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PubMed1986

Assessment-based group counseling to address concerns of chronic hemodialysis patients.

A Dialysis Patient Concerns Inventory (DPCI) was administered to 15 chronic hemodialysis outpatients by their nurses to assess concerns related to being a hemodialysis patient. This direct information from patients rather than experts in the field was used to construct a group counseling program to address these and other concerns later acknowledged by patients once group counseling began. Components of the counseling program, how the program was implemented, its effects, and factors important in effective program implementation with nurse involvement are discussed. It was concluded that it is important for nurses to play key roles in group counseling to address patients' concerns. It is also important for such counseling to be based on structured assessment of specific concerns reported from patients. Furthermore, it was concluded that group counseling should be planned and executed in ways that actively involve patients and that allow patients to participate for skill development and for life enhancement, rather than to get help with personal problems--a motivator that is often stigmatized.

Adult↗
PubMed1994

Psychosocial counseling to improve quality of life in HIV infection.

Psychosocial interventions such as cognitive behavioral stress management (CBSM), may enhance coping and social support which contribute to an improvement of quality of life factors such as emotional functioning, social functioning, and sense of well-being, for HIV-infected men during several phases of HIV spectrum disease. These phases include the acutely stressful period immediately following notification of HIV+ status, the adjustment period following this news, and the process of dealing with chronic symptomatic HIV infection. Normalization of some aspects of immunological status were found to accompany some of these psychosocial changes in the short-run. Longer-term follow-up indicated relationships between psychosocial factors and improved immunological status and physical functioning up to 2 years later. Factors such as an increased use of active coping strategies, including relaxation exercises, use of more functional appraisals and elicitation of social support, and decreased use of denial/avoidance coping strategies, may be key predictors of longer-term emotional well-being, social functioning, and physical functioning in HIV-infected populations. Special issues need to be addressed in emerging models of quality of life assessment in HIV populations. For example, the way resurgence of stigmatization and self-doubt affects sense of identity and well-being need to be addressed in quality of life research as well as in psychosocial interventions. Loss of employment and its financial and existential consequences are also factors which impact sense of self and well-being, and need to be addressed both in research as well as in interventions. The effect of repeated HIV-related bereavements upon an individual's social network and the emotional, social, and physical sequelae of bereavement have implications for HIV quality of life research as well. Quality of survival time has become a paramount issue in the context of HIV spectrum disease. Examining the relationships among coping strategies, social support, emotional well-being, realistic appraisals of one's functioning in comparison to their aspirations, and the influence of psychosocial functioning on disease course are central missions of our research program.

Adult↗
PubMed1996

Patients as teachers: an integrated approach to teaching medical students about the ambulatory care of HIV infected patients.

Our experience with medical students in a large inner city hospital left us concerned that students' fears affect their ability to learn about and care for HIV-positive people. Therefore, we decided to create an environment in which the students could feel safe exploring their own attitudes and feelings about HIV. To accomplish the goal, we developed a curriculum in the ambulatory care of HIV-positive people. We recruited and trained patients from an HIV support group at our hospital to work with students in one-on-one sessions to teach interviewing, physical exam, and patient counseling skills. As part of a 4-week ambulatory clerkship for third year students we developed a minicourse which included four sessions with didactic and experiential components. The first week consisted of an orientation and group discussion in which patients told the students about what its like to live with HIV. During each of the following three sessions, students met with a preceptor to learn about HIV in an ambulatory care setting. The didactic session was followed by one-on-one student/patient encounters in which students practised skills discussed that week and patients gave them feedback. At the close of the day, the entire group reconvened to discuss what had happened. As a result of this integrated approach, students are experiencing the relational aspects of providing medical care, often for the first and only time. In the process they are learning to take good social histories and are learning how patients with HIV relate to and sometimes reorganize their family and social support systems. Students have the opportunity to get to know, in depth, a relatively healthy person who is living with a chronic, stigmatizing illness. Both patients and students are talking to each other on a level of intimacy that is rare in the training environment. Patients express a new appreciation of their own role and power in the relationship and a new insight into the struggles of the provider. Faculty experience a renewed commitment to the importance of creating an environment where the students can discover for themselves the joy of the connection between doctor and patient. Students have an opportunity to relate to patients not as pathology, but as people with lives before and beyond the medical system. This model is practical and may be useful in teaching about other chronic diseases in the ambulatory setting.

Ambulatory Care↗
PubMed1989

Psychosocial and cultural issues in HIV infection.

HIV infection is distributed so that stigmatized groups (gay and bisexual men, IVDU, blacks, and Hispanics) form the majority of cases. Consequences of AIDS-related stigma have resulted in unnecessary discrimination: loss of job, loss of home, denial of insurance, and estrangement from family and friends. Because AIDS is an infectious disease with a high mortality rate, HIV-infected individuals live with the threat of impending death. An awareness of the cultural values, life-styles, and psychosocial problems of these patients will promote effective nursing care.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Homophobia and attitudes toward gay men and lesbians by psychiatric nurses.

Stereotypic and stigmatic attitudes toward homosexuality may interfere both directly and indirectly with the care provided to gay and lesbian patients. The purpose of this study was to measure attitudes toward gays and lesbians and assess homophobia among psychiatric nurses. The demographic characteristics of education, religious identification, and knowledge of gays and lesbians had positive affects on attitudes and homophobia. The Attitudes Towards Gays and Lesbians Scale (ATGLS) developed by the researcher specifically for this study assessed cognitive attitudes and the Index of Homophobia (IHP), developed by Hudson and Ricketts (1980), measured homophobia, the affective response to gays and lesbians.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The impact of genetic syndromes on children's growth.

Genetic syndromes that include short stature are recognized by their effect on children's growth rates, by their effect on the growth rate and pubertal development in adolescence, and by the presence of stigmata associated with certain syndromes. The effects of Down, Seckel, Turner, Russell-Silver, Prader-Willi, and Noonan syndromes on growth and the growth-inhibiting features of achondroplasia, hypophosphatemic rickets, and Laron dwarfism are reviewed. The terminology used by professionals in discussing genetic alterations should minimize the effects of labeling and stigmatization and should emphasize the normal aspects of a child's life.

Female↗
PubMedDate not supplied

Educational, psychologic, and social aspects of short stature.

Children with short stature may experience academic difficulties, psychologic impairment, and emotional stress related to an underlying medical condition or social stigmatization. Educational and psychosocial problems associated with short stature often can be alleviated with appropriate interventions. Parents, health-care practitioners, and teachers should be aware of the potential academic, psychologic, and social problems related to short stature and growth delay, so they can support the short child's normal development and intervene promptly if problems arise.

Body Height↗
PubMed2005

Women and cigarette smoking: does amount of weight gain following a failed quit attempt affect social disapproval?

This study examined the perception of social attractiveness and approval of smoking in a vignette of an American college female smoker after a failed quit attempt. It was hypothesized that she would be perceived more favorably when she was smoking to control her weight, compared to a non-weight related excuse during a failed quit attempt. The design was a 2 (gender: male vs. female)x4 (condition: control, 5, 10, 20 lb gain)x3 (participants' smoking status: never, former, or current smoker) factorial design with the Social Attraction Index and Perception of Smoking Index as dependent variables. Contrary to the hypothesis, perceptions of the female were not affected by her disclosed amount of weight gain. However, consistent with the literature on stigmatization of smokers, smoking participants perceived the female target as most socially attractive and nonsmokers perceived her to be the least attractive.

Adult↗
PubMed2006

An investigation of stigma in individuals receiving treatment for substance abuse.

This study examined the impact of stigma on patients in substance abuse treatment. Patients (N=197) from fifteen residential and outpatient substance abuse treatment facilities completed a survey focused on their experiences with stigma as well as other measures of drug use and functioning. Participants reported experiencing fairly high levels of enacted, perceived, and self-stigma. Data supported the idea that the current treatment system may actually stigmatize people in recovery in that people with more prior episodes of treatment reported a greater frequency of stigma-related rejection, even after controlling for current functioning and demographic variables. Intravenous drug users, compared to non-IV users, reported more perceived stigma as well as more often using secrecy as a method of coping. Those who were involved with the legal system reported less stigma than those without legal troubles. Higher levels of secrecy coping were associated with a number of indicators of poor functioning as well as recent employment problems. Finally, the patterns of findings supported the idea that perceived stigma, enacted stigma, and self-stigma are conceptually distinct dimensions.

Adaptation, Psychological↗
PubMed2005

[Hyperventilation syndrome in children].

Hyperventilation syndrome is frequent in adults. There are only very few and very ancient publications in children. Diagnosis is sometimes difficult, because the symptoms often mimic those of organic diseases. Hyperventilation syndrome and organic diseases, especially asthma, often coincide. Intensive efforts should be made to diagnose hyperventilation syndrome at an early stage because this will prevent stigmatization and fixation of symptoms and disease, and also prevent children from undergoing unnecessary medical examinations and therapies. The authors review the literature about hyperventilation syndrome in children.

Asthma↗
PubMed2005

The impact of obesity on psychological well-being.

Children and adolescents with obesity face stigmatization and discrimination in many areas of their lives, and it has been assumed that their psychological well-being will be compromised as a result. This chapter examines the most recent empirical evidence on the relationship between childhood obesity and body dissatisfaction, self-esteem and depression. Studies of clinical samples typically report poorer psychological well-being in treatment seekers when compared with population-based obese and normal weight controls. However, research in community samples suggests that despite moderate levels of body dissatisfaction, few obese children are depressed or have low self-esteem. A number of important moderators and mediators of the association between obesity and well-being have emerged, with females, Caucasians and adolescents being particularly at risk. Implications for treatment and future research priorities are suggested.

Adolescent↗
PubMed2006

Reconstructive surgery of the leprosy nose: a new approach.

There has still been no reduction in the detection rate worldwide for leprosy, despite supervised multi-drug therapy. In time, leprosy can result in a severe saddle-nose deformity leading to functional problems, disfiguration and stigmatization. In severe cases, only the nasal skin tissue and the lower lateral cartilages are preserved. In such cases, the ideal would be to restore the cartilaginous skeleton but, by contrast with other causes of saddle-nose deformities, this is complicated by the quantity and the poor quality of the remaining nasal mucosa. Leprosy-related saddle-nose deformities are therefore challenging and difficult to reconstruct with the techniques that have been proposed in the past. In this study, 24 patients underwent rhinoplastic surgery involving the use of autogenous costal and/or auricular cartilage or composite grafts. The nasal septum, the upper laterals and the anterior nasal spine were reconstructed with a dorsal onlay attached to a columellar strut with an extension on the proximal side. Before surgery, the saddle-nose deformities were classified according to severity with a new system based on clinical symptoms and signs. Postoperative evaluation was performed at least two years after surgery (N=17). Functional and aesthetic improvement, resorption rate, warping, infection and extrusion were analysed. Functional and aesthetic improvements were achieved in 15/17 patients. None of the patients developed an infection and extrusion or warping of the implants was not observed. The resorption rate depended on the localization and the type of cartilage implant. In general, auricular conchal cartilage implant grafts resulted in less resorption than costal cartilage. Least resorption (4/17 patients) was observed in the dorsal onlay grafts of both conchal (1/6) and costal cartilage grafts (3/11). Resorption of columellar strut implants and shield grafts was observed in 7/17 patients. No resorption was seen of composite grafts (0/4) and alar battens (0/7). Autogenous cartilage implants can be used to reconstruct saddle-nose deformities in leprosy with a minimum risk of complications. The preoperative grade of severity was used as a basis for the development of guidelines for optimal long-term functional and aesthetic outcome.

Adolescent↗
PubMed2004

Urinary incontinence: historical, global, and epidemiologic perspectives.

Urinary incontinence (UI) is a devastating worldwide problem in older adults. Establishing the true prevalence and incidence of UI remains a challenge as different societies define and approach UI differently. Nevertheless, most societies share the common practice of stigmatizing elders with incontinence. Enhanced awareness of global perspectives and epidemiological trends of incontinence isa necessary pre-requisite to improving management of this distressing geriatric syndrome.

Female↗
PubMedDate not supplied

Medical consequences of obesity.

The obese are subject to health problems directly relating to the carriage of excess adipose tissue. These problems range from arthritis, aches and pains, sleep disturbance, dyspnea on mild exertion, and excessive sweating to social stigmatization and discrimination, all of which may contribute to low quality of life and depression (Table 1). The most serious medical consequences of obesity are a result of endocrine and metabolic changes, most notably type 2 diabetes mellitus, cardiovascular disease, and increased risk of cancer. Not all obesity comorbidities are fully reversed by weight loss. The degree and duration of weight loss required may not be achievable by an individual patient. Furthermore, "weight cycling" may be more detrimental to both physical and mental health than failure to achieve weight loss targets with medical and lifestyle advice.

Aged↗
PubMed2005

Psychologic factors in psoriasis: consequences, mechanisms, and interventions.

The article examines the English-language research literature concerning psychologic aspects of psoriasis published since 1995. The literature is concerned with (1) the consequences of psoriasis in terms of quality of life, disability, depression, anxiety, and stigmatization and factors that may predict such outcomes; (2) potential mechanisms of the interaction between psychologic factors, stress, and the pathophysiology of psoriasis; and (3) examination of the clinical utility of psychologic interventions on extent of psoriasis and psychologic distress. The implications of the findings are discussed with reference to future directions for research and practice.

Humans↗
PubMed2006

Treatment-related stresses and anxiety-depressive symptoms among Chinese outpatients with type 2 diabetes mellitus in Hong Kong.

Based on focus group findings, a descriptive instrument was developed to examine the relationship among treatment-related stress, anxiety and depressive symptoms, distress, and impairment of 333 Chinese outpatients with type 2 diabetes mellitus (DM) in Hong Kong. It was found that the main stresses included fears of diabetes complications, work impairment, lifestyle adjustment, stigmatization, and discrimination. Over 1/4 of patients concealed their DM from family members in order not to make the latter worry. 28.3% felt that life was not worth living. 33.6% of patients exhibited four or more anxiety and depressive symptoms accompanied by significant distress and/or impairment. These patients were more likely to be female, of lower educational level, and unemployed. Diabetes complications, concealment of DM, and feeling of being a burden to the family predicted anxious-depressed status. The study showed that treatment-related stresses and anxiety-depressive symptoms were common and associated among Chinese diabetes outpatients in Hong Kong.

Adolescent↗
PubMed2004

Patients' satisfaction with hospitalization in a mixed psychiatric and somatic care unit.

A patient satisfaction survey was undertaken in a mixed psychiatric and somatic care unit. An anonymous self-report questionnaire covering setting and satisfaction with care was completed by 60 patients. Median age was 42 (range 20-64), and the majority female (63%). Main ICD-10 diagnostic categories were depressive disorders (51.7%), substance-related disorders (33%) and personality disorders (25%). Somatic comorbidity was present in 60% of patients. Overall satisfaction with care and setting was high. Higher satisfaction was significantly associated with a history of previous hospitalizations in a psychiatric hospital and with being referred to the program by a psychiatrist. These findings emphasize the perceived advantages of mixed units, such as decreased stigmatization of psychiatric inpatients and opportunity to receive adequate treatment for both physical and mental problems during a single hospital stay.

Adult↗