Are patients improving during and after a psychiatric hospitalisation? Continuity of care outcomes of compulsory and voluntary admissions to an Italian psychiatric ward

Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients’ outcomes improved during hospitalisation and follow-up in mental health services (MHS) based on community continuity of care.Design and Method: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed up for six months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes’ improvement.Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes’ improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug’s efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2.Conclusion: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that community-based MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients’ subjective experiences and assessing long-term improvement in those who received person-centred interventions.

‘Backwards talk’ in Smith Island, Maryland

This article presents an exploration of the discourse-level phenomenon known as ‘backwards talk’ in Smith Island, a small, endangered dialect community in Maryland’s Chespaeake Bay, on the U.S. mid-Atlantic coast. The article examines how backwards talk, basically pervasive, highly creative irony, compares with irony more generally; how it patterns across generations and contexts; how important it is to island residents, who view backwards talk as the defining feature of their dialect; and why the feature has gained such importance in the face of dialect loss - and potential loss of community continuity as well. Because backwards talk is irony, it has important solidarity functions. As playful, nonliteral language, it serves as a symbol of the performed ‘islandness’ that islanders increasingly take up as they come into more and more contact with outsiders. Finally, as a means of offering critical evaluation of outsiders, backwards talk can be seen as a form of anti-language or counterlanguage, with a central function of resistance against outside forces.

Experiencing Community: Continuity and Transformation of Residential Life under the Inka Empire in Huarochirí (Lima, Peru)

Most archaeological research on the impact of Inka imperialism at the domestic level centers on the intrusion of Inka-style buildings into pre-Inka domestic settlements as transforming the experience of domestic life and actively hindering interhousehold interaction. Results from excavations in the site of Ampugasa in Huarochirí (Lurín valley, Lima, Peru) show that pre-Inka residential spaces (patio-groups) were replaced by enclosures with a single access to an internal patio for domestic activities. My analysis shows that pre-Inka houses were ritually closed, directly connected to the site's ritual core, and remained part of the everyday life experience of people in the settlement. I argue that Ampugasa's transformation corresponds to a pattern of Inka imperialism in Huarochirí that enshrined rather than erased the collective ritual practices through which the people of Huarochirí maintained a broad regional identity. I propose that the interplay between Inka transformation of domestic space in Ampugasa and the continuity of ritual and secular practices among the site's inhabitants shows a space of negotiation where Inka imperialism still relied heavily on local practices that fostered the continuity of collective identities.

The Digital Educational Model

The declaration of the sanitary emergency of COVID-19 changed the way that multiple sectors operate. In education, in addition to taking care of the health and safety of the community, continuity and academic quality of programs must be ensured. This transition gave rise to a new digital educational model to offer a quality distance university experience. The objective of this chapter is to present a framework to assess the quality of a digital educational model, and to present the findings of an implementation of this model that resulted from the transformation of a medical program amid the health emergency of COVID-19.

“Why Do I Need to Sign it? Issues in Carrying Out Child Assent in School-Based Prevention Research Within a First Nation Community

The practice of and procedures for obtaining child assent in research involving children are based in Western conceptions of individual decision-making rights, free from any form of coercion including that of parents. In the context of obtaining assent for children involved in research in an Alberta First Nation, the issue can become more complex given respect for ethical frameworks based in collective decision-making and the responsibility of Elders and families to protect children in interactions with Western institutions. This article explores the results of a focus group held to discuss our experience with child assent in research taking place with a community-initiated and culturally-adapted substance abuse prevention program being taught in the community school. In this case the process of being asked to sign written individual assent in the classroom was perceived as bearing extrinsic risk. Given collective cultural norms, the communities past experiences with the safety of signatures, and the proper roles of Elders and family, the children asked “Why do I have to sign it” when asked to sign their assent for participation in the project. A process that involved gathering child assent with children surrounded by family and community was recommended. Greater researcher and REB responsiveness to the issue of non-malfeasance is needed, in this case, by not asking researchers and community members to act in ways that violate culturally-based ethical norms and protocol all of which are important to community continuity, self-determination, and well-being.

Critical Issues in Death and the Afterlife in Ancient Judaism

Studies of the afterlife in ancient Judaism have often charted the historical emergence and development of beliefs, like resurrection, that would ultimately become normative within Western religions. Yet recent studies have focused more intently on specific aspects of ancient literary evidence, including apocalypses, sapiential texts, Philo, Josephus, and select Dead Sea Scrolls. Social-scientific analysis has also brought clearer insights into the interactive roles that attitudes toward death may play in shaping behavior, community continuity, political resistance, and self-definition. The present article surveys these developments, highlighting the conceptual diversity of attitudes toward death and the varied social roles that they played within their ancient Jewish contexts. The conceptual variety and social adaptability of afterlife beliefs to varying sectors of Judaism offer a revealing window into the process of theodicy-creation and legitimation in ancient Judaism.