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9-1-1 Activations from Ambulatory Care Centers: A Sicker Pediatric Population
- Theodore W. Heyming, Chloe Knudsen-Robbins, Shelby K. Shelton, Phung K. Pham, Shelley Brukman, Maxwell Wickens, Brooke Valdez, Kellie Bacon, Jonathan Thorpe, Kenneth T. Kwon, Carl Schultz
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 25 October 2023, pp. 749-756
- Print publication:
- December 2023
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Background:
Pediatric patients transferred by Emergency Medical Services (EMS) from urgent care (UC) and office-based physician practices to the emergency department (ED) following activation of the 9-1-1 EMS system are an under-studied population with scarce literature regarding outcomes for these children. The objectives of this study were to describe this population, explore EMS level-of-care transport decisions, and examine ED outcomes.
Methods:This was a retrospective review of patients zero to <15 years of age transported by EMS from UC and office-based physician practices to the ED of two pediatric receiving centers from January 2017 through December 2019. Variables included reason for transfer, level of transport, EMS interventions and medications, ED medications/labs/imaging ordered in the first hour, ED procedures, ED disposition, and demographics. Data were analyzed with descriptive statistics, X2 test, point biserial correlation, two-sample z test, Mann-Whitney U test, and 2-way ANOVA.
Results:A total of 450 EMS transports were included in this study: 382 Advanced Life Support (ALS) runs and 68 Basic Life Support (BLS) runs. The median patient age was 2.66 years, 60.9% were male, and 60.7% had private insurance. Overall, 48.9% of patients were transported from an office-based physician practice and 25.1% were transported from UC. Almost one-half (48.7%) of ALS patients received an EMS intervention or medication, as did 4.41% of BLS patients. Respiratory distress was the most common reason for transport (46.9%). Supplemental oxygen was the most common EMS intervention and albuterol was the most administered EMS medication. There was no significant association between level of transport and ED disposition (P = .23). The in-patient admission rate for transported patients was significantly higher than the general ED admission rate (P <.001).
Conclusion:This study demonstrates that pediatric patients transferred via EMS after activation of the 9-1-1 system from UC and medical offices are more acutely ill than the general pediatric ED population and are likely sicker than the general pediatric EMS population. Paramedics appear to be making appropriate level-of-care transport decisions.
Iron status and inherited haemoglobin disorders modify the effects of micronutrient powders on linear growth and morbidity among young Lao children in a double-blind randomised trial
- Sonja Y. Hess, K. Ryan Wessells, Guy-Marino Hinnouho, Maxwell A. Barffour, Kanokwan Sanchaisuriya, Charles D. Arnold, Kenneth H. Brown, Charles P. Larson, Supan Fucharoen, Sengchanh Kounnavong
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- Journal:
- British Journal of Nutrition / Volume 122 / Issue 8 / 28 October 2019
- Published online by Cambridge University Press:
- 15 July 2019, pp. 895-909
- Print publication:
- 28 October 2019
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Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes, but modifying factors are unknown. We aimed to investigate whether Fe status and inherited Hb disorders (IHbD) modify the impact of MNP on growth and diarrhoea among young Lao children. In a double-blind controlled trial, 1704 children of age 6–23 months were randomised to daily MNP (with 6 mg Fe plus fourteen micronutrients) or placebo for about 36 weeks. IHbD, and baseline and final Hb, Fe status and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrolment, 55·6 % were anaemic; only 39·3 % had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhoea prevalence. Baseline Hb modified the effect of MNP on length-for-age (LAZ) (P for interaction = 0·082). Among children who were initially non-anaemic, the final mean LAZ in the MNP group was slightly lower (–1·93 (95 % CI –1·88, –1·97)) v. placebo (–1·88 (95 % CI –1·83, –1·92)), and the opposite occurred among initially anaemic children (final mean LAZ –1·90 (95 % CI –1·86, –1·94) in MNP v. –1·92 (95 % CI –1·88, –1·96) in placebo). IHbD modified the effect on diarrhoea prevalence (P = 0·095). Among children with IHbD, the MNP group had higher diarrhoea prevalence (1·37 (95 % CI 1·17, 1·59) v. 1·21 (95 % CI 1·04, 1·41)), while it was lower among children without IHbD who received MNP (1·15 (95 % CI 0·95, 1·39) v. 1·37 (95 % CI 1·13, 1·64)). In conclusion, there was a small adverse effect of MNP on growth among non-anaemic children and on diarrhoea prevalence among children with IHbD.
Screening for Frailty in Canada’s Health Care System: A Time for Action
- John Muscedere, Melissa K. Andrew, Sean M. Bagshaw, Carole Estabrooks, David Hogan, Jayna Holroyd-Leduc, Susan Howlett, William Lahey, Colleen Maxwell, Mary McNally, Paige Moorhouse, Kenneth Rockwood, Darryl Rolfson, Samir Sinha, Bill Tholl, for the Canadian Frailty Network (CFN)
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- Journal:
- Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 35 / Issue 3 / September 2016
- Published online by Cambridge University Press:
- 23 May 2016, pp. 281-297
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As Canada’s population ages, frailty – with its increased risk of functional decline, deterioration in health status, and death – will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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Contributors
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- By Jennifer Alvarez, Ananda B. Amstadter, Metin Başoğlu, David M. Benedek, Charles C. Benight, George A. Bonanno, Evelyn J. Bromet, Richard A. Bryant, Barbara Lopes Cardozo, M. L. Somchai Chakkraband, Claude Chemtob, Roman Cieslak, Lauren M. Conoscenti, Joan M. Cook, Judith Cukor, Carla Kmett Danielson, JoAnn Difede, Charles DiMaggio, Anja J.E. Dirkzwager, Cristiane S. Duarte, Jon D. Elhai, Diane L. Elmore, Yael L.E. Errera, Julian D. Ford, Carol S. Fullerton, Sandro Galea, Freya Goodhew, Neil Greenberg, Lindsay Greene, Linda Grievink, Michael J. Gruber, Sumati Gupta, Johan M. Havenaar, Alesia O. Hawkins, Clare Henn-Haase, Kimberly Eaton Hoagwood, Christina W. Hoven, Sabra S. Inslicht, Krzysztof Kaniasty, Ronald C. Kessler, Rachel Kimerling, Richard V. King, Rolf J. Kleber, Jessica Mass Levitt, Brett T. Litz, Maria Livanou, Katelyn P. Mack, Paula Madrid, Shira Maguen, Paul Maguire, Donald J. Mandell, Charles R. Marmar, Andrea R. Maxwell, Shannon E. McCaslin, Alexander C. McFarlane, Thomas J. Metzler, Summer Nelson, Yuval Neria, Elana Newman, Thomas C. Neylan, Fran H. Norris, Carol S. North, Lawrence A. Palinkas, Benjaporn Panyayong, Maria Petukhova, Betty Pfefferbaum, Marleen Radigan, Beverley Raphael, James Rodriguez, G. James Rubin, Kenneth J. Ruggiero, Ebru Şalcıoğlu, Nancy A. Sampson, Arieh Y. Shalev, Bruce Shapiro, Laura M. Stough, Prawate Tantipiwatanaskul, Warunee Thienkrua, Phebe Tucker, J. Blake Turner, Robert J. Ursano, Bellis van den Berg, Peter G. van der Velden, Frits van Griensven, Miranda Van Hooff, Edward Waldrep, Philip S. Wang, Simon Wessely, Leslie H. Wind, C. Joris Yzermans, Heidi M. Zinzow
- Edited by Yuval Neria, Columbia University, New York, Sandro Galea, University of Michigan, Ann Arbor, Fran H. Norris
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- Mental Health and Disasters
- Published online:
- 07 May 2010
- Print publication:
- 20 July 2009, pp xi-xvi
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Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample
- JOSHUA BRESLAU, SERGIO AGUILAR-GAXIOLA, KENNETH S. KENDLER, MAXWELL SU, DAVID WILLIAMS, RONALD C. KESSLER
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- Journal:
- Psychological Medicine / Volume 36 / Issue 1 / January 2006
- Published online by Cambridge University Press:
- 05 October 2005, pp. 57-68
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Background. Epidemiological studies have found lower than expected prevalence of psychiatric disorders among disadvantaged race-ethnic minority groups in the USA. Recent research shows that this is due entirely to reduced lifetime risk of disorders, as opposed to persistence. Specification of race-ethnic differences with respect to clinical and social characteristics can help identify the protective factors that lead to lower lifetime risk among disadvantaged minority groups.
Method. Data on 5424 Hispanics, non-Hispanic Blacks, and non-Hispanic Whites came from the National Comorbidity Survey Replication, a nationally representative survey conducted with the World Mental Health version of the Composite International Diagnostic Interview. Race-ethnic differences in risk of disorders were compared across specific diagnoses, ages of onset, cohorts and levels of education.
Results. Both minority groups had lower risk for common internalizing disorders: depression, generalized anxiety disorder, and social phobia. In addition, Hispanics had lower risk for dysthymia, oppositional-defiant disorder and attention deficit hyperactivity disorder; non-Hispanic Blacks had lower risk for panic disorder, substance use disorders and early-onset impulse control disorders. Lower risk among Hispanics, relative to non-Hispanic Whites, was found only among the younger cohort (age [les ]43 years). Lower risk among minorities was more pronounced at lower levels of education.
Conclusion. The pattern of race-ethnic differences in risk for psychiatric disorders suggests the presence of protective factors that originate in childhood and have generalized effects on internalizing disorders. For Hispanics, but not for non-Hispanic Blacks, the influence of these protective factors has emerged only recently.
Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States
- JOSHUA BRESLAU, KENNETH S. KENDLER, MAXWELL SU, SERGIO GAXIOLA-AGUILAR, RONALD C. KESSLER
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- Journal:
- Psychological Medicine / Volume 35 / Issue 3 / April 2005
- Published online by Cambridge University Press:
- 29 September 2004, pp. 317-327
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Background. Recent research in the United States has demonstrated striking health disparities across ethnic groups. Despite a longstanding interest in ethnic disadvantage in psychiatric epidemiology, patterns of psychiatric morbidity across ethnic groups have never been examined in a nationally representative sample.
Method. Ethnic differences in psychiatric morbidity are analyzed using data from the National Comorbidity Survey (NCS). The three largest ethnic groups in the United States – Hispanics, Non-Hispanic Blacks and Non-Hispanic Whites – were compared with respect to lifetime risk and persistence of three categories of psychiatric disorder: mood disorder, anxiety disorder, and substance use disorder.
Results. Where differences across ethnic groups were found in lifetime risk, socially disadvantaged groups had lower risk. Relative to Non-Hispanic Whites, Hispanics had lower lifetime risk of substance use disorder and Non-Hispanic Blacks had lower lifetime risk of mood, anxiety and substance use disorders. Where differences were found in persistence of disorders, disadvantaged groups had higher risk. Hispanics with mood disorders were more likely to be persistently ill as were Non-Hispanic Blacks with respect to both mood disorders and anxiety disorders. Closer examination found these differences to be generally consistent across population subgroups.
Conclusions. Members of disadvantaged ethnic groups in the United States do not have an increased risk for psychiatric disorders. Members of these groups, however, do tend to have more persistent disorders. Future research should focus on explanations for these findings, including the possibility that these comparisons are biased, and on potential means of reducing the disparity in persistence of disorders across ethnic groups.
Introduction
- Kenneth Maxwell, Council on Foreign Relations, New York
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This book is concerned with dictatorship and its legacy; with revolution and its history; and with the emergence and consolidation of democracy. It is an attempt to discuss and to explain the making of Portuguese democracy. The Portuguese revolution of 1974–76 is at the center of the transition to democracy in Portugal as it is in this book. It was an extraordinary period – unexpected, much misunderstood, dramatic in its effects on the international scene. The Portuguese upheaval was more like the European revolutions of the 1820s and 1848 than like the “great” revolutions of 1789 in France or 1917 in Russia. That is, it was startling in psychological power, yet limited in its ability to reorder society; significant enough in its impact to transform the context of social and political discourse and the institutional context within which political power is exercised but, once over, hard for many outsiders to take seriously.
In some peculiar ways, however, the extraordinary events of the mid 1970s are already ancient history, and the Portuguese constitution and economic system are both marked by a selfconscious escape from the legacy of this period. For reasons I hope to explain in this book, contemporary Portuguese democracy rests in part on the sublimation of this conflictive experience which tends to make for a highly fragmented view of these events, and risks making the history of those years the captive of selective memories.
9 - Picking up the pieces
- Kenneth Maxwell, Council on Foreign Relations, New York
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I could have been the Fidel Castro of Europe.
Otelo Saraiva de Carvalho (August 1975)Europe is with us.
Socialist Party manifestoSomething like this happened after April when the ants woke up, when poor people were allowed to smile and Portugal learned to say tu. It was the foretaste. But the heavy hand of bourgeois good sense tamed the revolution [and] put it in a straight jacket.
Urbano Tavares RodriguesFrancisco Sá Carneiro, the social democratic leader and the new prime minister, had placed constitutional reforms at the top of the political agenda in the 1980 election campaign, but the fact that a two-thirds vote in the Assembly of the Republic was needed to achieve constitutional change required the Democratic Alliance to seek the support of the Socialist Party to achieve these reforms. This, in turn, immediately created a major internal debate among the socialists over the extent to which they should collaborate in this revision process. A “letter of intent” agreed to between the socialists and President Eanes before the second presidential election in December 1980 (in which Eanes was reelected), however, became central to the choice between a presidential or a parliamentary route for the revision process, since both Eanes and Soares opposed the calling of a referendum on the constitutional question as had been proposed by the prime minister.
Frontmatter
- Kenneth Maxwell, Council on Foreign Relations, New York
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7 - Counter-revolution
- Kenneth Maxwell, Council on Foreign Relations, New York
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I'm telling you the elections have nothing to do with the dynamics of a revolution … I promise you there will be no parliament in Portugal.
Alvaro Cunhal (June 1975)… it was the election that turned the situation around.
Frank C. Carlucci, US ambassador to Portugal (1975–77), Congressional hearing (1976)Words like revolution, agrarian reform, popular power, nationalization, and praetorian power, etc., have of course a great mobilizing power and a value and political implication which I do not minimize; but alone, they are not enough to deal adequately with real situations.
Mário Soares (June 1975)Friend Boss: The people are with you. Out with the Union Committee. Death to the communists.
Anticommunist demonstration invading the offices of Têxtil Manuel Gonçalves, Famalicão (August 1975)As the situation in Angola deteriorated and the superpowers began to maneuver ominously but clandestinely in the interests of their African clients, international attention remained fixed on the struggles in Lisbon. Between March and November 1975 the fate of the revolution was settled and despite the left's apparently formidable assets in March 1975 – control of the administration, unions, army, the media, and political initiative – by the end of November the left was disunited, weakened, on the defensive, with its power broken. Why?
The answer lies in four aspects of those turbulent months.
5 - African dilemmas
- Kenneth Maxwell, Council on Foreign Relations, New York
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Spínola wanted to make the FNLA's Holden Roberto leader of Angola with Chipenda and UNITA's Jonas Savimbi at his side.
Admiral Rosa Coutinho (July 1975)The same forces that oppressed the peoples of the former territories under Portuguese administration also oppressed the Portuguese people. It is with great modesty and humility that we must say, without ambiguities, that the struggle of the colonial peoples against Portuguese fascism also aided our liberation from the same fascism.
Colonel Vasco Gonçalves in Lourenço Marques (June 1975)In the first months after the April 25 coup, the young officers of the Armed Forces Movement stayed very much in the background, preferring to remain as anonymous as possible. This did not mean they had any desire to see the fruits of their victory taken away from them. In a conversation with David Martin of the London Observer, Major Vítor Alves commented pointedly that the problem with the coup of 1926 was that “although the soldiers knew what they did not want they did not know what they did want. They had no program.” In 1974 Major Alves' CCP had already rectified the error of their predecessors. The problem was how the program that existed was to be interpreted and by whom.
The MFA's ambiguous phrases about colonial policy and the “need of a political not military solution” had been, if anything, gross understatements.
Acknowledgments
- Kenneth Maxwell, Council on Foreign Relations, New York
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Conclusion
- Kenneth Maxwell, Council on Foreign Relations, New York
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The collapse of Portuguese rule in southern Africa in 1975 ended the last of Europe's overseas empires. Five and a half centuries after the conquest of Ceuta, for the first time the Portuguese standard was no longer hoisted above a fortress in Africa. The events of the mid 1970s in Portugal also played a significant and precocious part in the great ideological conflict of the twentieth century. The triumph for anticommunist democrats in the Portuguese domestic conflicts between 1974 and 1976, on the one hand, together with the initial victory of the communist-backed forces in Angola in the same period on the other, set in motion many of the forces which would help bring about the end of the Cold War in Europe, by reinvigorating democracy at the grassroots and by escalating the costs of proxy conflicts in the third world. By the 1990s, some political scientists, most notably Samuel Huntington, looking back at the 1970s, came to regard Portugal's democratization as the beginning of the “third wave” of democratization, which would see the fall of the communist regimes in eastern Europe and eventually in the Soviet Union itself, a period comparable to that of the 1820s and the 1940s in world history.
The chain of events set in motion by the April 1974 coup thus had widespread and long-lasting international ramifications.
Glossary
- Kenneth Maxwell, Council on Foreign Relations, New York
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8 - The revolution tamed
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The classical case of wooing the mother in order to marry the daughter, and the daughter is Angola.
Admiral Rosa Coutinho (November 1975)Let us put aside for one moment the ideologies which inspire us and humbly note the fact that whereas nearly all the people were with our revolution, today we have to recognize that this is not the case. The march of the Revolution has gained a pace which the people have not the capacity to absorb.
General Costa Gomes to the Armed Forces Movement Assembly (July 1975)General Vasco Gonçalves wants us to believe that the dilemma before us in Portugal is “revolution or counterrevolution” … we refuse this false and simplistic dilemma [which] deforms Portuguese reality.
Mário Soares (August 1975)The scale of outside intervention in Angola remained largely hidden from public view until December 12, 1975 when a story by David Binder on the New York Times front page revealed the full extent of US clandestine involvement. Most public attention over the summer and autumn of 1975 remained focused on Portugal. The land seizures in the south, and some highly publicized but isolated seizures elsewhere in the country thoroughly alarmed small landowners and scared them into mutual political action and collaboration in August 1975. Often encouraged by local priests, mobs burned and sacked at least forty-nine of the Communist Party's offices in central and northern Portugal, virtually expelling the Communist Party from these regions.
1 - Prisoners of history
- Kenneth Maxwell, Council on Foreign Relations, New York
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A libertarian may properly disapprove of Dr. Salazar, but I doubt whether Plato would.
Dean Acheson, US secretary of state (1950)Dictatorships of this type are sometimes necessary in countries whose political institutions are not so far advanced as ours.
President Dwight D. Eisenhower (1960)I want this country poor but independent; and I do not wish it colonized by American capital.
Salazar (1963)I love Portugal because it is a country of political unreality.
André Malraux (1960)During Portugal's golden age of exploration, in the late fifteenth and early sixteenth centuries, its mariners – Vasco da Gama, Bartolomeu Dias, Pedro Alvares Cabral, and Ferdinand Magellan – vastly expanded the world known to the Europeans. The Portuguese established colonies in Africa, the Far East, and South America. The places where they landed added scores of new names to Europe's commercial lexicon – Luanda, Mombasa, the Maldives, Ormuz, Diu, Goa, Macao, Malacca, Malindi, Timor, Rio de Janeiro. The Portuguese named the waters off Salvador, their first capital in Brazil, the Bay of All Saints (and nicknamed it the Bay of All the Sins). They also exported such European innovations as the movable-type printing press, which they introduced in the Middle East and possibly Japan. Portuguese words entered the languages of the Japanese (“tempura”), the Indians (“Caste”), and other distant peoples. In sum, as Lisbon would never forget, it was the Portuguese who first “linked up, for better and for worse, the widely sundered branches of the great human family,” as historian Charles R. Boxer has noted.
3 - Coup d'état
- Kenneth Maxwell, Council on Foreign Relations, New York
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If you fire, it will be civil war. Is the Army going to fire on the Army?
Captain Salgueiro Maia to loyalist tank commanders, Lisbon (April 25, 1974)You must maintain control. I am frightened by the idea of power loose in the street.
Marcello Caetano to General Spínola as he surrendered (April 25, 1974)When the Revolution took place in Portugal the United States had “gone out to lunch.” We were completely surprised.
Cord Meyer, CIA station chief in London (April 1974)The alliance of the people and the military is, in the specific situation existing today, an essential condition for the progress of democratization of Portuguese society.
Alvaro Cunhal (April 1974)As the base of the old regime in Lisbon was being undermined by changing social and economic conditions, and with widespread plotting and dissatisfaction spreading throughout the armed forces from the highest ranks to the junior officers corps, Portugal's NATO partners were blissfully unaware that anything was amiss with their old, docile, and occasionally useful ally.
A major policy review of US relations with southern Africa took place in 1969, early in the administration of Richard Nixon. That summer an interdepartmental group on Africa reported to the National Security Council that “the outlook for the rebellion [in Portuguese Africa] is one of continued stalemate: the rebels cannot oust the Portuguese and the Portuguese can contain but not eliminate the rebels.”
Bibliography
- Kenneth Maxwell, Council on Foreign Relations, New York
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2 - The praetorian guards
- Kenneth Maxwell, Council on Foreign Relations, New York
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The Army must be honored and revered as being the scaffolding indispensable to the building of the New State.
Salazar (1939)Nationalism does not exist in either Angola or Mozambique. You Americans have invented it.
Salazar (1961)Nations prefer to live prosaically rather than disappear in glory.
General António Spínola (1974)It was the contact with the people [of Guinea-Bissau] and with you [my company] during two years that aided me immensely in opening my eyes to see the injustice of the colonial war and the illegitimacy of the fascist government in Portugal and the consequent necessity to overthrow it.
Captain Vasco Lourenço (1974)Even in early 1974 the withering of the old social basis of Salazar's regime and the fragmentation of the coalition of interests which long sustained the dictatorship were largely hidden from view. Many outside observers, in fact, were impressed by the solidity of the regime and even saw it as a model of corporatism triumphant. But as the fighting with the African liberation movements entered a second decade, bitter differences reemerged at the top of the military hierarchy and these disputes were more difficult to hide. Several of the civilian governors and military commanders in Africa were ambitious men who became important public figures in Lisbon. General Spínola, commander-in-chief of Guinea, was one of them, but the least typical.