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Cultural factors affecting urban Mexican male homosexual behavior.

Some aspects of the mestizoized urban culture in Mexico are linked to male homosexuality in support of the theory that cultural factors play an important role in the kind of life styles and sex practices of males involved in homosexual behavior. The following factors are considered relevant: the sharp dichotomization of gender roles, dual categorization of females as good or bad, separate social networks maintained by males before and after marriage, proportion of unmarried males, and distribution of income. One result of the sharp dichotomization of male and female gender roles is the widely held belief that effeminate males generally prefer to play the female role rather than the male. Effeminacy and homosexuality are also linked by the belief that as a result of this role preference effeminate males are sexually interested only in masculine males with whom they play the passive sex role. The participation of masculine males in homosexual encounters is related in part to a relatively high level of sexual awareness in combination with the lack of stigmatization of the insertor sex role and in part to the restraints placed on alternative sexual outlets by available income and/or marital status. Males involved in homosexual behavior in Mexico operate in a sociocultural environment which gives rise to expectations that they should play either the insertee or insertor sex role but not both and that they should obtain ultimate sexual satisfaction with anal intercourse rather than fellatio. In spite of cultural imperatives, however, individual preferences stemming from other variables such as personality needs, sexual gratification, desires of wanted partners, and amount of involvement may override the imperatives with resulting variations in sexual behavior patterns.

Adolescent↗

Lesbian mothers and their children: a comparison with solo parent heterosexual mothers and their children.

Two types of single-parent households and their effects on children ages 3-11 years were compared. One type comprised 50 homosexual mothers and their 56 children, and the other was a group of 40 heterosexual mothers and their 48 children. There were 30 daughters and 26 sons of homosexual mothers and 28 daughters and 20 sons of heterosexual mothers. The sexual identity and social relationships of the children were assessed in relation to the sexual orientation of the mothers. The samples consisted of families from rural and urban areas in 10 American states. All have lived without adult males (18 years or older) in the household for a minimum of 2 years (average 4). Families with heterosexual mothers were matched to families with homosexual mothers on age and race of mother; length of mother and child separation from father; educational level and income of mother; and number, age, and sex of children. Data are reported from childrens' tests designed to provide information on general intelligence, core-morphologic sexual identity, gender-role preferences, family and peer group relationships, and adjustment to the single-parent family. No significant differences were found between the two types of households for boys and few significant differences for girls. Concerns that being raised by a homosexual mother might produce sexual identity conflict and peer group stigmatization were not supported by the research findings. Data also revealed more similarities than differences in parenting experiences, marital history, and present living situations of the two groups of mothers. The postulated compromised parental fitness of lesbian mothers, commonly asserted in child custody cases, is not supported by these data.

Adult↗

Plastic and aesthetic surgery on children with Down's syndrome.

Since 1978, 300 children with Down's syndrome have received plastic- and aesthetic-surgical corrections of the face--to the tongue, nose, and less frequently, ears and chin--so that they will be less conspicuous. The parents' satisfaction in 95% of the cases indicates that the children's situation has been improved by the operations. The children are less stigmatized and their social integration became easier.

Adolescent↗

"Sex-role preference" as an explanatory variable in homosexual behavior.

Sex-role preference is an important neglected variable in statistically controlled studies of homosexual behavior. This variable must accompany controls for degree of psychopathology of respondents and degree of heterosexual and homosexual behavior experienced by respondents. Cross-cultural differences exist. Mexican males have rigidly defined insertor-insertee roles, with earlier life events serving as predictors of these sex-role preferences. Greece is comparable to Mexico. In Turkey, stigmatization accompanies passive homosexuality. Role playing may be age graded, as in the Southwest Pacific. In lower socioeconomic classes of the United States, sex roles for homosexual males are more stereo-typically and unequivocably defined. Chicanos generally have strong sex-role preferences when involved in homosexual encounters; their attitude is similar to that found in Mexico. Among middle-class Anglo-American males, few or no sex-role feelings are associated with types of sex acts by most homosexually behaving males. This may be related to a focus on oral-genital rather than anal sex acts. The sharply dichotomized gender roles and the cultural formulation linking effeminacy and homosexuality appear to provide the necessary conditions for the development of sex-role preferences in many societies.

Adult↗

Race-related PTSD: the Asian American Vietnam veteran.

This article presents a conceptual framework by which to understand race-related post-traumatic stress disorder (PTSD) for the Asian American Vietnam veteran. The framework draws from cognitive schema theory, social behaviorism, the notion of cumulative racism as trauma, and the assumption that bifurcation and negation of one's bicultural identity is injurious. Classifications of race-related stress or trauma that may be experienced by Asian American Vietnam veterans, with exemplifying clinical case material, are presented. These types of stressors include being mistaken for Vietnamese, verbal and physical assaults that are race-related, death and near-death experiences that are race-related, racial stigmatization, dissociation from one's Asian identity, and marginalization. As studies of combat trauma and sexual assault forced the psychological stresses attendant to war and sexist oppression into public consciousness, so this article addresses psychological stress and trauma attendant to racism.

Adaptation, Psychological↗

Leilani Muir versus the philosopher king: eugenics on trial in Alberta.

The Province of Alberta in Canada was the only jurisdiction in the British Empire where a eugenic sterilization law was passed (in 1928) and vigorously implemented. The pace of sterilization orders accelerated during the Nazi era and remained high after World War II, terminating only in 1972 when the Sexual Sterilization Act was repealed. The Alberta Eugenics Board operated away from public and legislative scrutiny, and many things done in the name of eugenics were clearly illegal. Eugenics was put on trial in Alberta in 1995 and a judge of the Court of Queen's Bench ruled in 1996 that the government had wrongly sterilized Leilani Muir. After hearing evidence about the history of the eugenics movement, the origins of Alberta's Sexual Sterilization Act, the operation of the Eugenics Board, and details of Muir's life, Madam Justice Joanne B. Veit found that 'the damage inflicted by the operation was catastrophic', the 'wrongful stigmatization of Ms. Muir as a moron ... has humiliated Ms. Muir every day of her life', and 'the circumstances of Ms. Muir's sterilization were so high-handed and so contemptuous of the statutory authority to effect sterilization, and were undertaken in an atmosphere that so little respected Ms. Muir's human dignity that the community's, and the court's, sense of decency is offended'. Veit awarded Muir damages of $740,780 CAD and legal costs of $230,000 CAD. The order for Muir's sterilization was signed by John M. MacEachran, founder of the Department of Philosophy and Psychology at the University of Alberta and chairman of the Eugenics Board from 1929 to 1965. An exponent of Platonic idealism, MacEachran believed sterilization of children with a low IQ test score was a means of 'raising and safeguarding the purity of the race'. However, the Alberta Sterilization Act was passed and implemented with cavalier disregard for the principles of genetics as well as the rights of children.

Adult↗

An ecological model for school-based mental health services for urban low-income aggressive children.

An ecological model for school-based mental health services that targets urban low-income aggressive children--a highly vulnerable and underserved population--is presented. The goals of the model are to increase children's and teachers' involvement in the delivery of services and to increase the integration of these services into existing school resources and activities. The model proposes that mental health service providers work in collaboration with teachers to deliver services that (1) can be managed by existing school resources and personnel, (2) are related to empirically based factors associated with reduced aggression and increased social functioning, and (3) are group administered to increase the number of children served and to reduce stigmatization associated with mental health services. The model is individualized and flexible by acknowledging that contexts for aggression differ across classrooms and children and by providing services specific to those contexts. Two studies are presented illustrating the application of this model to decrease aggression and increase academic engagement in low-income urban public schools.

Achievement↗

Public knowledge, attitudes, and beliefs about homeless people: evidence for compassion fatigue.

Media reports suggest that the public is becoming impatient with the homeless--that so-called "compassion fatigue" has gripped the nation. This characterization of public sentiment could have important policy consequences-- restrictive measures can be justified by growing public impatience, and progressive housing policies seem feasible within a hostile climate of opinion. But evidence to support the compassion fatigue notion is anecdotal. We examine the issue by tracking the results of public opinion polls and by reporting detailed evidence from a nationwide random-digit dial telephone survey (N = 1,507) concerning knowledge attitudes and beliefs about homeless people. To be sure, the public sees homelessness as an undesirable social problem and wants something done about it. However, although the homeless are clearly stigmatized, there is little evidence to suggest that the public has lost compassion and is unwilling to support policies to help homeless people.

Adolescent↗

[Esthetic facial surgery].

In the last few years, aesthetic facial surgery--especially soft-tissue surgery--has received increasing attention, not only from the medical profession but also particularly from the media. This is due, in part, to the growing level of general acceptance of the formerly stigmatized issue of aesthetic surgery, and in part to increasing patient expectations. Moreover, the introduction of less invasive procedures with outstanding long-term results have brought about a considerable change in aesthetic surgery. A comprehensive account of face lifting, forehead lifting, brow lifting, blepharoplasty, cervical liposuction and adjuvant techniques of skin rejuvenation will be given and discussed.

Adult↗

[Influence of gender and social inequality on nutrition and overweight in children and adolescents].

Overweight and adiposity in children and adolescents are increasing problems in Germany, and more and more primary and secondary prevention programs are being developed. When planning and designing prevention strategies, one should be aware of the target groups and settings. Analysis of epidemiological data for sex/gender, social class, and ethnicity indicates where there is increased need for intervention. Clearly elevated prevalence rates for overweight and adiposity can be found in socially underprivileged children, whereas findings for sex differences are inconsistent because of different systems of reference. This paper gives an overview of epidemiological data in Germany and discusses starting points for prevention. The argumentation focuses on the idea of cooperation between health,education, and social services to reach socially underprivileged children without stigmatizing them and their families.

Adolescent↗

[Psychosocial consequences of psoriasis--an empirical study of disease burden in 3753 affected people].

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the psychosocial consequences of psoriasis in a large sample in Germany. PATIENTS AND METHODS: A questionnaire including the Psoriasis Disability Index (PDI) circulated by the German Psoriasis Alliance was answered by 3753 members representing a return rate of 42.3%. Psoriasis was graded-at the time of the examination-with less than 3% of the body surface affected as "mild", between 3 and 10% as "moderate," and more than 10% as "severe." RESULTS: The general impact of the illness on everyday life was "mild" in about 27%, "problematic" in about 45%, and "severe" in about 25% of the respondents. About 50% of the participants in the study had, concerning the skin, "mild" (PDI=9), about 35% "moderate" (PDI=14), and about 15% "severe" psoriasis (PDI=19). The differences of the PDI values are significant (ANOVA: p<0.001). CONCLUSIONS: This investigation confirms the enormous burden caused by the skin disease in the form of impairment and stigmatization, depending on the somatic severity, even when the current affection is rather mild. In connection with psychosocial consequences, future study should also focus on the disease burden of psoriasis.

Cost of Illness↗

[Illness-related stress in psoriasis vulgaris. Validation of the "Psoriasis Daily Stress Inventory"].

BACKGROUND AND OBJECTIVE: Illness specific stress plays an important part in the daily life of psoriatic patients. Until now for the measurement of relevant aspects of daily stress only the "Psoriasis Life Stress Inventory" (PLSI) of Gupta & Gupta exists; with the "Psoriasis-Alltagsstress-Inventar" (PAI), a German version of the PLSI is presented and its psychometric properties are discussed. PATIENTS/METHODS: 385 in-patients completed the PAI. The internal validity was examined by factor analysis. Moreover, the correlations between the PAI total score and sociodemographic parameters (ANOVA) and extent of skin involvement (multiple regression) were determined. RESULTS: The PLSI score proves to be sufficiently independent of age, sex, age at onset, and general extent of skin involvement. However, affections of the hands, the lower abdomen and the genitals show a strong influence on the total score. We found marked interrelations with the stigmatization feeling ("Questionnaire on Experience with Skin Complaints" QES, Schmid-Ott et al. 1998). CONCLUSIONS: The results suggest that the PAI is a useful and psychologically relevant questionnaire for psoriatic patients.

Adult↗

[Hairdex: a tool for evaluation of disease-specific quality of life in patients with hair diseases].

Because of a strong reduction of life quality in patients with hair loss, a special questionnaire was developed following the general Skindex questionnaire for dermatoses. The Hairdex was evaluated in 75 female hair patients. The aim of the study was to prove the questionnaire's statistical values, reliability, validity, general acceptance and accuracy. The clinical manifestation of hair loss was categorized as "not visible", slightly visible" and "obviously visible". The hair loss lead to great differences in the life quality of both the patients with obvious hair loss and in patients with non-visible hair loss, especially in the categories "emotions", "self-confidence" and "stigmatization". The convergent and discriminant validity of the questionnaire was satisfactory. The acceptance of the questionnaire was very good with 90%. The hairdex-questionnaire represents a reliable and patient-oriented instrument for evaluation of life quality in hair diseases. The reliability of the questionnaire concerning longitudinal therapeutic effects will need to be investigated in further studies.

Adult↗

[Active electronic cochlear implants for middle and inner ear hearing loss--a new era in ear surgery. I: Basic principles and recommendations on nomenclature].

Hearing aids have fundamental disadvantages: (1) stigmatization of the patient; (2) the sound is often found to be unsatisfactory due to the limited frequency range and undesired distortion; (3) in many patients, the ear canal fitting device generally necessary leads to an occlusion effect; (4) acoustic feedback when amplification is high. Conventional hearing aids transmit sound into the ear canal via a small microphone. Sound has the disadvantage of requiring high output sound pressure levels for its transmission. This along with the necessary miniaturization of the loudspeaker as well as the resonances and reflections in the closed ear canal contribute to the disadvantages mentioned. In contrast, implantable hearing aids do not make sound signals but micromechanical vibrations. An implantable hearing aid has an electromechanical transducer instead of the loudspeaker of a conventional hearing aid. The hearing signal does not leave the transducer as sound but as a mechanical vibration which is directly coupled to the auditory system bypassing the air. This implantable hearing aid is either coupled to the tympanic membrane, the ossicular chain, the perilymph of the inner ear, or the skull. An implantable hearing aid is expected to have: 1 Better sound fidelity than a hearing aid 2 No ear canal fitting device, free ear canal 3 No feedback 4 Invisibility Requirements on electronic hearing implants designed for patients with conductive hearing loss differ from those on implants for sensorineural hearing loss. Conductive hearing loss requires the implant to replace the impedance transformation, thus being an impedance transformation implant (ITI). In various respects, the demands on an ITI are lower than the demands on an electronic hearing aid for patients with sensorineural hearing loss. The latter are mostly patients with a failure of the cochlea amplifier (CA). A damage to the CA is clinically discernible by a positive recruitment and loss of otoacoustic emissions (OAE). Since these patients form the majority of cases with sensorineural hearing loss, an active hearing implant for such patients should partially replace the function of the CA. Therefore, the suggestion is to refer to a CAI (cochlea amplifier implant). The implant expressions ITI (for patients with conductive hearing loss) and CAI (for patients with sensorineural hearing loss) used in this context allow nomenclatural association with the CI (cochlear implant) for complete inner ear failure as well as with the BSI (brainstem implant) in the case of hearing nerve failure.

Cochlear Implants↗

[Active electronic hearing implants for middle and inner ear hearing loss--a new era in ear surgery. III: prospects for inner ear hearing loss].

The perspectives for active hearing implants lie in the treatment of patients with sensorineural hearing loss (SNHL). The majority of patients with SNHL suffer from a cochlea amplifier (CA) failure which is discernible by a positive recruitment and loss of otoacoustic emissions (OAE). Therefore, the electronic implant is expected to partially replace functions of the CA. Thus, the implant is thought to function as a CAI (cochlea amplifier implant). An approved implant for routine use is not yet available. Clinical studies have thus far only used the high energy consuming (HEC), narrow-band, electromagnetic floating-mass transducer, as well as the Maniglia-HEC implant. The high energie consuming, yet broadband Canadian Fredrickson implant is soon to be used in humans. Of the piezoelectrical implants, a German CAI (Tübingen implant) at present consisting of a piezoelectrical transducer and a microphone has thus far been acutely implanted in first patient. It is a low energy consuming (LEC), broad-band implantable system for patients with sensorineural hearing loss. Routine surgical treatment of patients with sensorineural hearing loss with a CAI will only be achieved if complete implants (with transducer, microphones, batteries, and control unit) are made available. They combine distinct acoustic superiority with invisibility (end of stigmatization), an open ear canal, and hopefully, the end of feedback whistling. Among the implants mentioned, the German CAI is the only LEC implant. Its energy requirements are so low that with today's technologie implantable batteries (e.g., in pacemakers), the additional implantation of an energy carrier seems feasible. Since the implantable microphone is already available in the German system, the only essential part missing for a totally implantable CAI is the implantable control unit.

Cochlear Implants↗

[First implantation of a totally implantable electronic hearing aid in patients with inner ear hearing loss].

For the majority of patients with sensorineural hearing loss (SNHL) many available hearing aids often do not achieve satisfactory results. For these patients partially implantable hearing devices have been developed, allowing distortion-free hearing and speech intelligibility that may be superior to conventional hearing aids. The external parts of partial implants, however, may result in a patient's stigmatization. Furthermore, they do not use the acoustic properties of the external auditory canal. Recently, we published the successful development of the first totally implantable hearing device for the treatment of SNHL (HNO 46 [1998] 853-863). Here we report the first implantations of this unique, totally implantable electronic hearing system in patients with SNHL: Implex TICA LZ 3001. The implant microphone is implanted subcutaneously in the outer ear canal near the ear drum. The signal is processed by a digitally programmable multichannel audioprocessor located subcutaneously on the bony skull behind the ear. A piezoelectric transducer is coupled to the body of the incus and drives the ossicular chain by vibratory actions. Energy is provided by an implantable battery. Implanted patients describe hearing as being distortion-free and transparent. Speech intelligibility and the hearing of music are improved. Patients may achieve better speech discrimination, especially in the presence of background noise. The aid can be used during sports, including swimming. To our knowledge, this is the first report of the implantation of a totally implantable electronic hearing system in patients. These results encourage further implantations of the totally implantable hearing system in the course of an ongoing clinical study.

Audiometry, Speech↗

[Psychosocial aspects of fertility disorders].

The number of couples experiencing unwanted childlessness will in all likelihood continue to grow. Thus, ever more couples are undergoing IVF treatment; in Germany, this is, however, successful in only 13.9% of attempts. An unfulfilled wish for a child can have both negative emotional effects on individual partner and consequences for the couple's relationship. Women in particular suffer from the psychological stress that can be caused by infertility; they are more anxious, depressed, and have a decreased self-esteem than their partners. The desire to counteract these emotional strains and to enhance the quality of life is increasing and accordingly requests for counseling services are on the rise. As is the case in so many other psychosocial counseling services offered, there are shortcomings in the information available and a threshold of fear and dread of stigmatization by others persist. Studies have shown that various psychological treatments can often contribute to reducing stress but they do rarely increase the possibility of pregnancy.

Adaptation, Psychological↗

The role of self-report questionnaire in the screening of postnatal depression- a community sample survey in central Tokyo.

BACKGROUND: Numerous studies have shown that health care professionals often experience difficulty in detecting postnatal depression. In Japan, where mental illness has traditionally been stigmatized, detection seems even more difficult. This study investigates the prevalence of postnatal depression in the community and its relation to screening methodology. METHODS: The Edinburgh Postnatal Depression Scale (EPDS) was distributed at community health centers in a district in central Tokyo. The results from both non-identifiable questionnaires and identifiable questionnaires were compared. Screening by EPDS and clinical judgment by community nurses were compared. RESULTS: Making the questionnaire identifiable did not change the score distribution pattern. Among mothers with 3- to 4-month-old babies in the community, 13.9% scored high (9 or above) on EPDS. In 51.1% of high scorers,nurses did not detect postnatal depression. Clinically, postnatal depression can be easily missed in the community health-check setting especially when there was hitherto no report of obstetric abnormality during pregnancy or delivery. CONCLUSION: The prevalence of high scorers is comparable to those reported in other countries. The use of the questionnaire was helpful in drawing the attention of mothers and health care professionals to issues of mental health.

Adult↗