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PubMed1993

Doctors, opioids, and the law: the effect of controlled substances regulations on cancer pain management.

Opioids are underused by physicians for the treatment of cancer pain. Reasons for this include excessive concern about opioid-induced respiratory depression, tolerance, and addiction, as well as the impact of controlled substances regulations. The negative impact of controlled substances regulations on patient care is not well understood. This paper reviews the historical basis and current structure of the regulatory system. Four potential ways in which controlled substances regulations and policies can affect medical care are discussed: (1) by placing restrictions on physician practice, (2) by affecting patient access to opioids, (3) by stigmatizing patients, and (4) indirectly through physicians' perceptions of regulations, resulting in modified medical practices. Physicians are urged to work with state regulatory agencies to identify regulatory impediments to appropriate patient care.

Analgesics, Opioid↗
PubMed1995

Minority stress and mental health in gay men.

This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.

Adult↗
PubMed1995

Health promotion in human immunodeficiency virus-infected patients through psychosocial interventions.

The extreme fear, prejudice, and stigmatization associated with human immunodeficiency virus disease make the acquired immune deficiency syndrome epidemic a unique phenomenon of the modern era. A fundamental understanding of the phychosocial issues surrounding the disease is essential, if nurses are to design interventions that promote optimal health among those infected and those at risk for infection.

HIV Infections↗
PubMed1995

The impact of health care reform on social phobia.

According to the National Comorbidity Survey, social phobia is the third most frequent psychiatric disorder in the United States. Its lifetime prevalence rate of 13.3% ranks behind only major depressive episode (17.1%) and alcohol dependence (14.1%). As was the case with depression 15 years ago, social phobia has often been trivialized and stigmatized. For example, some with social phobia may be dismissed as having mere "stage fright" or excessive shyness, while, in fact, social phobia is a serious mental illness associated with substantial psychosocial distress, comorbidity, and morbidity. Typical onset of social phobia is in the midteens and often continues throughout an individual's lifetime, leading to severe social and occupational impairment. Several excellent, efficacious treatments are available. Access to these treatments for social phobia may be more difficult in the future due to managed care initiatives and health care reform. Various proposals are now being considered as a part of health care reform that may have significant impact on the diagnosis and treatment of social phobia.

Adolescent↗
PubMed1994

[From deinstitutionalization to social rejection: the point of view of ex-psychiatric patients].

A series of in-depth interviews conducted with ex-psychiatric patients who use alternative resources in the area of mental health has revealed several manifestations of rejection, stigmatization and discrimination. These are experienced as significant and determining with respect to the social integration of patients, as well as harmful to their quality of life in the community. Data shows that this population suffers from social isolation due to lack of communication with community members and from various forms of rejection and disparating attitudes on the part of entourage. Their fragile socio-economic conditions confine them to live in a sub-culture and at the fringe of society.

Adult↗
PubMed1994

[Comparison of corneal topography and keratometer in patients with cataract preoperatively and postoperatively].

The comparison of corneal topography with keratometer in 200 patients (278 eyes) was made. The results revealed that Sim K values of corneal topography were 44.22D and 44.26D, mean diopters of keratometer were 44.16D and 44.23D in 150 eyes of 116 patients with cataract preoperatively. There was no significant difference between Sim K values of topography and diopters of keratometer (P > 0.05). The Sim K values of the topography were 46.37D and 43.06D and diopters of keratometer were 46.09D and 42.88D in 90 eyes of 67 patients who received cataract extraction with IOL implantation or second IOL implantation. No significance was found in results between Sim K values and diopters of keratometer in patients postoperatively (P > 0.05). Our investigation demonstrated that Sim K values of corneal topography were in agreements with diopters of keratometer in patients with cataracts preoperatively or postoperatively. However, corneal topography has great values in diagnosis of corneal diseases, traumatic astigmatism, severe non-rule stigmatisms, in which keratometer is often useless.

Adolescent↗
PubMed1994

[Importance of socio-cultural data for accessibility of health care and observance of treatment in leprosy. Example of the Zarma region in Niger].

From an epidemiological point of view leprosy remains a problem of public health. Various factors influence the accessibility to health care and the observance of treatment. The study carried out in Niger shows that beyond the stigmatism associated with the disease, the most important factors concern the difference between scientific and popular etiology and semiology. In the face of such problems it is necessary, from a theoretical point of view, to make anthropological enquiries based on the theme of the different representations of this pathology, and from a practical point of view, to examine the possibility of the participation of former patients in public health teams.

Culture↗
PubMed1995

[Family secrets exemplified by heterologous insemination].

Potential consequences of intrafamilial concealment are discussed in the context of coping with the stigmatizing diagnosis of male infertility and its treatment by artificial insemination by donor. First results of a longitudinal study are presented. A 5-year follow-up was obtained from 40 out of 57 couples initially interviewed. 34 of the couples had kept donor insemination secret even towards their families. 10 of them considered themselves oppressed by the secrecy, especially at the time of insemination. Only two out of 26 successful couples intended to reveal details of conception to the child. These findings suggest that information of the children can follow different strategies. Children should be acquainted with details of their conception if friends or relatives of the parents are informed, in order to reduce the risk of the traumatic event of information by others. In all other cases the decision to inform children or not is to be left in the hands of the parents. Even though maximum candidness is considered desirable today, the "cathartic" revelation of family secrets can be as destructive as their conservation.

Adaptation, Psychological↗
PubMed1994

Dermatography, a simple and effective method for colouring leucoma corneae.

Since antiquity many attempts were made and hence many methods were devised in order to minimalize the disfiguration and stigmatization caused by leucoma corneae. Dermatography, a refined, modified tattooing technique, was developed to treat this affliction. Materials and method are safe and simple. A number of 12 patients has been treated over a period of 3 years. During the 2-year follow-up no negative reactions were found. The cosmetic results were very satisfactory. The method is suitable to rural clinics in the developing world. The technique is safe in the hands of any well-instructed doctor.

Corneal Opacity↗
PubMed1994

[Handicap: definitions, treatment principles, recuperation process].

The traditional model of disease takes no account of its implications in daily life. The concept of handicap originates from the medical, social and economic dimension essential for the individual as well as for the community. Notions of impairment, disability and disadvantage were used to construct a relationship model involving the whole chain of phenomena linked to the initial disease (ICIDH). The handicap situation results from an incompatibility in the triple confrontation of an individual, a life scheme and an environment. Whether disadvantage occurs or not for a same type of impairment, depends on the situation. Handicap means maladaptation of an individual to his context or his environment. Given the endless possible schemes, an individualized and methodical analysis is imperative to deliver comprehensive treatments respectively applied to: the individual himself directly (to do again or to do otherwise) or indirectly by means of appliances to avoid disability (to cope with), the social, occupational, physical and economico-administrative environment (not to be faced anymore with) by restricting as far as possible the number of solutions which imply deviations from the ordinary environment and thereby "stigmatize" the handicap. The plan has to be changed when previous measures are proved ineffective (not to have to do anymore); another plan for life has to be actively constructed and adopted. Anyway, maintaining independence is a significant goal ("to lead one's life according to one's own rules").

Persons with Disabilities↗
PubMed1994

[Education of Mexican health personnel on AIDS].

We describe the epidemiology of AIDS as it pertains to health workers in Mexico. Of the 12,151 cases notified in adults up until 1993, 2.9% occurred among such workers. Two cases of occupational transmission have been documented. Seroprevalence surveys have shown an infection rate of less than 0.1%. Nonetheless, the frequency with which hepatitis B viral markers are present (11.8% of anti-HBs antibody carriers and 2% of anti-HBsAg antibody carriers) points to the fact that mechanisms for the transmission of both types of viruses are at work. Surveys conducted among health workers to explore their knowledge and attitudes on the subject of AIDS indicate that they share many false notions about the disease and that they stigmatize its victims. Educational campaigns have improved knowledge about the illness but have not modified people's attitudes significantly. Holding workshops has proved to be the most useful strategy for attitude modification. We describe a few strategies that may be useful for changing negative attitudes among health personnel. When calculating the frequency with which biosafety measures are implemented, it has been noted that their application is erratic. Epidemiologic studies have confirmed the existence of an association between the time of occupational exposure and the presence of hepatitis B viral markers. Many people reject adopting certain measures, such as anti-hepatitis vaccination. Finally, we analyze the need for continuous training and supplies if increased biosafety measures are to be adopted.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Conspiracies, contagion, and compassion: trust and public reactions to AIDS.

AIDS educational programs can be effective only to the extent that they are perceived as credible by their target audiences. In this study, public trust associated with AIDS was assessed in a national telephone survey. African-Americans were more likely than whites to express distrust of doctors and scientists concerning HIV transmission through casual contact, to believe that AIDS is being used as a form of genocide against minority groups, and to believe that information about AIDS is being withheld from the public. Individuals high in distrust did not differ from those low in distrust in their exposure to AIDS information. Higher levels of AIDS-related distrust were not related to self-reported personal risk reduction, but were related to inaccurate beliefs about HIV transmission through casual contact and greater willingness to avoid and stigmatize people with AIDS. The importance of overcoming distrust in AIDS education programs is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The validity of survey responses on abortion: evidence from Estonia.

This paper presents results of a validation survey of abortion conducted in Tallinn, Estonia in April and May 1992. The sample was drawn from patient records in a maternity hospital. Women who had an abortion in that hospital in 1991 were asked about recent abortions as part of a survey about women's health. More than 80% of the respondents reported having a recent abortion. Some respondents misreported their abortion as a miscarriage. Moreover, some variation in reporting was associated with respondents' characteristics. Ethnic Estonians were less likely to report their abortion than were Russians, women over age 40 were less likely to report the abortion than younger women, and women who had the abortion late in the first trimester were less likely to report that abortion. There was some evidence that unmarried women were less likely than married women to report their abortion, and that women who had borne three or more children were less likely to report their abortion than women who had borne fewer children. These differences probably stem from the extent to which pregnancy or abortion is considered stigmatizing for women in different situations.

Abortion, Legal↗
PubMed1994

Congenital syphilis.

Congenital syphilis offers many parallels with perinatal HIV infection. Both affect multiple organs including the central nervous system, may be asymptomatic for months to years, and pose diagnostic dilemmas, especially from a laboratory perspective. Syphilis is a co-infection in some cases of HIV. Public policy issues raised by the AIDS epidemic, including stigmatization, discrimination, and denial of access to health care, have their antecedents in syphilis.

Anti-Bacterial Agents↗
PubMed1994

Overweight and depression.

Is being overweight distressing? If it is, is the distress due to negative appraisals by others, to the stresses of trying to fit norms of thinness by dieting, or to the health consequences of being overweight? If being overweight is stigmatizing, negative evaluations by others may be internalized as high levels of depression. This perspective predicts that being overweight has a direct effect on depression, and that the effect is greater in social groups where being overweight is less common, especially among women, Whites, younger people, the well-educated, and the well-to-do. Alternatively, overweight may not be distressing per se. Instead, attempting to fit norms of appearance that equate thinness with attractiveness by dieting is distressing. According to this perspective, the association between being overweight and depression is explained by dieting. Finally, this association may be due to the health consequences of being overweight. A random sample of 2,020 U.S. adults aged 18-90 were interviewed by telephone in 1990. Results showed that being overweight has no direct effect on depression in any social group except among the well-educated. Overweight persons are more likely to diet and to experience worse physical health, both of which are associated with depression. Combined, these explain the negative effects of being overweight on depression.

Adolescent↗
PubMed1994

A research agenda for Mexican-American adolescent mental health.

In spite of their vulnerability, Mexican-American adolescents are almost non-existent in the psychological literature. There is little information on the mental health status, needs, and availability of services for this group. This paper provides information on the mental health of Mexican-American adolescents, with emphasis on the prevalence of mental health disorders, service delivery, and utilization. An agenda for research on this group is outlined. Topics include: epidemiology of mental health disorders (stressing longitudinal studies, service delivery, and utilization); developmental processes; the family; and primary and secondary therapeutic interventions. The focus of this agenda is not particular problems. Rather, it is to understand the objective and subjective worlds of adolescents themselves. Such an approach is useful because the knowledge and insights gained can be applied to the development of prevention/intervention programs across a broad range of areas. The present approach also avoids stigmatization of Mexican-American adolescents as a "problem" population.

Adolescent↗
PubMed1993

[Immunohematologic screening and immunocorrection in cardiac surgery at an early age].

110 patients with "blue" and "pale" congenital heart disease in age of 2.43-0.18yrs have been inspected in order to work out the diagnostic criterion of the manifest latent, local and generalized infection, presence during the patients' training for operative healing and in postoperative period. The indexes of cellular and humoral immunity links, the state of phagocytosis, leukocyte index of intoxication have been analysed. Value of NST-test as a 1st level screening and dependence of this index from the degree of blood circulation incompetence, hypoxemia, general stigmatization have been established.

Antibody Formation↗
PubMed1993

Molecular genetics of cell interactions in Arabidopsis.

Many events in plant development are regulated by the interactions of neighboring cells. We are interested in determining what sorts of molecules act as signals and/or receptors in these interactions and how these mechanisms relate to those used in animals and fungi. We are presently working on two different types of systems to try to address this question. In one case we are starting at the molecular level and characterizing a family of receptor protein kinase genes which seem natural candidates for mediating cellular interactions. By analyzing the expression patterns of these genes as well as the phenotypes of transgenic plants bearing altered genes we hope to determine what roles these proteins play in plant development. In the second case we are starting from the organismic level and using genetics to identify genes essential to a whole range of cellular interactions which are required for proper male gametophyte development during reproduction. These interactions involve both recognition of the pollen grain to verify that it is from the correct species and also a transfer of positional information from the female to the male which first allows the pollen tube to determine the polarity of the stigmatic cell on which it has germinated and later provides 'guidance' for the elongating tube to find the ovule.

Arabidopsis↗

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