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In Leviathan, Hobbes uses his new theory of authorization to explain the nature of corporate persons. While On the Citizen lacks the theory of authorization, it includes several accounts of corporate persons. In On the Citizen, Hobbes suggests that a group forms a corporate person when its members accept obligations to support a sovereign, when the members are all compelled to act in concert, or when the members of the group adopt voting rules for making decisions. Hobbes also uses his analysis of the commonwealth as a corporate person to argue for the sovereign’s immunity in On the Citizen much as he does in Leviathan. Generally speaking, the Leviathan account of corporate persons is superior to the ones in On the Citizen. However, Hobbes needs the voting rules account from On the Citizen in order to explain how democratic and aristocratic assemblies can serve as sovereigns. Since he tries to replace the voting rules account with the authorization account in Leviathan, this raises a problem for him that he does not appreciate.
De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.
The discussion of the achievements and limitations of the strategies prioritised in global mental health that has taken place in recent years contributed to a unified vision for action that addresses the gaps still existing on prevention, treatment, quality of care and human rights protection. This editorial presents four reflections on the impact of this vision on the definition of future priorities, particularly in the areas of policy implementation, services reconfiguration and organisation, human rights and research. It concludes that further debate is needed to redefine the balance between priorities and strategies that can better promote an effective response to the needs of low and middle income countries, and to ensure an efficient coordination of efforts in the future.
Elder law is often approached in terms of a ‘body’ of law. In this article, I argue for a contextualised and externalised perspective on the ageing individual as the subject of elder law. Elder law relates to the implications of law as an institutionalisation of society seen through the lens of older persons. The aged subject is a contested and differentiated social construct to be studied in relation to an externalised social ‘problem’ and properly contextualised. Whereas the ageing individual in the context of labour law and anti-discrimination regulation turns out to be remarkably young, the specific history of LGBT persons in society comes to the fore in cases where age intersects with a ground such as sexual orientation. The ‘ageing’ worker must thus be understood in relation to work as the dominant distributive order in society, and in relation to institutions and developments associated with work. Due to the role of age as a traditional social stratifier, the prohibition against age discrimination has been given a weaker format than have prohibitions against other kinds of discrimination, and the ban on ageism has failed to achieve a clear legal status. Deficiencies in the measures taken against age discrimination are also evident in their incapacity to address situations where age intersects with other grounds, resulting in a compartmentalised application and interpretation of discrimination bans, leaving vulnerable sub-groups without protection. In sum, elder law is very much a field in process and – although arguing for the added value of a contextualised perspective – it may for the time being suffice to say that ‘elder law is what elder law researchers do’.
The organizational model for Disabled Persons' Organizations as rights advocates, which is embedded in the UN Convention on the Rights of Persons with Disabilities, reflects a larger global trend within the international community promoting rights advocacy as the only legitimate form of civic participation, regardless of the people represented, the issue being addressed, or local history or tradition. This singular script for civil society has its origins in Cold War politics in the West, where the promotion of a free civil society throughout the Global South was used as a tool for defeating authoritarian regimes in the non-West. This history can best be understood using new institutional theory from organizational sociology, which shows how fields are governed by specific norms. What new institutional theory often ignores, however, is that organizations often belong to two or more fields at once. Disabled Persons' Organizations in Nicaragua are part of the international disability-rights movement, but they are also part of local norms civil society. Nicaraguan solidaridad has structured local civil society since the Nicaraguan Revolution (1979), when the population mobilized through “mass” organizations to promote the “common good.” This legacy leaves local disability associations caught between two institutional fields.
One organization, the Association of the Blind, finds a way of blending the norms of the international disability-rights movement with the norm of solidaridad in local civil society. Their founder, who is fully aware of international disability NGOs’ attempts to change the practices of his disabled-persons’ organization, takes a nuanced approach that seeks to link disability rights to the continuation of the association’s history of self-help by providing education and employment services to persons with visual impairments. Using this blended approach, the association is able to generate new interest in a job training and placement services. But, they soon realize they need more resources to keep up with the demand from local employers for more persons with disabilities. The Association of the Blind then turns to international donors in the hope that they will see their program as advancing disability rights in a concrete, material way. This new proposal, however, is universally rejected as not conforming sufficiently with the international norm of DPOs maintaining a singular focus on advocating for disability rights.
Studies on the intake of different types of carbohydrates and long-term mortality are sparse. We examined the association of starch, total and each type of sugar and free sugars with the risk of total and cause-specific mortality in a cohort of the general population in Japan. Study subjects were 29 079 residents from the Takayama Study, Japan, who responded to a self-administered questionnaire in 1992. Diet was assessed by a validated FFQ at the baseline. Mortality was ascertained during 16 years of follow-up. We noted 2901 deaths (974 cancer related and 775 cardiovascular related) in men and 2438 death (646 cancer related and 903 cardiovascular related) in women. In men, intake of starch was inversely associated with total mortality after controlling for covariates (hazard ratio (HR) for the highest quartile v. lowest quartile: 0·71; 95 % CI 0·60, 0·84; Ptrend < 0·001). Intakes of total sugars, glucose, fructose, sucrose, maltose and free and naturally occurring sugars were significantly positively associated with total mortality in men (HR for the highest v. lowest quartile of total sugar: 1·27; 95 % CI 1·12, 1·45; Ptrend < 0·0001). Similar relations were observed for cardiovascular mortality and non-cancer, non-cardiovascular mortality in men. In women, there was no significant association between any type of carbohydrates and mortality except that intake of free sugars was significantly positively associated with total and non-cancer, non-cardiovascular mortality. Data suggest that the high intake of starch reduces mortality, whereas the high intake of sugars, including glucose, fructose and sucrose, increases mortality in Japanese men.
Scientific societies recommend early interaction between oncologic and supportive care, but there is still a lack of systematic evaluations regarding symptoms from the perspective of oncologists.
Patients and methods
The aim of this prospective study was to evaluate the PERSONS score, in both “simultaneous care” and “supportive care” settings using the Edmonton Symptom Assessment Scale (ESAS) as a comparator.
From November 2017 to April 2018, 67 and 110 consecutive patients were enrolled in outpatient and home care cohorts, respectively. The final study population comprised 163 patients. There were no significant changes over time in the total PERSONS scores and total ESAS scale. The intra-interviewer reliability (ICC2,1) and inter-interviewer reliability (ICC2,k) showed good reproducibility (test-retest) in each group of patients: 0.60 (0.49–0.70) and 0.82 (0.75–0.87), respectively, for the home care patients and 0.73 (0.62–0.81) and 0.89 (0.83–0.93), respectively, for the outpatient cohort. There were high correlations between PERSONS and ESAS, both at the baseline and final assessments. The mean PERSONS and ESAS scores between the home care patients and outpatients were not different at the baseline and final assessments. Receiver operating characteristics (ROC) curve for the PERSONS total score revealed good diagnostic ability. Area under the curve (AUC) was 0.825 and 0.805 for improvement and deterioration, respectively.
The PERSONS score is an easy to apply tool for symptom assessment. Importantly, the PERSONS score showed high concordance with the established ESAS scale and, therefore, provides an alternative for everyday use in supportive care assessment.
Many psychiatrists in the UK may be surprised to find that the Government ratified a convention ten years ago that suggests compulsory mental health treatment be prohibited. The Convention on the Rights of Persons with Disabilities is arguably the most important legal instrument that no one in psychiatry ever discusses, but if moved from ratification to enforcement it would have enormous effect on day-to-day practice. Here, Dr Paul Gosney argues that the convention if enforced would be damaging for the people it aims to protect, whereas Professor Peter Bartlett defends it as a necessary challenge to the inequalities in our current system.
This chapter investigates whether and to what extent the Court of Justice of the European Union (CJEU) refers, in addition to EU's own fundamental rights norms, also to other international human rights norms. The entry into force of the Lisbon Treaty is a landmark moment in this analysis. Pre-Lisbon, EU fundamental rights were protected as unwritten general principles of EU law and international human rights norms were declared to be, next to national constitutional traditions common to the Member States, a source of inspiration thereof. The ECHR was given special significance. Post-Lisbon, the EU Charter of Fundamental Rights has not entirely displaced these sources of EU fundamental rights. Both the European Convention on Human Rights (ECHR) and other international human rights norms continue to appear in the Court’s case law, although the latter much more sporadically. This chapter considers in a first part the CJEU’s use of the ECHR and in a second part its use of other international human rights treaties, including the European Social Charter, ILO Conventions, the Convention on the Rights of Persons with Disabilities, and the Convention relating to the Status of Refugees.
This chapter critically examines the development of the Japanese adult guardianship system. It identifies the inadequacies of the previous system and points out the distinctive features of the new system, principally the addition of advisorship and the incorporation of the continuing power of attorney system. It is argued that the Japanese system does not comply with the demands of the greying society: the appointment of guardians accounts for an overwhelming share of cases, the use of continuing power of attorney is virtually stagnant and the system centres on asset management, with inadequate functions for support in daily life and ability to help oneself. In light of international developments in this field, it encourages the adaptation of a human rights perspective rather than the traditional healthcare policy perspective and further proposes that a combination of trust and adult guardianship system would be beneficial to society; the assets of the person concerned could be managed by the trust system and the livelihoods of the persons could be managed by the continuing power of attorney system, which better respects self-determination.
This chapter reviews legal instruments and avenues available for planning support for people with cognitive impairments in Australia, including adult guardianship, durable powers of attorney, representative payee and nominee appointments, and special needs disability trusts; the associated public institutions such as guardianship tribunals, office of the public advocate, and public trustees; and their interaction with service delivery programs such as the National Disability Insurance Scheme and social security. It is argued that the configuration of planning instruments, and the timing of their introduction, reflects adaption to the architecture of its welfare state, including its somewhat unique combination of extensive access to tightly means-tested income support (and reforms to overcome tax minimisation or avoidance), the absence of any expectation of family support, and acceptance of state responsibility for funding of services for disabled people least able to care for themselves.
A growing body of evidence has shown that persons with physical disabilities experience substantial barriers in accessing primary healthcare (PHC) services in rural areas. Negative attitudes from healthcare providers and inaccessible healthcare facilities and equipment are common experiences that negatively affect access to quality healthcare for persons with physical disabilities. However, there is limited research that explores this issue from the perspectives of healthcare providers. This qualitative study explores the perspectives of healthcare providers in delivering PHC services to persons with physical disabilities in rural Ghana. Understanding healthcare providers’ perspectives could help leverage previous findings from clients’ experiences to more fully inform the development of specific and actionable research and interventions to improve healthcare delivery for disabled people.
We conducted in-depth interviews with 15 healthcare providers and used thematic analysis to analyze the data.
Participants reported their perspectives in three major themes: challenges in providing healthcare (eg, limited availability of drugs and medical equipment, limited healthcare providers, financial constraints, and inaccessible facilities and equipment); strategies in navigating the challenges (eg, improvising techniques and employing professional values, referring clients, and providing financial assistance to clients); and positive experience in providing healthcare (eg, feeling rewarded and appreciated).
The findings reinforce the need to consider the availability of rehabilitation professionals and services to address the specific healthcare needs of disabled people at the PHC level in Ghana. The findings also point to a need for further research on the perspectives of healthcare policymakers about how to navigate the systemic barriers encountered by providers in providing care to persons with physical disabilities in rural Ghana in particular, and other similar rural areas.
To describe self-rated health in relation to lifestyle and illnesses and to identify risk factors for ill health such as pressure ulcers, falls and malnutrition among 75-year-old participants in a new clinical routine involving health assessment followed by tailored one-to-one health promotion at preventive clinic visits to a nurse at primary health care centres (PHCC).
There is a rapidly growing ageing population worldwide. It is central to health policy to promote active and healthy ageing. Preventive clinic visits to a nurse in primary health care were introduced as a new clinical intervention in a region in Sweden to improve the quality of health for the older adults.
A quantitative cross-sectional population-based study.
The sample consisted of 306 individuals in six primary health care centres in Sweden aged 75 years who attended preventive clinic visits to a nurse. Data were collected from March 2014 to May 2015 during structured conversations with a nurse based on self-administered questionnaires, clinical examinations, risk assessments and after the clinic visit existing register data were collected by the researcher.
Participants experienced good self-rated health despite being overweight and having chronic illnesses. Daily exercise such as walking and housework was more common than aerobic physical training. The majority had no problems with mobility but reported anxiety, pain and discomfort and had increased risk of falls.
It is important to encourage the older adults to live actively and independently for as long as possible. The healthy older adults may benefit from the clinical intervention described here to support the individual’s ability to maintain control over their health. Such supportive assessments might help the healthy older adult to achieve active ageing, reducing morbidity and preventing functional decline.
The Chinese government encourages the promotion of community-based older people centres as a way to use space rationally, improve social inclusion and support older residents’ everyday lives. This exploratory study is the first to examine in depth the contradictory and consistent attitudes and suggestions of residents of different age groups for the design of an inclusive community-based centre for older and younger people in China. An integrative mixed-methods approach was used. In the quantitative phase, 270 older adults (⩾60 years) and 250 younger adults (<60 years) from Harbin were asked to complete questionnaires (older adults’ response rate = 87.0%; younger adults’ response rate = 87.2%). In the qualitative phase, seven focus group discussions (four groups of older adults, three groups of younger adults) were conducted. The findings indicate that older adults have a higher acceptance level of inclusive design and prefer to share spaces to improve intergenerational interactions than younger adults. Residents of all ages are more likely to share functional spaces related to health services, living services and physical exercise. Moreover, the study reveals some design suggestions: the location of the centre should be away from the residential area and integrated into a public community building; comprehensive services should be provided to older people and be accessible to the whole family; design should be barrier-free, and the climate and nearby spaces should be considered.
From the early 1990s through the 2008 “Russo-Georgian war,” waves of armed conflicts in the Abkhazia and South Ossetia/Tskhinvali regions of Georgia forced thousands of residents, mainly ethnic Georgians, to leave their homes. More than two decades of protracted internal displacement, marked by tough economic and social problems, led this vulnerable community to a common trap in reckoning with the past: an overwhelming sense of the fundamental ruptures between the idealized past and current, miserable reality. Failures of the displacement policy and “side effects” of numerous humanitarian aid projects hinder internally displaced persons’ social integration and leave them on the margins of Georgian society with almost a singular option: to constantly recall meaningful life in the lost homeland, which they remember as free of ethnic phobias and economic problems. In this article, we suggest that for persons who are internally displaced, memories are defined not only by their past lived experiences and present hardships, but also by the official historical narratives that argue that Georgian-Abkhazian and Georgian-Ossetian “endemic” unity and cohabitation was destroyed by Russian imperial politics. Living in constant pain also narrows the future expectations of the internally displaced persons. However, it is the past and the memories that are supposed to be useful in achieving the utopian dream of a return.
For a long time researchers have used photography for different purposes, in different ways and with different focus. Photovoice is a qualitative visual research method that refers to photographs taken by the participants themselves. It has been used with different age groups and populations. The use of photovoice in older populations requires its own study of approaches, techniques and challenges. In this article, we review existing studies using photovoice with older participants specifically, to consider its potential as a qualitative research method in the field of gerontology. We discuss advantages and limitations of the method in gerontological research and provide guidelines for future studies. Our results show that photovoice has been used to study a wide range of topics in older people, from health issues and the impact of environment on health and wellbeing, to leisure experiences of groups living with HIV/AIDS. Using photovoice helps researchers to capture live experiences and perceptions of older persons and conduct engaging, involving and empowering research facilitating interaction, reflection and connection of participants. However, conducting photovoice studies can be practically challenging, such as when addressing special needs of the participants, or ethical and other feasibility issues. To conclude, photovoice has great potential for being used in gerontological research, it can be altered to fit specific goals, divergent issues studied and different research contexts.
A significant proportion of adults who are admitted to psychiatric hospitals are homeless, yet little is known about their outcomes after a psychiatric hospitalisation discharge. The aim of this study was to assess the impact of being homeless at the time of psychiatric hospitalisation discharge on psychiatric hospital readmission, mental health-related emergency department (ED) visits and physician-based outpatient care.
This was a population-based cohort study using health administrative databases. All patients discharged from a psychiatric hospitalisation in Ontario, Canada, between 1 April 2011 and 31 March 2014 (N = 91 028) were included and categorised as homeless or non-homeless at the time of discharge. Psychiatric hospitalisation readmission rates, mental health-related ED visits and physician-based outpatient care were measured within 30 days following hospital discharge.
There were 2052 (2.3%) adults identified as homeless at discharge. Homeless individuals at discharge were significantly more likely to have a readmission within 30 days following discharge (17.1 v. 9.8%; aHR = 1.43 (95% CI 1.26–1.63)) and to have an ED visit (27.2 v. 11.6%; aHR = 1.87 (95% CI 1.68–2.0)). Homeless individuals were also over 50% less likely to have a psychiatrist visit (aHR = 0.46 (95% CI 0.40–0.53)).
Homeless adults are at higher risk of readmission and ED visits following discharge. They are also much less likely to receive post-discharge physician care. Efforts to improve access to services for this vulnerable population are required to reduce acute care service use and improve care continuity.
In spring 1999, amidst a wider ethnic cleansing campaign, Serb police forces abducted Ferdonije Qerkezi’s husband and four sons, who were never to be seen alive again. She subsequently transformed her private house into a memorial to the lost normalcy of her entire social world. We trace this memorialization process; her struggle for recognition; her transformation into an iconic mother of the nation and her activism, both for missing persons and against the internationally-driven Serb-Albanian normalization process in Kosovo. From a multi-disciplinary perspective, we critically reflect on the theoretical concept of “normative divergence” in intervention studies. We are guided by social anthropological (including immersive, historical-ethnographic, and semantic) analysis of the core tropes of social memory as both narratively and materially embodied by the House Museum. In systematically juxtaposing these to the normative transitional justice principles of truth, justice, non-recurrence, and reparations, and the overarching international intervention goal of reconciliation, we critically interrogate normative divergence per se. The ethnographic “thick description” of this case study—cognizant of context contingency, victims’ agency and experience, cultural change, and social transformation—points to divergent meanings of these principles as resulting directly from the political and institutional failure to provide key transitional justice goals.
According to a ‘Straight’ reading of Elizabeth Anscombe’s (1975) ‘The First Person’, she holds a radically non-referring view of ‘I’. Specifically, ‘I’ is analogous to the expletive ‘it’ in ‘It’s raining’. I argue that this is not her conclusion. Her substantive view, rather is that if what you mean by ‘reference’ is a certain rich and recherché notion tracing to Frege, then ‘I’ is not a referring term. Her methodological point is that one shouldn’t be ‘bewitched by language’ into thinking that ‘I’, because of its syntax, must exhibit ‘reference’ in this sense.