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PubMed2001

Epilepsy in Estonia: a quality-of-life study.

PURPOSE: To study the impact of epilepsy and its treatment on people with epilepsy in Estonia and to analyze how it is affected by the characteristics of epilepsy. METHODS: Clinical and demographic data about patients were obtained from medical notes and mailed self-completed questionnaires (including the RAND 36-Items Health Survey 1.0 (RAND-36)). RESULTS: Information was collected from 203 patients aged 20-74 years, who all had active epilepsy. A third of the respondents had been seizure free during the last year. Eighty-four percent were receiving monotherapy. More than half of respondents felt stigmatized by epilepsy, 24.7% of them highly so. A third were working full-time, 31.9% were underemployed workers, and 11%, unemployed. Sixty-two percent of these same unemployed or underemployed workers considered their epilepsy to be a significant reason for this situation. Overall, 44% believed they had been treated unfairly at work or when trying to get a job. Study respondents scored lower in all domains on the RAND-36 than did persons from the control group. The biggest differences were found in five domains: Social functioning, Role limitations-physical, Role limitations-emotional, General health, and Vitality. CONCLUSIONS: The clinical characteristics of this study were similar to those of most other series of prevalence cases of epilepsy. The level of employment among persons with epilepsy was not lower than that in the general population. The percentage of stigmatization was high. There were significant differences in the way respondents scored on the stigma scale and on the RAND-36 domains when measuring their health status, depending above all on seizure frequency and type.

Adult↗
PubMed2003

[Shame, embarrassment and trouble...relatives of patients with OCD describe stigma experiences in every-day life].

BACKGROUND: There are numerous studies on the stigma of mental illness. However, the subjective stigma experiences of patients with obsessive-compulsive disorder and their relatives have, so far not been investigated. METHOD: Narrative interviews with 22 family members of patients with OCD were carried out as part of a study on the burden of mental illness on the family. Experience of stigma was analysed as an aspect of subjective burden using a grounded theory approach. RESULTS: Different areas of life could be described, in which stigmatization is anticipated or experienced by family members of patients with OCD. Concealing is a relevant strategy for the members in dealing with the illness. DISCUSSION: Stigmatization can be minimized by impartially handling the illness and cooperation of patients, their relevant others and professionals.

Adaptation, Psychological↗
PubMedDate not supplied

Molecular evolution of the s locus controlling mating in the brassicaceae.

Flowering plants possess self-incompatibility (SI) mechanisms that promote outbreeding and thereby increase their genetic diversity. In the self-incompatible Brassicaceae, recognition and rejection of self-pollen is based on a receptor-ligand interaction between male and female SI determinants. A transmembrane receptor kinase (S locus Receptor Kinase, SRK) determines the SI specificity in stigmatic cells, whereas a pollen coat-localized ligand (S locus Cysteine-Rich, SCR) determines the SI specificity in pollen. During recent years, major advances have been made in the understanding of the molecular basis of self-pollen recognition by stigmatic cells. In this review, we will focus on evolutionary aspects of the SI system in Brassicaceae. We will describe how the study of the molecular aspect of SI, not only in the historical Brassica model but also in Arabidopsis species, has contributed to highlight certain aspects of evolution of SI in the Brassicaceae.

Brassicaceae↗
PubMed1991

Courtesy stigma: the social implications of associating with a gay person.

We investigated the operation of courtesy stigma with American male college students who reacted to a fictitious male student described as gay, rooming by choice with a gay male student, involuntarily assigned to room with a gay, or rooming with a male heterosexual. Among respondents who expressed strong intolerance of gays, the voluntary associate of a gay was perceived as having homosexual tendencies and as possessing the same stereotyped personality traits attributed to a gay. No such courtesy stigma was attached to the involuntary associate of a gay by these respondents. Relatively tolerant respondents engaged in no courtesy stigmatization at all. Thus, courtesy stigmatization occurred only under circumscribed conditions and appeared to depend more on the tendency of highly intolerant individuals to infer that a male student who apparently liked a gay individual was himself gay than on a motivation to maintain cognitive consistency.

Adult↗
PubMed1987

Gender identity and gender transposition: longitudinal outcome study of 24 male hermaphrodites assigned as boys.

The longitudinal case histories of 24 male-assigned male hermaphrodites aged 18 or older were indexed and abstracted for the presence or absence of variables related to gender transposition, namely, bisexualism, homosexuality, or sex reassignment to live as a female. The sample was biased in favor of cases (N = 20) not showing signs of gender transposition. In these cases, there was no gender transposition even if the following variables were in evidence; neonatal ambivalence in announcing the sex; cosmetic inadequacy of masculine genital appearance; sitting posture for urination; and feminizing (N = 9) instead of virilizing (N = 11) puberty. Despite the small size of the minority subsample (N = 4), it showed a trend toward an association between gender transposition and sitting to urinate, and being stigmatized in childhood. This trend is consistent with the association between stigmatization and gender transposition found in a counterpart study of male hermaphrodites announced and reared as girls. Freedom from gender transposition did not prevent suicidal depression, drug or alcohol addiction, marital failure, or death from testicular cancer.

Adolescent↗
PubMedDate not supplied

Mental health nursing in the 21st century.

Mental health nursing in the 21st century will expand to include a neuropsychiatric focus that encompasses the science, knowledge, and skills of both neurology and psychiatry. The shift to neuropsychiatric nursing is directed by the explosion of knowledge in the neurobiologic basis of mental illness, tremendous advances in diagnostic technology, and the discovery of new and more effective psychopharmacologic treatments. Neuropsychiatric disorders are common, disabling, costly, and stigmatizing. A neuropsychiatric paradigm allows treatment to reach more people who are affected and is less stigmatizing than a psychosocial view alone. Neuropsychiatric advanced practice nurses will need both primary care and specialty knowledge and skills. The challenge to nursing education is to determine how best to incorporate this knowledge and skills into curricula. Neuropsychiatric research must focus on both biologic and behavioral measures and interventions. The philosophical and ethical challenge to nursing is to integrate biologic and behavioral concepts into the nursing care of mentally ill people while remaining centered in the nursing domain and maintaining our focus on caring and our sensitivity to the human condition.

Biological Psychiatry↗
PubMedDate not supplied

"Living with the dirty secret": problems of disclosure for methadone maintenance clients.

This article focuses on the management of stigma by methadone maintenance patients. It explores (1) the consequences of this persistent stigma, which necessitates the need for secrecy, (2) the adaptations made in order to successfully "pass as normal," and (3) the contexts in which methadone-maintained individuals decide to disclose their stigmatized status. The data reported and analyzed were gathered between 1980 and 1989 during a series of studies funded by the National Institute on Drug Abuse. The three studies--"Women on Methadone," "Getting Off Methadone," and "Alameda County Methadone Study"--utilized qualitative, in-depth interviews and ethnographic sampling techniques, primarily chain referral sampling. After ten years of interviewing women and men in various stages of their methadone maintenance careers, recurring themes emerged, one of which was that being a methadone patient is a marginal identity; not quite junkie, not quite conventional. Clients' efforts to manage this stigmatized identity were often shrouded in anguish and secrecy. Methadone patients were in a kind of identity limbo; a holding pattern between two extremely different social worlds. They were trying to effect an identity transformation; however, in many circumstances they were still associated with and defined by their "dirty secret."

Adult↗
PubMedDate not supplied

The stigma of being named "AIDS carriers" on Haitian-American women.

AIDS-related stigma has impacted the lives of many individuals, including Haitians. Little, however, is known about the long-term effects AIDS-stigmatization has had on Haitian women living in the United States. A pilot study was conducted to explore Haitian-American women's perceptions of the impact of the AIDS epidemic on their lives. The long-term effects of AIDS-stigmatization fell into five categories: rejection by the dominant society, self-doubt, effect on self-esteem, effect on intimate relationships, and rejection by Haitians within their community. More extensive research is needed to explore the long-term effects of the AIDS epidemic on Haitian women. Additionally, to counter the negative effects of the AIDS epidemic, intervention strategies need to be developed and tested.

Acquired Immunodeficiency Syndrome↗
PubMed2006

HIV-related knowledge, stigma, and willingness to disclose: A mediation analysis.

Increasing HIV knowledge is a focus of many HIV education and prevention efforts. While the bivariate relationship of HIV serostatus disclosure with HIV-related knowledge and stigma has been reported in the literature, little is known about the mediation effect of stigma on the relationship of HIV knowledge with HIV serostatus disclosure. Data from 4,208 rural-to-urban migrants in China were analyzed to explore this issue. Overall, 70% of respondents reported willingness to disclose their HIV status if they were HIV-positive. Willingness to disclose was negatively associated with misconceptions about HIV transmission and stigma. Stigma mediated the relationship between misconceptions and willingness to disclose among women but not men. The mediation effect of stigma suggests that stigmatization reduction would be an important component of HIV prevention approaches. Gender inequality needs to be addressed in stigmatization reduction efforts.

Adolescent↗
PubMed1998

Transgender HIV prevention: a qualitative needs assessment.

Although clinical experience and preliminary research suggest that some transgender people are at significant risk for HIV, this stigmatized group has so far been largely ignored in HIV prevention. As part of the development of HIV prevention education targeting the transgender population, focus groups of selected transgender individuals assessed their HIV risks and prevention needs. Data were gathered in the following four areas: (1) the impact of HIV/AIDS on transgender persons; (2) risk factors; (3) information and services needed; and (4) recruitment strategies. Findings indicated that HIV/AIDS compounds stigmatization related to transgender identity, interferes with sexual experimentation during the transgender 'coming out' process, and may interfere with obtaining sex reassignment. Identified transgender-specific risk factors include: sexual identity conflict, shame and isolation, secrecy, search for affirmation, compulsive sexual behaviour, prostitution, and sharing needles while injecting hormones. Community involvement, peer education and affirmation of transgender identity were stressed as integral components of a successful intervention. Education of health professionals about transgender identity and sexuality and support groups for transgender people with HIV/AIDS are urgently needed.

Adult↗
PubMed1998

Do nurses avoid AIDS patients? Avoidance behaviours and the quality of care of hospitalized AIDS patients.

To examine whether AIDS patients are stigmatized by nurses providing their care a study was conducted with 100 matched AIDS and general medical (GM) patients in two university and two community hospitals. Quality of care and avoidance behaviours were measured by direct, systematic observation during a concurrent 12-hour period. Stigmatizing attitudes of nurses were measured using standardized instruments of homophobia, fear of AIDS and attitudes toward illicit drug use. Nurses made more eye contact and touched AIDS patients more frequently then GM patients, however these differences did not reach the level of statistical significance They spent significantly more time with AIDS patients (W = 3134.0, p = 0.012). Whether or not nurses were fearful of HIV infection, were homophobic or held negative feelings about drug use made no difference in the level of care provided to AIDS patients, but did for GM patients. However, avoidance behaviours were associated with lower quality of care across all patients regardless of diagnosis. Hierarchical regression models demonstrated that increased time spent with patients and higher percentage positive of verbal mannerisms were associated with an increase in the quality of patient care. Provision of physical care showed the least amount of variation between patients in general. It was concluded that nurses' attitudes had no impact on whether or not AIDS patients were shunned by nurses. The provision of psychosocial care showed the greatest variation and seemed more sensitive to individual nurses' attitudes. The quality of care received by the overwhelming majority of patients could only be termed adequate. Nurses exhibited the greatest caution when performing procedures with patients whose HIV status was unknown. The AIDS population studied were mostly well-educated, homosexual men. Whether these results would be replicated with a different population of patients is as yet unknown.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Health-related stigma: rethinking concepts and interventions.

As a feature of many chronic health problems, stigma contributes to a hidden burden of illness. Health-related stigma is typically characterized by social disqualification of individuals and populations who are identified with particular health problems. Another aspect is characterized by social disqualification targeting other features of a person's identity-such as ethnicity, sexual preferences or socio-economic status-which through limited access to services and other social disadvantages result in adverse effects on health. Health professionals therefore have substantial interests in recognizing and mitigating the impact of stigma as both a feature and a cause of many health problems. Rendering historical concepts of stigma as a discrediting physical attribute obsolete, two generations of Goffman-inspired sociological studies have redefined stigma as a socially discrediting situation of individuals. Based on that formulation and to specify health research interests, a working definition of health-related stigma is proposed. It emphasizes the particular features of target health problems and the role of particular social, cultural and economic settings in developing countries. As a practical matter, it relates to various strategies for intervention, which may focus on controlling or treating target health problems with informed health and social policies, countering the disposition of perpetrators to stigmatize, and supporting those who are stigmatized to limit their vulnerability and strengthen their resilience. Our suggestions for health studies of stigma highlight needs for disease- and culture-specific research that serves the interests of international health.

Communicable Diseases↗
PubMed2005

Public tolerance, private pain: stigma and sexually transmitted infections in the American Deep South.

This pilot telephone survey sought to identify social barriers to treating sexually transmitted infections (STIs) in a socially conservative state (Alabama, USA). The sample consisted of 250 household residents aged 19-50 years, mostly African-American and White, who were drawn from the general population. The participants reported that infected persons, per se, should not be stigmatized. However, almost half of respondents stated that they would seek revenge against a partner who infected them. Feelings of embarrassment negatively affected willingness to seek health care; almost half of the respondents stated that, if infected, they would delay treatment or not seek treatment at all. Differences in responses emerged in relation to ethnicity and religiosity, with African-Americans and regular churchgoers being more likely than others to say they would delay or refuse treatment because of embarrassment. Gender differences also emerged: respondents reported that women would be more stigmatized than men if they were infected, even though men should be held responsible for spreading STIs. These findings suggest that stigma may be a compelling barrier to STI control in the American Deep South, and that ethnicity, gender and religiosity play an important role in attitudes toward treatment.

Adult↗
PubMed2002

Chronic sorrow in the HIV-positive patient: issues of race, gender, and social support.

This study used Olshansky's (1962) concept of chronic sorrow to examine social support needs of 21 human immunodeficiency virus (HIV)-positive men and women in a southern U.S. city. The methods of inquiry consisted of narrative interviews and a quantitative assessment of depression (the Center of Epidemiological Studies on Depression [CES-D] Scale). This combined approach indicated that chronic sorrow in HIV-positive persons is related to illness, fear of death, poverty, and social isolation, especially for women with children. More than half of the subjects scored as depressed, with African American women scoring significantly higher than Caucasian men or women. Social isolation often resulted from the effects of stigma, as framed in Erving Goffman's theory of discredited identity. The women were likely to be stigmatized because of their association with "dirty sex," contagion, and moral threat in heterosexual communities. Most of the men had been protected from the worst effects of stigma because of their ties to the gay community and associated health networks. Based on these preliminary findings, stigma should be considered a marker of chronic depression in the HIV-positive, and support services should take account of the stigmatizing contexts of HIV-positive persons.

Adult↗
PubMed2004

Adherence to antiretroviral therapy in HIV-infected adults in Soweto, South Africa.

Little is known about achievable levels of antiretroviral treatment (ART) adherence in resource-limited settings. We conducted a cross-sectional study of adherence among patients at Chris Hani Baragwanath Hospital's Adult HIV Clinic in Soweto, South Africa. Adherence was assessed using a 1-month, self-report questionnaire and was calculated as a ratio of doses taken to doses prescribed. The 66 patients studied had a mean age of 36.1 years, a median duration of ART use of 18 months, and an overall baseline median CD4(+) cell count of 200/mm(3) (IQR: 114-364). The adherence reported by these patients for the previous month was >95% for 58 patients (88%), 90-95% for 6 (9%) and, < 90% for 2 (3%). The main reasons given for missing doses were being away from home (30%), difficulty with the dosing schedules (23%), and running out of pills (12%). Adherence decreased considerably with fear of being stigmatized by the sexual partner (OR = 0.13 95%, CI 0.02-0.70). Plasma HIV RNA levels were <400 copies/ml in the majority of patients (73% of those with adherence >95% and 88% of patients with < or =95% adherence) and the overall median CD4(+) cell count rose to 324/mm(3) (IQR: 193-510). High adherence and viral suppression are achievable for a significant proportion of HIV-infected patients taking ART in a resource-limited area such as Soweto, South Africa. Strategies to maximize adherence in this setting should emphasize ready access to affordable and simple ART regimens, as well as HIV education programs to help increase awareness and decrease disease stigmatization.

Adult↗
PubMed2002

The pollination mechanism in Trigonidium obtusum Lindl (Orchidaceae: Maxillariinae): sexual mimicry and trap-flowers.

The pollination process in Trigonidium obtusum Lindl. (Epidendroideae: Maxillariinae) is documented. The flowers are pollinated by sexually excited drones of Plebeia droryana (Meliponinae). When attempting to copulate either with sepals or petals, these bees slip on the waxy perianth surface and become trapped in the funnel-like flower tube. Bees trying to escape from the flowers may instead access the space between the column and lip, fixing the pollinarium on their scutellum. Pollinarium-bearing bees may pollinate the flowers when repeating the above-mentioned steps, leaving pollinia on the concave stigmatic surface, thus effecting pollination. Recently removed pollinaria are too broad to enter the stigma but they begin to dehydrate and within 40 min of removal are small enough to fit the stigmatic cavity. This mechanism prevents insect-mediated self-pollination and promotes cross-pollination. Preliminary evidence based on experiments with cultivated plants suggests that they are self-compatible but that fruit set is pollinator-dependent. The data obtained are discussed in a phylogenetic context. It is suggested that the pseudocopulatory syndrome in Trigonidium could have evolved from rewardless (food advertising) ancestors. Pseudocopulation in the context of the long flowering period of this orchid species (about 7 months) is understandable since the eusocial Plebeia bees produce fertile individuals several times a year.

Animals↗
PubMed2003

Female flower and cupule structure in Balanopaceae, an enigmatic rosid family.

The Balanopaceae, whose flowers were poorly known, have, in the past, been variously allocated to the Fagales, Euphorbiaceae, Salicales or other hamamelids and rosids (these groups being in Fagales, Malpighiales and Saxifragales, according to the Angiosperm Phylogeny Group). This paper attempts a clarification based on flower morphology. Female flowers and cupules were studied in Balanops vieillardii, young fruits in B. australiana. The cupules are simple involucres of bracts which are spirally arranged (according to a Fibonacci pattern) on the floral axis preceding the flower. They contrast with the complicated cupules of Fagaceae which consist of a condensed cymose ramification system of axes of several orders around the flower. Flowers appear later than most of the cupular bracts, in contrast to Fagaceae. In addition to a terminal flower there may be several smaller lateral flowers in the axil of cupular bracts, each surrounded by its own small cupule. The female flowers do not have a perianth. They consist of two to three large carpels. At anthesis, the ovary is completely septate; the syncarpous part (ovary and lower style) is completely symplicate. The carpels are free for most of their length, with the free parts once, twice or three times bifurcate, in contrast to simple in Fagales. The stigmatic surface covers the ventral side of each stigmatic branch and at the margins also spreads to the dorsal side. The stigma is wet and secretion appears holocrine. The two ovules per carpel are collateral and axile in early development. However, at anthesis they appear one above the other, because in one ovule the funicle greatly elongates. As the ovary elongates only above the placenta, the ovules appear basal at anthesis. The ovules are (weakly) crassinucellar, bitegmic (not unitegmic), anatropous, and intermediate between apotropous and epitropous (not apotropous). The ovules are mature at anthesis, in contrast to Fagales. In mature ovules the upper part of the nucellus disintegrates, and a weakly differentiated endothelium is present in the inner integument. The morphological results of this study support a position of Balanopaceae in Malpighiales, and not Fagales or other orders, and are thus in accordance with recent molecular results based on chloroplast rbcL sequences data. However, within Malpighiales, as opposed to molecular results, Balanopaceae agree more with Euphorbiaceae s.l. than with Dichapetalaceae/Trigoniaceae and Chrysobalanaceae/Euphroniaceae.

Flowers↗
PubMed2004

Heteromorphic incompatibility and efficiency of pollination in two distylous Pentanisia species (Rubiaceae).

BACKGROUND AND AIMS: Distyly has been hypothesized to promote cross-pollination by reducing intrafloral and geitonogamous self-pollination, and enhancing intermorph pollination. Distylous plants typically display both reciprocal herkogamy and a heteromorphic incompatibility system, which allows mating only between morphs. Distyly and its pollination consequences were examined in two Pentanisia species with long-tubed flowers which are pollinated almost exclusively by butterflies. METHODS: Anther and stigma heights were measured to quantify reciprocal herkogamy. The type of incompatibility system was determined by observing pollen tubes and seed production following controlled hand pollination. Pollen loads on pollinators and stigmas were also examined to assess the efficiency of intermorph pollen flow. KEY RESULTS: Pentanisia prunelloides and P. angustifolia exhibit reciprocal herkogamy and a host of ancillary dimorphisms, including pollen colour, exine sculpturing, stigmatic papilla shape and floral-tube pubescence. Controlled hand-pollinations revealed the presence of a strong heteromorphic incompatibility system in both species. The site of incompatibility differed between the morphs; intramorph pollen tubes were blocked in the style of the short-styled morph and on the stigmatic surface of the long-styled morph. Butterflies carried pollen from the short- and long-styled morphs primarily on their head and proboscis, respectively. Natural pollination resulted in a higher proportion of pollen transfer from long- to short-styled plants than vice versa. Nevertheless, fruit set did not differ between morphs. CONCLUSIONS: Both Pentanisia species are fully distylous. Reciprocal herkogamy results in pollen from the two morphs being carried on different locations on pollinators' bodies, which in turn promotes intermorph pollination. Intramorph pollination does not result in fertilization, because of an effective heteromorphic incompatibility system.

Flowers↗