLD IT INVENTED AND HOW WE CAN COME BACK by Thomas L. Freidman and Michael Mandelbaum.
De la ncessit du cadre d'intervention avec les familles dites maltraitantes

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A global leader in serving libraries of all types, ProQuest LLC (“ProQuest”) supports the breadth of the information community with innovative discovery solutions that power the business of books and the best in research experience. More than a content provider or aggregator, ProQuest is an information partner, creating indispensable research solutions that connect people and information. Through innovative, user-centered discovery technology, ProQuest offers billions of pages of global content that includes historical newspapers, dissertations, and uniquely relevant resources for researchers of any age and sophistication—including content not likely to be digitized by others.
PAKISTAN AND US PARTNERSHIP: COST OR BENEFIT?

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Despite the long involvement, the US-led military campaign has not succeeded in defeating the Taliban and Al Qaeda or restoring political stability in the country. The purpose of this article is four-fold: (1) to examine why the Bush administration declared war on the Taliban, and why it initially appeared successful, but became disappointing as the war continued; (2) to look at the Obama administration's new strategy to end the Taliban/Al Qaeda threat launched in Afghanistan and why it has not achieved its goals; (3) to discuss the opportunities still favoring the continued war, and the impediments to realizing US war goals; and (4) to offer reasons why the administration may have to consider pulling out of Afghanistan while limiting itself to drone attacks, and leaving the responsibility of fighting the insurgents with the Afghan security forces if it wants to establish a stable Afghanistan where all Afghans can live in dignity and freedom. [PUBLICATION ABSTRACT]
THE SHARED TRAJECTORIES OF AL QAEDA AND THE KU KLUX KLAN

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This article compares the numerous philosophical, organizational and operational parallels between Al Qaeda, a religious supremacist organization, and the Ku Klux Klan, a racial supremacist organization. Unlike Germany and Japan after WWII, where pockets of resistance were quelled quickly, the U.S. military presence in Iraq and Afghanistan has met continued resistance. This prolonged resistance is compared to the Klan in the U.S. South. The Klan fought inclusive democracy and pluralism for more than a century. In the South, White Christians ultimately opposed the Klan to the point where several states that had been KKK strongholds voted for President Barack Obama in 2008. The emergence of the Awakening Movement in Iraq, a Sunni Muslim-based resistance to Al Qaeda intimates that Al Qaeda may also eventually find itself uprooted by the power of rule of law and an enlightened populace that no longer subscribes to the maxim that "the enemy of my enemy is my friend." [PUBLICATION ABSTRACT]
CIVIL SOCIETY ORGANIZATIONS CONTRIBUTION TO THE UNIVERSAL DECLARATION ON THE HUMAN RIGHT TO PEACE

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The article reviews the Spanish Society for International Human Rights Law (SSIHRL) and 1795 associated CSO activities (2005-2011) to translate peace into the legal category of human right and to encourage the official codification process undertaken since 2010 by the UN Human Rights Council and its Advisory Committee. It is expected that the General Assembly will approve a Universal Declaration on the Human Right to Peace taking into account the Santiago Declaration on the Human Right to Peace adopted on 10 December 2010 by the international civil society-as well as its preparatory work. [PUBLICATION ABSTRACT]
THE STEPS TO WAR: AN EMPIRICAL STUDY

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Izbicki reviews THE STEPS TO WAR: AN EMPIRICAL STUDY by Paul D. Senese and John A. Vazquez.
PEACE IN AN IMBALANCED WORLD

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Document Overview:

A global leader in serving libraries of all types, ProQuest LLC (“ProQuest”) supports the breadth of the information community with innovative discovery solutions that power the business of books and the best in research experience. More than a content provider or aggregator, ProQuest is an information partner, creating indispensable research solutions that connect people and information. Through innovative, user-centered discovery technology, ProQuest offers billions of pages of global content that includes historical newspapers, dissertations, and uniquely relevant resources for researchers of any age and sophistication—including content not likely to be digitized by others.
Substantial Changes in Prescription Recommendations for Bipolar Disorder in Canada: 2002-2010

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We examined trends in prescription recommendations for treatment of bipolar disorder (BD) in Canada during 2002-2010. Data collected by IMS Brogan in a database known as the Canadian Disease and Therapeutic Index were used for this analysis. These data are collected from a representative physician panel who record each drug recommendation and reason for recommendation in their practices for 2 consecutive days each calendar quarter of the year. Prescription patterns of medications for BD, including lithium, anticonvulsants, antipsychotic agents, anxiolytics, and antidepressants, were evaluated both for general practitioners and for specialists. The number of prescription recommendations for BD increased by 72.1% from 2002 to 2009, and then dropped by 24.8% from 2009 to 2010. This increase from 2002 to 2009, and subsequent decrease from 2009 to 2010, was observed for all classes of medications. The overall increase from 2002 to 2010 was statistically significant for the atypical antipsychotics (P = 0.04). The largest change for an individual drug during this period was a 438% increase in recommendations for quetiapine (P = 0.01). The number of prescription recommendations for BD increased substantially from 2002 to 2009 and sharply dropped in the following year. These results suggest that the influence of the concept of the bipolar spectrum and its promotion may have resulted in a substantial increase in treatment that has recently begun to wane.
The Enablers and Barriers to the Use of Direct Observation of Trainee Clinical Skills by Supervising Faculty in a Psychiatry Residency Program

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Studies have reported that medical trainees do not get sufficient direct observation. Our study aimed to determine the frequency of direct observation and the enablers and barriers to direct observation in the department of psychiatry at a large Canadian university. Focus groups and interviews explored the role and use of direct observation, followed by a survey both of faculty and of residents. Direct observation was used in various contexts in the residents' last rotation. Missed opportunities are identified. Enablers include financial compensation, guidelines, and a discussion at the beginning of each clinical rotation. Barriers are identified at the resident, faculty, and administrative levels. Direct observation is used in many contexts in psychiatric training. While there are barriers which limit its use, our data indicate numerous potential enablers and missed opportunities for more observation.
Suicidal Behaviours in Affective Disorders: A Deficit of Cognitive Inhibition?

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Suicide has been related to affective disorders. We hypothesized that suicide could be associated with cognitive inhibition deficit. Our study aimed to systematically review all published articles that examined the relation between cognitive inhibition deficit and suicidal behaviours (that is, suicide attempt or suicidal ideation) in patients with affective disorders. We performed an English and French MEDLINE and EMBASE search, ranging from 1970 to 2010, indexed under the MeSH terms of suicide, neuropsychology, neuropsychological tests, and executive function, combined with the following title and abstract terms: neuropsychological functions, executive functioning, and executive performance. Among the 164 selected studies, 9 observational studies met the selection criteria and were included in the final analysis. The number of participants ranged from 57 to 244 (28% to 66%, respectively, were men). Executive dysfunction was more frequently found among patients with suicidal behaviours. In particular, higher cognitive inhibition deficit was observed in depressed subjects with suicide behaviours, compared with depressed subjects without any suicidal behaviour. The results of the meta-analysis showed a higher impairment in inhibition score, according to the number of perseverations in the Wisconsin Card Sorting Test (Cohen d = 0.68) than in inhibition according to the time needed to perform the TrailMaking Test part B (d = 0.01) among patients with suicidal behaviour, compared with patients with no suicidal behaviour. This systematic review and meta-analysis showed a positive association between cognitive inhibition deficit and suicide attempts in patients with affective disorders. Future research should examine whether cognitive inhibition deficit precedes the suicidal behaviour.
La consommation d'alcool et de drogue des tudiants suite la fusillade de Dawson : une analyse diffrencie selon le sexe

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Les analyses statistiques de calculs de frquences, de corrlations et de rgressions logistiques et multiples ont t ralises grce au logiciel SPSS version 14,0 pour Windows, avec niveau de significativit retenu de 0,05. Seuls les troubles anxieux et dpressifs, la dpendance l'alcool ou aux drogues, ainsi que les caractristiques sociodmographiques ont t conservs aux fins de cette tude.\n D'un point de vue thorique, ces rsultats portent croire que l'automdication des symptmes d'ESPT est une explication plausible des comportements de consommation d'alcool suite la fusillade.
Risk Assessment Instruments in Clinical Practice

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To determine whether the items in one of the most widely validated instruments of violence risk assessment, the Historical-Clinical-Risk Management-20 (HCR-20), are used in review board hearings to assess the risk of violence by people found Not Criminally Responsible on account of Mental Disorder (NCRMD). This study was conducted from October 2004 to August 2006 in Quebec's sole forensic psychiatric hospital and 2 large civil psychiatric hospitals designated for the care of people declared NCRMD in the Montreal metropolitan area. The risk assessments presented by clinicians at annual review board hearings and the boards' rationale for the release or detention of people found NCRMD were contrasted with the risk assessments conducted by the research team using the HCR-20. The final sample was comprised of 96 men. Very few of the risk factors identified by prior research (HCR-20 items) were mentioned in the hearing process, whether in clinical reports, discussions during the hearing, or in the disposition justification. The findings confirm that there remains a significant gap between research evidence and risk assessment practice.
Factor Structure of Borderline Personality Disorder Symptomatology in Adolescents

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To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.
A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors Before and After Introduction of Generic Equivalents

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Generic drugs are less expensive than their branded equivalents, but receive limited promotion. This study sought to examine how user rates of individual selective serotonin reuptake inhibitors (SSRIs) changed after the introduction of their generic equivalents. Administrative health and census data were used to examine the rates of use of all 6 SSRIs from 1996 to 2009 in the province of Manitoba (population of 1.2 million). The primary outcome measure was a comparison of the rates of use in the pre- and post-generic periods, using generalized estimating equations. Secondary analyses were stratified by specialty of physician prescriber. Escalating rates of use of branded SSRIs in the pre-generic period significantly decreased after generic versions became available (all Ps 0.001). Incident use of sertraline and paroxetine continued to decrease throughout the post-generic period (1.5% and 1.9% quarterly decreasing rates, respectively). During the years when generic sertraline, fluoxetine, and fluvoxamine were available, their use declined while branded paroxetine and citalopram use continued to increase. Use of branded citalopram, sertraline, and paroxetine prescribed by general practitioners (GPs) increased at rates significantly higher than when prescribed by psychiatrists (all Ps 0.001). The introduction of cheaper generic alternatives of SSRIs paradoxically resulted in their use diminishing rather than increasing. With the exception of escitalopram, branded SSRIs tended to be preferentially used, compared with available less expensive generic SSRIs. These patterns were more pronounced for prescriptions by GPs.
Stepped Care: A Method to Deliver Increased Access to Psychological Therapies

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To introduce stepped care as a method of organizing the delivery of treatments, and to consider the factors necessary for implementation. Stepped care is described within the context of strategies such as collaborative care that aim to increase access to mental health care through the improved coordination of care between primary and specialist mental health services. Results from the implementation of stepped care in the United Kingdom and elsewhere are used to highlight the factors required for introducing stepped care into routine services. Issues to address when implementing highvolume services for common mental health problems are derived from this experience. Stepped care sits within the continuum of organizational systems, from situations where responsibility rests almost entirely with primary care clinicians to systems where all patients are managed by specialists for the entire duration of their treatment. Its core principles of delivering low-burden treatments first, followed by careful patient progress monitoring to step patients up to more intensive treatment, are easy to articulate but lead to considerable implementation diversity when services attempt to work in this manner. Services need to ensure they have specific staff competency training, including skills in delivering evidencebased treatments, access to telephony, and smart patient management informatics systems. Stepped care can provide the delivery system for supported self-management. To be successful, health systems need high levels of clinical outcome data and appropriately trained workers. Further attention is required to ensure equity of access and to reduce patient attrition in these systems.