bluuebunny/crossref_metadata_2025 huggingface dataset:
Wheelchair Use Among Community-Dwelling Older Adults: Prevalence and Risk Factors in a National Sample
Authors: Clarke Philippa , Colantonio Angela
Published: August 2005

Older adults are the largest group of wheelchair users yet there are no peer-reviewed studies on the national profile of older wheelchair users in Canada. We investigated the characteristics of wheelchair users in a national sample of community-dwelling older adults from the Canadian Study of Health and Aging (CSHA-2). Questions on the use of assistive technology were asked of 5395 Canadians (over 64), and 4.6 per cent reported using a wheelchair. Logistic regression was used to model the factors associated with wheelchair use. Controlling for age, gender, and cognitive impairment, older adults who reported greater dependence in basic self-care and instrumental activities of daily living were more likely to use a wheelchair. However, the effects of self-care dependence on wheelchair use varied by gender, with men more likely than women to use wheelchairs with increasing self-care dependence. The number of chronic health conditions and being unmarried also increased the odds of wheelchair use. This paper quantifies the risk of wheelchair use according to critical factors that can be used to project use and plan for services.

The data reported in this paper were collected as part of the Canadian Study of Health and Aging. The core study was funded by the Seniors' Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606-3954-MC[S]). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603-1417–302[R]), Bayer Incorporated, and the British Columbia Health Research Foundation (projects no. 38[93-2] and no. 34[96-1]). The study was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada. Additional funds for the preparation of this manuscript were made available from the Opportunities Fund of the M-THAC Research Unit (from Medicare to Home and Community) at the University of Toronto, and from a post-doctoral fellowship awarded to the first author by the Social Sciences and Humanities Research Council of Canada.
Facteurs associés à la consommation de courte et de longue durée des benzodiazépines chez les personnes âgées du Québec
Authors: Fortin Dany , Préville Michel , Ducharme Claire , Hébert Réjean , Allard Jacques , Grégoire Jean-Pierre , Trottier Lise , Bérard Anick
Published: August 2005

In Quebec, benzodiazepines are some of the most extensively used drugs by the elderly. The goal of this study was to identify factors associated with short- and long-term benzodiazepine use among 2,039 elderly persons having participated in the Quebec Health Survey conducted in 1998. Results of the multivariate, multinomial logistic regression showed that a higher number of chronic health problems, a higher number of physicians visited and general practitioners consulted were associated with short- and long-term use of benzodiazepines. Factors specifically associated with long-term use were female gender (OR=1.84) and the presence of benzodiazepine users in the household (OR=1.90). In this study, we were unable to show a difference between the two groups of users with regards to the risk factors studied. This result leads us to conclude that prevention of long-term use must be aimed at all new benzodiazepine users.
F. Michael GlothIII (Ed.). Handbook of Pain Relief in Older Adults: An Evidence-Based Approach. Totowa, NJ: Humana Press, 2004.
Authors: Gibson Margaret C.
Published: August 2005

L'objectif, tel qu'il est énoncé dans le Handbook of Pain Relief in Older Adults: An Evidence-Based Approach, est d'aller au-delà des simples preuves scientifiques et de tenir compte du contexte sociopolitique dans lequel la science médicale est (ou n'est pas) mise au service des patients ayant des douleurs. Ce the`me revient sans cesse dans la majeure partie du texte. Un deuxième thème omniprésent est qu'il est possible de soulager la douleur chez la majorité des patients, si on laisse de côté les considérations sociopolitiques qui dictent les services associés à la douleur. Dans le livre, on passe en revue les preuves étayant les stratégies de traitements pharmacologiques, d'intervention, de réadaptation et de prise en charge de la douleur, puis on parle de leur mise en oeuvre dans les soins de santé offerts aux personnes âgées. Les soins de longue durée, qui représentent un contexte particulier en raison de la forte prépondérance des personnes âgées, sont examinés en détail. Ce livre porte sur l'aspect sensibilisation et sur les aspirations, et contient des idées provocatrices, ce qui le rend intéressant et formateur. Il faut noter que le texte est accessible en version électronique (eBook)/assistant numérique personnel (PDA), pour ceux qui préfèrent ce moyen de transmission de l'information.
Unit Manager's Role with Family Members of Clients in Complex Continuing Care Settings: An Untold Story
Authors: Guruge Sepali , McGilton Katherine , Yetman Linda , Campbell Heather , Librado Ruby , Bloch Lois , Ladak Salima
Published: August 2005

Most literature on staff-family relationships has come from studies of long-term care settings, has focused mainly on the families' perspectives on factors affecting their relationships with staff, and has included scant findings from the staff's perspective. No studies that examined staff-family relationships in complex continuing care (CCC) environments from the perspective of staff were found in the literature. A qualitative study that draws on a grounded theory approach was conducted to explore staff-family relationships in CCC, and the findings presented in this article illuminate the unit manager's role. Data were collected through in-depth interviews with nine unit managers and a follow-up focus group with five unit managers who work in three CCC facilities. Three categories reflecting the unit manager's role with family members of clients in CCC settings were derived: establishing supportive entry; building and preserving relationships; and closing the loop. Implications of the findings for practice and future research are presented.
Evaluation of the Restorative Care Education and Training Program for Nursing Homes
Authors: Johnson C. Shanthi Jacob , Myers Anita M. , Jones Gareth R. , Fitzgerald Clara , Lazowski Darien-Alexis , Stolee Paul , Orange J.B. , Segall Nicole , Ecclestone Nancy A.
Published: August 2005

Restorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six “wait-list” facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.
Dimensions of Grandparent-Adult Grandchild Relationships: From Family Ties to Intergenerational Friendships
Authors: Kemp Candace L.
Published: August 2005

This paper examines the growing demographic phenomenon of grandparent–adult grandchild relationships from the perspectives of both generations. Drawing on qualitative life-history interviews (n= 37), this research explores the subjective meanings of the relationship, as well as the experiences of being grandparents and adult grandchildren. Despite tremendous diversity in grandparent–adult grandchild relationships, including differences among and between generations, both groups in this study view one another positively and conceptualize their ties as personally and existentially meaningful. They classify their relationships as a distinct family tie centred on unconditional love, mutual support, respect, and obligation. A number of individuals also discuss their grandparent–adult grandchild relationships as friendships, involving mutual trust, shared confidences, and personal choice. Overall, this research suggests that grandparent-grandchild relationships often grow more profound and meaningful as grandparents and grandchildren age, move through the life course, and experience life events.
J. Mantel and J. Funke-Furber. Forgotten Revolution: The Priory Method – A Restorative Care Model for Older Persons. Victoria, BC: Trafford, 2003.
Authors: Perry JoAnn
Published: August 2005

Les auteurs passent en revue les progrès les plus novateurs en soins de longue durée au Canada dans le livre Forgotten Revolution. À partir d'entrevues et de documents historiques, les auteurs racontent comment Vera McIver, avec le soutien de l'administration et du personnel, a élaboré un modèle en soins de rétablissement. Ce modèle, qui se veut une réflexion sur l'art et la science nécessaires pour fournir des soins aux personnes âgées, révèle comment un milieu vraiment thérapeutique peut favoriser chez une personne la capacité à avoir une vie intéressante, même en vivant en établissement de soins prolongés. Les résidents ont appris à devenir plus actifs, à s'engager et à jouer un rôle plus important dans l'ensemble de la collectivité.
Care-Receiver and Caregiver Assessments of Functioning: Are There Gender Differences?
Authors: Shaver Julie C. , Allan Diane E.
Published: August 2005

In situations where care-receivers cannot respond to questions about their functional status, caregiver proxies are often substituted. Yet studies addressing caregiver-care-receiver agreement remain limited in scope, focusing primarily on cognitive functioning and caregiver relationship. This study broadens the range of research in this area by examining caregiver and care-receiver reports of individual IADL and AADL items by gender of care-receiver. As well, the degree to which the care-receiver's age and mental and physical health status influence agreement are investigated. Data for this study come from a sample of 388 Manitoba older adults aged 65 and over. Results (using Cohen's kappa) suggest less agreement on the presence of disability for men than for women, particularly among those aged 75–84. Differences by health status were also revealed. The implications of the findings for assessments of functioning are considered.
Understanding Barriers to Continence Care in Institutions
Authors: Tannenbaum Cara , Labrecque Danielle , Lepage Christiane
Published: August 2005

This work seeks to identify factors that facilitate or diminish care-providers' propensity to improve continence care in long-term care (LTC) settings. We conducted a cross-sectional qualitative study using focus group methodology in four long-term care institutions in Montreal, QC. Forty-two nurses, nursing assistants, and orderlies caring for incontinent elderly residents were asked how they perceived urinary incontinence (UI), how it was being managed, and what factors enabled or hindered continence care in their institution. Content analysis was used. Facilitating and inhibiting elements of three individual/internal factors (beliefs about UI, attitudes towards the elderly, and knowledge about UI) and five institutional/external factors (workload demands, type of patient, environmental support, co-worker support, and attributes of UI interventions) emerged as important determinants of care-providers' propensity to manage UI. To be successful, continence programs must target multidimensional elements that take into account personal, systems, and organizational level factors.
A Comparison of the Behavioural and Emotional Characteristics of Alzheimer's Dementia in Individuals with and without Down Syndrome
Authors: Temple Valerie , Konstantareas M. Mary
Published: August 2005

The behavioural and emotional changes associated with Alzheimer's disease (AD) are compared for individuals with Down syndrome and AD and individuals with AD from the general population (AD-only). The primary caregivers of 30 people with Down syndrome and AD and 30 people with AD-only completed the BEHAVE-AD and the Apathy subscale of the CERAD. As well, behavioural observations at adult day programs were undertaken with selected participants (n= 26). The Down syndrome group experienced fewer delusions and had lower total scores on the BEHAVE-AD, indicating fewer problem behaviours overall. Day program observations suggested that the AD-only group were more likely to be sedentary and observe the activities of others, while the Down syndrome group were more physically active. Improving our understanding of the similarities and differences between these two groups may help facilitate the integration of individuals with Down syndrome into adult day programs for the general population.
Infectious Diseases Treated in Emergency Departments: United States, 2001
Authors: Adekoya Nelson
Published: August 2005

Emergency departments (EDs) are an important source of medical care in the United States. Information is limited concerning epidemiologic patterns of ED visits for infectious diseases. Data for 2001 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. The NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of non-federal, short-stay, and general hospitals in the United States. Data are collected annually and are weighted to generate national estimates. In 2001, an estimated 19.8 million visits were made to hospital EDs for infectious diseases (rate = 71 visits/1,000 persons). Children under 15 years old made 36% of these visits and had the highest rate of visits (rate = 119 visits/1,000 persons). The rate of visits for females was 37% higher than for males (82 versus 60/1,000 persons). Although the white population had the highest volume of visits, the rate of visits for blacks was more than twice that of whites (130 versus 64 visits/1,000 persons). Laboratory tests were ordered in 84% of visits. An estimated 18% of visits to the EDs concern infectious diseases. The issue of health care access and ED use is complex and the reasons for the higher rate of visits for blacks than for whites are not fully understood.
The Impact of Welfare Reforms, Health, and Insurance Status on Welfare Recipients' Health Care Access
Authors: Cheng Tyrone
Published: August 2005

This study explores ways in which welfare reforms have affected utilization of four health services (physician visits, hospital care, prescription medication, and dentist visits) and the impact of health insurance on these services. A secondary data analysis of a nationally representative sample of 1,259 non-elderly adult current and former welfare recipients shows that use of health services is significantly affected by state-specific welfare policy, health insurance, and race/ethnicity, when other variables are controlled. More restrictive state welfare policies were variously associated with lower likelihood of using dental care, visiting a physician and using prescriptions. Non-Hispanic whites in the sample were more likely than members of other racial/ethnic groups to use prescriptions; Hispanics were less likely than non-Hispanic whites to visit physicians or dentists. The proportion of respondents reporting fair or poor health was three times as great as the estimated proportion of non-elderly adults reporting fair or poor health in the general population. Policy implications are discussed.
Periods of Unmanaged Care in Medicaid Managed Care
Authors: Fairbrother Gerry , Park Heidi L , Haidery Arfana , Gray Bradford H.
Published: August 2005

Churning in Medicaid has been long recognized as a problem leading to breaks in coverage. Tenure in Medicaid managed care has received less attention. Recent reports indicate that children's tenures in health plans are far shorter than tenures in Medicaid itself, but explanations for the difference are not given. In the research reported here, we conducted case studies in five states to determine difference in tenure and reasons for the difference. Our investigation showed that children were enrolled in Medicaid two to four months longer than in specific Medicaid health plans. The major reasons for the gap were retroactive enrollment in Medicaid and delays in selecting a health plan. Frequent and burdensome Medicaid renewal processes exacerbate the problem, resulting in breaks in enrollment and the need to reenroll. The task of managing the care of Medicaid children is difficult without adequate tenures in health plans.
Impact of Providing a Medical Home to the Uninsured: Evaluation of a Statewide Program
Authors: Gill James M , Fagan Heather Bittner , Townsend Bryan , Mainous Arch G
Published: August 2005

Lack of health insurance and a regular source of care (RSOC) are associated with suboptimal health care. This study examined the impact of a statewide program called the Community Healthcare Access Program (CHAP), which provided a RSOC for uninsured persons in Delaware. This cohort study used survey data to compare health care utilization from baseline to six months after enrollment in CHAP. The 795 eligible enrollees had significant increases in Pap tests, mammograms, breast exams, cholesterol tests, sigmoid/colonoscopy and influenza immunizations but not stool blood tests or pneumococcal immunizations. There was a significant decrease in the proportion with emergency department visits but not hospitalizations, and there was a significant improvement in satisfaction with care. Delaware's CHAP program is associated with significant improvements across many measures of health care utilization and represents a successful and financially feasible method for states to improve health care for their uninsured populations.
Planning for and Securing Health Insurance in the Context of Welfare Reform
Authors: Hartley Heather , Seccombe Karen , Hoffman Kim
Published: August 2005

Previous research indicates that 25% to 50% of former Temporary Assistance to Needy Families (TANF) recipients and approximately 15% to 30% of their children become uninsured after the expiration of the one-year transitional Medicaid coverage they receive when leaving welfare. Using data from 90 face-to-face interviews, this paper explores the expectations, plans, and coping strategies of TANF leavers in Oregon who are in the middle of this year of transitional coverage. The paper examines (1) the information available to these individuals, (2) their planning and expectations about securing health insurance, and (3) their perceptions of opportunities for obtaining jobs that provide insurance. The paper shows that while TANF leavers often assume their Medicaid coverage will continue after the transitional year, many lack complete information about this. Many respondents have no active plans for securing health insurance. Even those who do have sufficient information to plan for the end of the transitional year may find themselves having to make stark choices (e.g., sacrificing income in order to keep coverage). Policy recommendations are presented.
Reducing Disparities in Dental Care for Low-income Hispanic Children
Authors: Kim Young O. Rhee
Published: August 2005

Using a social ecological model, this study examined the influences of socio-demographic factors, mother's attitudes, financial barriers, and the health care delivery system on the use of dental services for 4–8 year-old Hispanic children. Initiating dental care during the preschool years was significantly related to the mothers' beliefs and her social network's beliefs in the value of preventive dental care. The mother was almost four times more likely to continue the care if she believed that dentist visits would keep the child's teeth healthy. Extended clinic hours in the evenings also increased the likelihood of the mother's return to the dentist to continue child's care. It was not the mother's attitudes but provider availability, dental insurance (including Medicaid) and family income that were related to frequency of planned visits. The study findings can be used in improving access to care and reducing barriers for low-income, urban Hispanic children.
Donated Care Programs: A Stopgap Measure or a Long-Run Alternative to Health Insurance?
Authors: Kullgren Jeffrey T , Taylor Erin Fries , McLaughlin Catherine G
Published: August 2005

In the absence of broad federal health care reform, interest has grown in local solutions to the problem of providing health care to the uninsured. Community-based donated medical care models have emerged as one alternative. We examine the early experience of a donated care program in southern Maine called CarePartners. Although such programs are often viewed as a short-term solution for those temporarily without health insurance, we find that CarePartners served a different role for many individuals. While clearly a stopgap measure for some enrollees, CarePartners appears to be a longer-term means for getting access to care for most enrollees.
Missed Appointment Rates in Primary Care: The Importance of Site of Care
Authors: Lasser Karen E , Mintzer Ira L , Lambert Astrid , Cabral Howard , Bor David H
Published: August 2005

The objective was to determine whether race, language, or gender concordance between primary care providers (PCPs) and patients is associated with lower missed appointment rates in neighborhood health centers. An additional objective was to determine whether site of care is a determinant of missed appointment rates. In analyses of 74,120 follow-up visits by 13,882 patients, odds ratios for missing an appointment for patients who had language, race or gender concordance with their PCP were 0.90 (95% confidence interval [CI], 0.81–0.99), 0.84 (95% CI, 0.79–0.90) and 1.01 (95% CI, 0.95–1.07) respectively, after adjustment for age, insurance, language, individual PCP open access, sessions per week PCP in practice, and health center. Odds ratios for missing an appointment varied nearly three-fold, depending upon the particular site of care. Race and language concordance between patients and PCPs has only a modest effect on missed appointment rates. Receipt of primary care services at specific neighborhood health centers was the strongest predictor of missed appointment rates in this sample.
The Financial Impact of Interim and Prospective Payment Systems on Home Health Providers in Rural Communities
Authors: Lin Chyongchiou Jeng , Davitt Joan K , Meit Michael , Schwartz Myron , Marainen Jonas , Davis Lisa , Leon Joel
Published: August 2005

The objective of the study was to examine the financial impact of the interim payment system and prospective payment system (PPS) on home health agencies (HHAs) in rural communities. Data sources used included a survey of administrators in all rural HHAs in Pennsylvania and financial and utilization data provided by 10 rural HHAs in Northwest Pennsylvania. The results of survey showed that, under the PPS, 40% of the HHAs reported financial vulnerability and 24% expressed concern that the fiscal uncertainties arising from the PPS threatened their continued operation. Two prospective analyses were conducted to examine how HHAs would be further affected by payment rate changes implemented in October 2002 and April 2003. The Medicare margin in rural Pennsylvania was 23.3% during the period from October 2000 to June 2002. This margin was slightly higher than the free-standing home health Medicare margin (21.6%) reported in analyses conducted by the Medicare Payment Advisory Commission (MedPac). However, this Medicare margin did not include hospital-based HHAs. The payment rate changes implemented in 2002 and 2003 would increase the proportion of care episodes that incur financial losses, assuming service provision remains constant. As of April 2003, the proportion of all episodes with loss would rise to 46.9%, the proportion of low-utilization payment adjustment (LUPA) episodes with loss would rise to 91.1%, and the proportion of non-LUPA episodes with loss would rise to 40.2%. New payment mechanisms are profoundly affecting the finances of rural HHAs and the use of home health services by Medicare beneficiaries.
Mind the Gap: Parents' Citizenship as Predictor of Latino Children's Health Insurance
Authors: Ojeda Victoria D , Brown E. Richard
Published: August 2005

Parents' citizenship appears to be correlated with high rates of uninsurance and low rates of job-based insurance among Latino citizen children in families headed by citizens and non-citizens. Few studies have examined the direct relationship between parents' citizenship and children's insurance status. Data for U.S.-born Latino and non-Latino white children ages 0–18 years in working two-parent households obtained from the March 2001 Current Population Survey were analyzed. Results from logistic regressions were adjusted for a design effect to account for survey design. After controlling for other sociodemographic and employment characteristics, only Latino children in families headed by non-citizen couples are more likely to be uninsured and less likely to have employer-based insurance than others in the dataset. Even controlling for non-citizen parents' duration in the U.S., citizenship status of the head of household predicts children's coverage. Latino children are more likely to have health insurance if they have at least one citizen parent. Continued and varied efforts are needed to promote coverage among U.S.-born Latino children.
Uninsured Adults Aged 65 Years and Older: Is Their Health at Risk?
Authors: Okoro Catherine A , Young Stacy L , Strine Tara W , Balluz Lina S , Mokdad Ali H
Published: August 2005

Some U.S. adults aged 65 years and older lack health care coverage. As a result, they may have unmet health needs and be vulnerable to excess morbidity and mortality. Due to their small numbers, little data on them exist. We used data from the 1996â2000 Behavioral Risk Factor Surveillance System, an ongoing telephone survey operated by the state health departments with assistance from the Centers for Disease Control and Prevention, to examine a representative sample of adults 65 years old and older. We found that blacks and Hispanics were disproportionately represented among uninsured older adults. Compared with their insured counterparts, the uninsured elderly experienced cost barriers to needed care, lacked receipt of an annual checkup, and did not receive preventive health screenings. Given the projected growth of the elderly population, particularly among blacks and Hispanics, it is crucial to ensure all older adults have access to preventive health services.
Characteristics Associated with Reservation Travel Among Urban Native American Outpatients
Authors: Rhoades Dorothy A , Manson Spero M , Noonan Carolyn , Buchwald Dedra
Published: August 2005

The objectives of this study were to ascertain the extent of, and health-related characteristics associated with, travel to reservations in a low-income, urban American Indian and Alaska Native (AI/AN) population. We surveyed more than 500 AI/AN adults at a primary care clinic. Measures included time spent visiting a reservation during the past year, and sociodemographic, cultural, and clinical characteristics. More than half (52%) of the patients had not traveled, 34% had traveled up to 30 days, and 14% had spent more than 30 days traveling to reservations. Multivariate ordinal regression revealed that a strong Native American cultural identification, presence of lung disease, absence of thyroid and mental problems, and greater dissatisfaction with care were independently associated with more travel to reservations (p ≤ 0.05). This research begins to augment the paucity of information on such travel and its relationship to health status and use of health services among urban AI/ANs.
Medicaid Managed Care for Mental Health Services in a Rural State
Authors: Willging Cathleen , Waitzkin Howard , Wagner William
Published: August 2005

State governments throughout the country increasingly have turned to managed care for their Medicaid programs, including mental health services. We used ethnographic methods and a review of legal documents and state monitoring data to examine the impact of Medicaid reform on mental health services in New Mexico, a rural state. New Mexico implemented Medicaid managed care for both physical and mental health services in 1997. The reform led to administrative burdens, payment problems, and stress and high turnover among providers. Restrictions on inpatient and residential treatment exacerbated access problems for Medicaid recipients. These facts indicate that in rural, medically underserved states, the advantages of managed care for cost control, access, and quality assurance may be diminished. Responding to the crisis in mental health services, the federal government terminated New Mexico's program but later reversed its decision after political changes at the national level. This contradictory response suggests that the federal government's oversight role warrants careful scrutiny by advocacy groups at the local and state levels.
Ships Passing in the Night: The Current State of the Human Rights and Development Debate seen through the Lens of the Millennium Development Goals
Authors: Alston Philip
Published: August 2005

The Millennium Development Goals (MDGs) are the most prominent initiative on the global development agenda and have a great deal in common with human rights commitments. But neither the human rights nor development communities has embraced this linkage with enthusiasm or conviction. This article explores the reasons why the two agendas resemble ships passing in the night, even though they are both headed for very similar destinations. The empirical evidence examined includes analyses prepared by a range of human rights NGOs, the MDG National Plans adopted by many developing countries, and the relevant analyses undertaken by UN human rights treaty bodies and special rapporteurs. The author calls upon the human rights community to engage more effectively with the development agenda, to prioritize its concerns rather than assuming that every issue needs to be tackled simultaneously, and to avoid being overly prescriptive.
Transnationalization of Human Rights Norms and Its Impact on Internally Displaced Kurds
Authors: Celik Ayse Betul
Published: August 2005

This paper addresses the less researched topic of internal displacement as a human rights issue and analyzes the extent that the transnationalization of human rights issues and the pressures from regional organizations affected the rights of ethnic minorities, particularly internally displaced ethnic groups. In order to shed light on how much state sovereignty on sensitive internal matters can be challenged by regional organizations, the paper examines Turkey's efforts to join the European Community (through membership in the Council of Europe and the European Union) in light of its policies toward its internally displaced Kurdish population. Although the analysis focuses on internal displacement as an issue within this field, it also studies general human rights problems, such as minority rights, cultural rights, and representation of minorities, within the context of Turkey's Kurdish Question.
Is Spain Recovering its Memory? Breaking the Pacto del Olvido
Authors: Davis Madeleine
Published: August 2005

This article considers the ongoing effort by campaigners in Spain to gain official recognition of the human rights crimes of the Franco dictatorship. Despite estimates placing the number of Republican supporters summarily executed and buried in unmarked graves during and after the civil war at 30,000, demand for an official investigation has only surfaced in the past five years. The article offers an explanation both for the longevity of Spain's unspoken pacto del olvido (pact of forgetting) and for its recent unraveling, in the context of contemporary debates involving issues of transitional justice and memory politics.
International Human Rights Law as Power/Knowledge
Authors: Evans Tony
Published: August 2005

It is often noted that the modern human rights discourse is predominately a discourse of international law. Interest groups, nongovernmental organizations, major international organizations, and states all accept that the global human rights regime is a legal construct. Scholarly work on human rights also adopts a predominately legal approach, as shown by several surveys of the literature and the human rights curriculum at the university level. This article places international human rights law within the context of critique in an effort to explain the hegemony of law within the human rights discourse. It begins with a discussion of the nature of human rights discourse as it is practiced in the current world order. It then moves to introduce the idea of discipline in world order, in particular "market discipline," which provides the dominant set of values upon which international action is undertaken. An additional section looks at the tensions between international human rights law and the norms that describe "market discipline." Finally, the conclusion is that international human rights law offers a discourse of both freedom and domination.
Global Governance, Dam Conflicts, and Participation
Authors: Goulet Denis
Published: August 2005

Globalization, as presently conducted, is governed badly. Large dams, long viewed as beneficial and essential to development, have become sites of major social conflict. Participatory decision-making by "affected" populations in macro sectors of development is viewed by many as impossible, notwithstanding its advocacy by the World Commission on Dams on the basis of its "rights and risks" approach. Brazilian initiatives in participatory governance in varied macro sectors, especially in water/dam policy, show that macro participation is feasible. Lessons yielded by dam conflicts in Northeast Brazil suggest how authentic participation can occur in water/dam policy and other arenas of globalization.
Kwangju and Beyond: Coping with Past State Atrocities in South Korea
Authors: Han In-sup
Published: August 2005

In May 1980, the Korean military committed a coup d'etat and massacred Kwangju citizens. South Korea's democratic transition exposed a variety of human rights abuses and raised several issues for the new government. The first issue was how to deal with the Kwangju Incident. Key figures, including two former Presidents, were found guilty of treason and massacre. However, lawyers faced a series of difficult legal questions: How could members of a victorious coup be punished? Would a trial seek retroactive punishment? Who should be held accountable for the massacre? In the struggle for truth and justice, Koreans declared and implemented basic principles for resolving the pain brought on by the Kwangju massacre: truth, justice, compensation, honor-restoration, and commemoration. Now, such principles set a standard for solving other military atrocities that may be committed under an authoritarian regime.
Testing the Red Lines: On the Liberalization of Speech in Morocco
Authors: Smith Andrew R. , Loudiy Fadoua
Published: August 2005

This article reports on the contradictions, ambiguities, and paradoxes associated with the liberalization of speech in Morocco. It includes analyses of interviews with human rights activists, journalists, and government officials; an overview of media and civil society; and an argument against equivocations of speech with conduct. The authors argue that the constitutional sanctification of the Moroccan monarch and his utterances fosters a magical conception of speech that militates against substantive and enduring democratic reforms. Public discourse that brings monarchical sanctity and legitimacy into question is illegal, but such discourse is essential if democratization is to be finally achieved.
Bremer's "Gordian Knot": Transitional Justice and the US Occupation of Iraq
Authors: Stover Eric , Megally Hanny , Mufti Hania
Published: August 2005

Shortly after the US invasion and occupation of Iraq, L. Paul Bremer III, in his capacity as the chief administrator of the Coalition Provisional Authority (CPA), introduced several transitional justice mechanisms that set the course for how Iraqis would confront the legacy of past crimes for years to come. In developing these mechanisms, Bremer consulted with a select group of Iraqi exiles that had returned to Iraq or were still living abroad. However, he failed to solicit the opinions and attitudes of the Iraqi people as a whole. He also failed to consult many of the governmental and nongovernmental entities that could pass on to the CPA and future Iraqi governments the "lessons learned" and "best practices" gleaned from transitional justice processes in other countries. As a result, many of the mechanisms introduced by Bremer either backfired or were hopelessly flawed.
Judging History: The Historical Record of the International Criminal Tribunal for the Former Yugoslavia
Authors: Wilson Richard
Published: August 2005

Scholars and legal officials have argued that courts should not attempt to write definitive historical accounts of mass human rights violations. Even if a court seeks to reconstruct a comprehensive history of a conflict, law and history use such different modes of thinking and inquiry that legal accounts are likely to be partial, deeply flawed, or just plain boring. These criticisms have appeared prominently in discussions of Holocaust trials in the domestic courts of Israel and France. Yet the Tadić and Krstić judgments written by the International Criminal Tribunal for the Former Yugoslavia (ICTY) are characterized by detailed contextualization of criminal acts and extensive historical interpretation. This Article asserts that the Tribunal's historical record represents a departure from previous courtroom accounts of mass atrocities for two reasons. First, because it is an international tribunal it has been less influenced by distorted narratives on national identity. Second, the ICTY has applied legal categories such as genocide which emphasize the collective nature of crimes against humanity, and this compels the court to situate individual acts within long-term, systematic policies.
Paradigms' Cost: Representing Vulnerable Subjects
Authors: Couser G. Thomas
Published: August 2005

The representation in life writing of vulnerable subjects—individuals who, for various reasons (most frequently disability), are not able to represent themselves, at least without assistance—poses difficult ethical questions. Cases should be addressed in terms of their particular characteristics, of course, but a broader approach to the ethical issues inherent in the representation of those with disabilities is to consider the benefits and risks of the three major paradigms of disability available today: the symbolic (or metaphorical), the individual (or medical), and the social (or cultural). The last of these paradigms is best suited to honor both the rights and the interests of vulnerable subjects because it alone acknowledges that disability is not solely an individual concern.
When Life Writing Becomes Death Writing: The Journal of Emily Shore
Authors: Gates Barbara T.
Published: August 2005

The recently discovered manuscript of Emily Shore's last journal, 1839, yields a number of interesting insights into the Victorian illness narrative. Shore inscribed this final journal in Madeira, where she had repaired to try to recover from tuberculosis. Unfortunately, she died there, only a few months after her arrival. Journal entries for Shore's last months are both poignant and revealing in terms of their narrative strategies. The last journal begins as a kind of travel narrative and study of island and family life, but it is transformed first into a careful relational narrative about others afflicted with the disease and then into a kind of spiritual autobiography. It ends abruptly with staccato entries made in an altered hand as Shore tries to record her last thoughts while fatally ill.
"The Blameless Physician": Narrative and Pain, Sassoon and Rivers
Authors: Hemmings Robert
Published: August 2005

Early twentieth-century psychoanalytic encounters were typically mediated through the case study, a kind of "sur-narrative"âone constructed from above and temporally beyond the physician-patient encounter â in which the physician fills in what Freud calls "gaps" and "imperfections" of the patient's own repression-addled narrative. However, there are cases in twentieth-century modernism of patients creating their own sur-narratives, not case studies, but homages, which do not so much fill in the gaps as cover them over with layers of idealized memories of the physician-analyst, layers replete with their own imperfections and gaps. This essay examines Siegfried Sassoon's sur-narratives of his encounter with W.H.R. Rivers, autobiographical poetry and fiction that work to transform Rivers from mere physician into a guiding spiritual presence. But fissures of pain disrupt his sur-narratives and reveal the poet-patient unable to escape his past or accept the spiritual future into which he projects his physician, safely beyond the harsh material conditions of the war-torn modern world.
The Other Side of Silence: Levinas, Medicine, and Literature
Authors: Irvine Craig
Published: August 2005

While medicine is surely among humanity's greatest works, the nature of this greatness is beyond its own power to judge. Medicine must answer to ethics. For Immanuel Levinas, ethics is the primordial call of the Other, whose alterity—beyond appropriation, possession or mastery—originally challenges my unquestioning ipseity and thus precedes all forms of knowledge. This recognition of the priority of the Other is quintessentially manifest in my encounter with his suffering and death. Out of this encounter arises the original demand for curative help—for medicine. Unfortunately, medicine, like all forms of knowledge, by nature veils the ethical imperative presupposed by its very existence. Literature helps lift this veil. With its power to bring close, or reflect, distance as such, literature helps medicine face the absolute alterity of the Other's suffering. Paradoxically, it is through its mirroring that literature points medicine beyond its own reflection.
"You Can Kill, but You Cannot Bring to Life": Aesthetic Education and the Instrumentalization of Pain in Schiller and Holderlin
Authors: Lyon John B.
Published: August 2005

Pain and physical violence are instrumental for German Classicism, that is, their representation serves an aesthetic and cultural ideal. This article locates pain and violence within the discourses of Bildung and aesthetics in late 18th Century Germany, and analyzes Friedrich Schiller's and Friedrich Hölderlin's responses to these discourses. Hölderlin, in his novel Hyperion, rejects the tendency of this era to instrumentalize pain. Initially, Hölderlin modeled his ideas of aesthetics and development on Friedrich
Schiller's, which privilege pain in order to further aesthetic and social ideals (i.e. the concept of Bildung). Ultimately, however, Hölderlin rejects Schiller's approach and posits a model of aesthetic Bildung that privileges the expression rather than the instrumentalization of pain. In doing so, he asserts a poetics of empathy, one that privileges expression of both individual and communal pain, yet that likewise must also forsake the ideals and totalities espoused by this epoch.
Making Poetry of Pain: The Headache Poems of Jane Cave Winscom
Authors: McKim Elizabeth
Published: August 2005

Jane Cave Winscom was an 18-century British poet who suffered from excruciating headaches. Three poems about her pain appear in the 1794 edition of her Poems. They provide both a valuable historical account of the treatments she underwent and a patient's account of the physical and psychological effects of headache. Winscom's poems display many of the same features as current pain narratives. They expose private and devastating suffering to public gaze, and publicly question the medical establishment that has failed to restore her to health. They also reveal features that have come to be understood as foundational in pain narratives: a body turned on itself and figured as an external enemy, and the absolute power of pain to silence the sufferer. Most important, the poems demonstrate Winscom's narrative composition of a self who has overcome this enforced silence to speak the experience of head pain.
Narrative Pain and the Moral Sense: Towards an Ethics of Suffering in the Long Eighteenth Century
Authors: Wandless Bill
Published: August 2005

Writers in the eighteenth century encountered a generative impasse in the representation of narrative pain. While they could capitalize on expressions of pain as common cultural currency, as varieties of corporeal experience they had in common with their audience, they could not recapture the idiosyncratic, ineffable qualities of pain, the ways in which suffering occurs differently and indescribably for every individual. By appealing to the elaboration of moral sense theory, a current of philosophy that describes how sensitive beings form impressions and make judgments based on a species of feeling that involves both physical and emotional responsiveness, contemporary readers may observe how writers of fiction during the period developed a series of representational strategies to deal with this impasse, to make pain visible, legible, and useful for a variety of narrative purposes.
Why Birdsong Is Sometimes Like Music
Authors: Baptista Luis Felipe , Keister Robin A
Published: August 2005

The sounds and songs of birds have inspired the musical compositions of numerous cultures throughout the globe. This article examines a variety of compositions from Western music that feature birdsong and explores the concept of birds as both vocalists and instrumentalists. The concept of birds as composers is then developed—how they use rhythmic variations, pitch relationships, and combinations of notes similar to those found in music—and the theory that birds create variation in their songs partially to avoid monotony is considered. Various families of birds that borrow sounds from other species are surveyed, in particular the European starling (Sturnus vulgaris), which may have inspired a Mozart composition. We conclude that the fusion of avian bioacoustics and the study of birdsong in music may function as a conservation tool, raising the awareness of humans and stimulating future generations to save for posterity what remains of the natural world.
Meeting Threats to Global Health: A Call for American Leadership
Authors: Benatar S. R , Fox Renee C. (Renee Claire)
Published: August 2005

Although the application of major biomedical advances has yielded spectacular results for individual health, there has been little improvement in the health of whole populations. There is a "back to the future" irony in the fact that at the inception of the 21st century, the eruption and spread of a multitude of "old" and "new" infectious diseases has become the most serious global threat to the health of humankind. At this historical juncture, the United States is the country with the most potential for favorably influencing global health and health care. Although there are historical, cultural, economic, and political factors that impede the United States from rising to this challenge, there is both a moral imperative and a rational long-term self-interest basis for the U.S. medical profession and government to exercise leadership in facing the health challenges of tragic and genocidal proportions that threaten everyone in an increasingly interdependent world.