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PubMed2006

International disparities in access to infertility services.

OBJECTIVE: To characterize the international availability of infertility services. DESIGN: A PubMed computer search to identify relevant articles. SETTING: Academic medical center. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULT(S): Epidemiological data suggests that approximately 80 million people worldwide are infertile. Most countries in the industrial west have declining fertility rates marked by late marriage, postponed childbearing, and primary infertility. In contrast, in the developing world, there is little voluntary effort to postpone childbearing and early first marriage is common. However, a high prevalence of sexually transmitted infections and infections acquired as a result of inadequate health care result in increased rates of secondary infertility. In developing societies, childlessness is often highly stigmatized and leads to profound social suffering for infertile women in particular, yet most infertile people in the developing world have virtually no access to effective treatment. Internationally, a minority of countries offer IVF, and even where it is available, on average it is prohibitively expensive and utilized by a fraction of those who could benefit from its use. CONCLUSION(S): Wide disparities exist in the quality, availability, and delivery of infertility services between the developed and developing nations of the world.

Female↗
PubMed2006

Expression analysis of the sunflower SF21 gene family reveals multiple alternative and organ-specific splicing of transcripts.

The SF21 proteins were originally identified in sunflower pollen and in the stigmatic and transmitting tissues of sunflower pistils [Kräuter-Canham, R., Bronner, R., Evrard, J.L., Hahne, G., Friedt, W. and Steinmetz, A., 1997. A transmitting tissue- and pollen-expressed protein from sunflower with sequence similarity to the human RTP protein. Plant Science 129, 191-202.]. They are polypeptides of about 350 amino acids showing limited but significant sequence similarities with the animal NDR/RTP family of proteins of yet unknown function. Based on genomic sequence information derived from BAC clones containing SF21-related sequences we have identified transcripts generated from three different, but highly related genomic copies: SF21C, SF21D and SF21E. A sequence analysis of SF21C transcripts amplified by RT-PCR using specific primer pairs revealed a complex splicing pattern producing a minimum of three splice variant forms of the protein, one of 355 residues, and two truncated proteins of 90 and 138 amino acids, respectively. One of these variants was detected only in styles from pollinated florets, indicating organ-specific splicing. Two other splice variants, identified for a related transcript, SF21D, generate proteins differing by an 8-residue extension at their C-terminus. This analysis of SF21 transcripts in sunflower supports already existing evidence that alternative splicing is complex and common in plants.

Alternative Splicing↗
PubMed2005

Transethnic itineraries for ethnomedical therapies in Nigeria: Igbo women seeking Ibibio cures.

Although therapeutic itineraries have been studied in a variety of contexts, little research has investigated care-seekers' quests for traditional medical treatments outside their own ethnic boundaries. The present study investigated 19 Igbo women seeking traditional cures from Ibibio indigenous healers in Akwa Ibom State, Nigeria. Emerging data show that these Igbo women were uptaking Ibibio indigenous treatments primarily for health conditions that have failed to respond to initial treatments in their places of origin, were stigmatized at their own places of origin, or and were thought to have resulted from supernatural causes. Care-seeking outside patients' ethnic borders was thus both a quest for a more effective treatment and a strategy for concealing therapeutic progress or and the nature of illness from the patients' places of origin. Findings underscore the critical role of culture and place in health-seeking behaviour and the need for health care services to be responsive to the complex nature of cultural organization involving care-seekers' and the critical ways this plays out in, flows into, and is negotiated through particular places during therapeutic quests.

Adolescent↗
PubMed2005

Off the map: a critical geography of intellectual disabilities.

A "critical geography of intellectual disabilities" is outlined. Drawing on personal experience and borrowing poetic inspiration, claims about the end of the institutional era for intellectual disabled people are disputed, and the continuing eugenic legacy, complete with its multiple stigmatizing effects, is emphasized. The extent of the social exclusion experienced by many people with intellectual disabilities in the wider community, linked to various poor quality of life indicators, is also given attention. Finally, speculations are raised about how to move beyond the "asylum" and the "ghetto", empowering intellectually disabled people in the process.

Deinstitutionalization↗
PubMed2005

The place of people with intellectual disabilities in Bandung, Indonesia.

This report is an attempt to 'make visible' people with intellectual disabilities in Bandung, Indonesia, who have been rendered invisible due the stigmatization of disabled bodies in Indonesian society. The Western concept of deinstitutionalization is not appropriate to the contemporary culture of Indonesia. Returning to the 'special schools' following completion of secondary education resolves some of the problems of social exclusion, while reinforcing other exclusionary aspects of Indonesian society. Institutionalization is seen as a privilege in the Indonesian context, as only the better off can afford the cost of placing people with intellectual disabilities in institutions.

Cultural Characteristics↗
PubMed2005

Patient-identified barriers to asthma treatment adherence: responses to interviews, focus groups, and questionnaires.

This article reviews 32 patient-interview studies that revealed that the most common barriers to adherence revealed by patients included concerns about drug safety and cost and a belief that the patient's asthma was not severe enough to require daily treatment. Important but less commonly cited concerns included worry about dependence or diminished effectiveness with long-term use of the medication. Children and their parents expressed concerns about safety, dependence, peer stigmatization, and parent-child conflict over taking medication. Low-income and minority patients cited similar concerns and barriers that included cost, difficulty of obtaining medication, daily life hassles, and a general distrust of the medical establishment. The information obtained from patients' perspectives indicates the need to reappraise current strategies for the management of asthma, including a more flexible approach to the use of expert guidelines for the treatment of asthma.

Activities of Daily Living↗
PubMedDate not supplied

Conceptualizing nursing research with offenders: another look at vulnerability.

In this article, vulnerability is examined as it applies to the conduct of nursing research with offenders. As a group, offenders present with a multitude of acute and chronic physical and mental health care needs; they are subject to discrimination, stigmatization, and marginalization; and as such, they often experience dual, multiple, or overlapping vulnerabilities. As research participants, they are especially vulnerable to coercion, as a direct consequence of their dependency status within the correctional system. Embracing a research agenda that focuses on offenders as a vulnerable population is fraught with ambiguities not generally encountered in other settings. The ethical conduct of research with vulnerable populations reflects a contemporary research problem that requires ongoing discourse within the nursing community and the health care community at large.

Confidentiality↗
PubMed2006

Forensic mental health law reform in Japan: from criminal warehousing to broad-spectrum specialist services?

Since the 1980s Japan has undergone a number of mental health law reforms culminating in the 2005 forensic law. This added to its enactments on involuntary commitment, long-term aged care and substitute decision making, bringing Japan into focus as an industrialized state now possessed of a full package of civil and forensic provisions. This article seeks to demonstrate that the new forensic law cannot achieve its own stated goals without seeking to put into place financial and administrative supports aimed to integrate the myriad of patient populations that will be inevitably affected by the new forensic system. In order to avoid the widespread syndrome that has already been experienced internationally of warehousing mentally ill offenders in jails, it is critical that the Japanese government develop effective and culturally sensitive techniques for dealing with low risk populations through a diversionary process. Furthermore, although the legislation addresses serious crimes, it is imperative that policies be put into place to avoid directing young offenders, violent patients from the general hospital system, the developmentally handicapped, already convicted persons found in hospital settings and problematic cases in the correctional system, to the new forensic units established by the legislation. It is only though contemplating unintended outcomes of the legislation that the Japanese government will be able to avoid the ongoing stigmatization and prolonged institutionalization of mentally ill populations. Despite apparent cultural differences internationally vetted human rights requirements must be properly protected, not only in the forensic context, but throughout the mental health system at large. The coordination of services and the development of specialty training are necessary conditions for the realization of improved and humane conditions for mentally ill persons in Japan.

Crime↗
PubMed2006

Reducing depression stigma using a web-based program.

OBJECTIVE: This study was designed to investigate the efficacy and feasibility of a web-based depression stigma education tool for healthcare professionals. METHODS: A web-based depression stigma program utilizing adult learning theories was developed. Forty-two consecutive subjects were enrolled from University of Maryland staff and graduate students. Primary outcomes were Bogardus Social Distance Scale with a vignette on major depression disorder (BSDS-MDD) and the Depression Stigma Scale (DSS) administered before and after the intervention. RESULTS: Internet-based education significantly decreased the level of depression stigma (BSDS-MDD 10.6+/-4.4 versus 7.2+/-4.4, p<0.001; DSS-personal 12.7+/-7.2 versus 7.8+/-5.3, p<0.001; DSS-perceived 21.7+/-5.5 versus 12.4+/-5.5, p<0.001). After the educational intervention the subjects' knowledge about depression significantly improved (pre-test DKS=18.2+/-8.2 versus post-test DKS=20.6+/-4.1, p<0.001). The program was very well accepted by participants. For 100% of participants, it was not difficult to operate the program. CONCLUSIONS: Computer-assisted education was effective in reducing the stigma of depression and increasing knowledge about depressive disorder. A web-based intervention has the potential to be used for educating graduate students and university staff about depression and for reducing depression stigmata. Healthcare professionals interacting with people with stigmatizing conditions can benefit from web-based computer education.

Computers↗
PubMed2005

Belief in the harmfulness of antidepressants: results from a national survey of the Australian public.

BACKGROUND: Surveys of the public in several countries have found that negative attitudes towards antidepressants are common. However, there has been little research into the factors associated with these attitudes. METHODS: A national survey of 999 Australian adults assessed beliefs about the helpfulness or harmfulness of antidepressants for a person with depression and suicidal thoughts. Associated factors investigated were as follows: sociodemographic characteristics, exposure to depression, ability to recognize depression, beliefs about other depression interventions, beliefs about long-term outcomes with and without treatment, beliefs about causes, and stigmatizing attitudes. RESULTS: Around a quarter of Australian adults believe that antidepressants would be harmful for a person who is depressed and suicidal. This group was less educated, had less exposure to depression, showed poorer recognition of depression, was less favorable about other standard interventions including psychological ones, was less pessimistic about the long-term outcome if the person did not have treatment, and was more likely to see depression as due to weakness and to be under the individual's control. LIMITATIONS: The survey did not directly ask about reasons for believing that antidepressants would be harmful. CONCLUSIONS: Belief in the harmfulness of antidepressants is associated with a general lack of exposure to depression, leading to an underestimation of its seriousness and of the necessity for intervention.

Adult↗
PubMed2006

Imaging of peptides in the rat brain using MALDI-FTICR mass spectrometry.

Analytical methods are pursued to measure the identity and location of biomolecules down to the subcellular (microm) level. Available mass spectrometric imaging methods either compromise localization accuracy or identification accuracy in their analysis of surface biomolecules. In this study, imaging FTICR-MS is applied for the spatially resolved mass analysis of rat brain tissue with the aim to optimize protein identification by the high mass accuracy and online MS/MS capabilities of the technique. Mass accuracies up to 6 ppm were obtained in the direct MALDI-analysis of the tissue together with a spatial resolution of 200 microm. The spatial distributions of biomolecules differing in mass by less than 0.1 Da could be resolved, and are shown to differ significantly. Online MS/MS analysis of selected ions was demonstrated. A comparison of the FTICR-MS imaging results with stigmatic TOF imaging on the same sample is presented. To reduce the extended measuring times involved, it is recommended to restrict the FTICR-MS analyses to areas of interest as can be preselected by other, faster imaging methods.

Animals↗
PubMed2005

Prenatal alcohol and cocaine exposure: influences on cognition, speech, language, and hearing.

UNLABELLED: This paper reviews research on the consequences of prenatal exposure to alcohol and cocaine on children's speech, language, hearing, and cognitive development. The review shows that cognitive impairment, learning disabilities, and behavioral disorders are the central nervous system manifestations of fetal alcohol syndrome (FAS), and cranio-facial abnormalities are also present. Delays in language acquisition, as well as receptive and expressive language deficits, are commonly reported. The cranio-facial abnormalities of FAS, which sometimes include cleft palate, make the child prone to otitis media with effusion and conductive hearing loss. The family environment in which one or both parents is a heavy alcohol user presents challenges to a child with normal intelligence, but may be especially deleterious to the child with mental retardation. Prenatal exposure to cocaine results in subtle cognitive disabilities when measured at 4 years of age. The cognitive effects may be ameliorated by a stimulating and sensitive care-giving environment. A small, deleterious "cocaine-effect" is also seen in speech and language development. The child with prenatal exposure to cocaine may be considered at increased risk for language delay or disorder. There is no evidence that prenatal cocaine exposure by itself is a risk factor for sensorineural hearing impairment, although auditory evoked potentials from the brainstem and cortex suggest some abnormalities in central auditory processing, at least during the newborn period. The strong effect of the home environment for ameliorating the effects of prenatal cocaine-exposure suggests that a family-focused approach for cognitive, language, and social-emotional habilitation would be beneficial to all. LEARNING OUTCOMES: The learner will be able to describe the major features of fetal alcohol syndrome and how they relate to speech, language, hearing, and cognitive disorders. The learner will review the literature and determine research needs with respect to language, speech, and hearing among infants and children with fetal alcohol syndrome. Similarly, the learner will distinguish the outcomes of prenatal alcohol-exposure from those of prenatal cocaine-exposure. The learner will summarize the controversy regarding the possible stigmatization of cocaine-exposed infants. The learner will summarize the speech, language, and hearing effects of prenatal cocaine-exposure.

Alcoholism↗
PubMed2006

Contemporary surgical management of HIV-associated facial lipoatrophy.

OBJECTIVES: The purpose of this study is to describe our experience with facial volume restoration in 39 HIV-associated facial lipoatrophy patients, and formulate a treatment algorithm that can be utilized for these patients based on their disease severity. METHODS: Preoperative and postoperative photographs were evaluated by 2 experienced facial plastic surgeons using grading scales. The reviewers' scores were then compared and the distribution of scores was analyzed. RESULTS: Thirty-nine patients underwent malar silastic implantation. Seven patients required postoperative adjuvant filler injection. Most patients' results were rated good to excellent. There were 4 late complications. CONCLUSION: HIV-associated facial lipoatrophy is a socially disabling condition that causes noticeable disfigurement and stigmatizes the patient. We demonstrate the importance of combining a reliable grading scale with a strategic treatment algorithm that utilizes multiple modalities for volume restoration. EBM RATING: C-4.

Adipose Tissue↗
PubMed2005

Infertility: a label of choice in the case of sexually dysfunctional couples.

OBJECTIVES: In Indian society infertility and sexual dysfunction are stigmatized characteristics. The aim of the study was to explore which label couples who have both complaints, prefer to describe their situation, and whether gender differ occur in this preference. METHODS: A total of 40 couples - all clients of the reproductive health clinic of the King Edward Memorial Hospital in Pune because of problems with infertility and sexual dysfunction - participated in this study. Data were collected by means of interviews. RESULTS: The findings show that sexual activity decreased as the number of childless years increased. However, the interspouse-relationship gets stronger and more supportive. The couples never revealed their sexual dysfunction to others. When the husband was sexually dysfunctional, the couples preferred to label their situation as 'infertility' in order to avoid stigma. CONCLUSION: Issues that are related to sexual dysfunction, sexual behavior, inter-spouse relationship and communication are important aspects into the reality of an infertile couple's life. PRACTICE IMPLICATION: In planning the treatment clinicians should give more attention to the specific cultural context of these aspects.

Adaptation, Psychological↗
PubMed2005

On the meaning of "drug seeking".

The term "drug seeking" is frequently used but poorly defined. By soliciting nurses' comments and suggestions, a survey was developed to identify behaviors that may cause nurses to refer to a patient as drug seeking, to identify what nurses think the term "drug seeking" means, to explore how nurses regard the use of the term "drug seeking" in health care, and to identify differences between general nurses, emergency nurses, and pain management nurses with regard to these items. Behaviors that would cause the majority of all three nurse groups to refer to a patient as drug seeking were as follows: going to different emergency departments to get opioids, telling inconsistent stories about pain or medical history, or asking for a refill because the prescription was lost or stolen. When the term "drug seeking" is used, all three groups of nurses agreed that it was very likely to mean the patient was addicted to opioids, the patient was abusing pain medicine, or the patient was manipulative. One-half or more for each nurse group said they used the term "drug seeking" in talking about patients, but less than 10% said they used it in charting. After completing the survey, approximately one half or more of nurses in each group were less inclined to use the term. The use of stigmatizing terms in clinical practice is addressed with suggestions for alternative approaches to patient behavior related to requesting opioids for pain relief.

Adult↗
PubMed2005

Psychophysiological evaluation of stigma towards schizophrenia.

Stigma is a potentially destructive phenomenon that may result in negative consequences for individuals diagnosed or labeled as having a mental illness. Several recent studies suggest that contact with various stigmatized out-group members result in psychophysiological reactions indicative of negative affect. It is unclear whether such reactions extend to encounters with individuals with mental illness. Participants imagined interacting with individuals labeled or unlabeled as having schizophrenia, while corrugator supercilii (brow) EMG, palmer skin conductance, and heart rate activity were monitored. Participants were 15 males and 20 females mainly African American students between the ages of 18 and 28 who attended a historically black university in the Southeastern region of the United States. Participants reported higher SUDS ratings and exhibited higher brow muscle tension during imagery with labeled than non-labeled individuals. Psychophysiological reactivity predicted global self-reported attitudes of stigma towards labeled individuals. The findings suggest that one reason why individuals avoid individuals with mental illness is physiological arousal, which is likely experienced as negative.

Adolescent↗
PubMed2005

Factors contributing to the stigma of epilepsy.

PURPOSE: To evaluate the factors, including personality and coping styles, likely to be influential in enhancing the social stigma of epilepsy. METHODS: Data were collected from 400 adults with epilepsy recruited from 10 epilepsy centers in Korea. Clinical information about seizures was obtained by neurologists, and other information was collected from self-completed questionnaires, including those measuring stigma scales. RESULTS: Thirty-one percent of people with epilepsy felt stigmatized by their condition and in 9% of these the stigma was severe. Multivariate analysis identified experiences of actual discrimination from society, introverted personality, problem solving controllability, and emotional subscale of QOLIE-31 as being independently associated with the social stigma of epilepsy. CONCLUSIONS: Episodes of discrimination, coping strategies, and personality may be important in feeling the stigma of epilepsy. These findings may provide a basis for further studies to clarify the causative factors generating the stigma of epilepsy.

Adult↗
PubMed2004

Risks, stigma and Honduran Garífuna conceptions of HIV/AIDS.

The HIV/AIDS epidemic along Honduras' north coast has intensified in recent years and become particularly severe in Garífuna communities. Based on a qualitative study in the community of Las Espinas and comparison with results from an earlier knowledge, attitudes, beliefs and practices survey, this article explores Garífuna ideas about the disease, focusing on issues of risk perception and stigma. Using correspondence analysis with data from systematic elicitation techniques we abstract the local schema of HIV/AIDS, showing how accurate knowledge of transmission co-occurs with cultural judgments about safe partners, increasing chances for infection. Despite broad familiarity with the disease in the community it remains highly stigmatized, suggesting continuing problems in coming to terms with the epidemic as treatment becomes more widely available in Honduras. Questions of power, sexuality and affective expectations about partners complicate the situation for women hoping to prevent infection. Given the broader risk environment characterized by labor migration and transnational movement, vital interventions and educational efforts in Garífuna communities will need to be complemented with prevention efforts in contexts where men make a living.

Adolescent↗