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PubMed1988

Managing symptoms in chronic disease: some dimensions of patients' experience.

This paper is a review of strategies that patients use to manage their symptoms in chronic conditions, with particular reference to multiple sclerosis. It emphasizes the complex and socially conditioned process through which symptoms come to be recognized and managed by patients. This process is compared and contrasted with that of medical recognition of symptoms. A range of patient-based strategies and their implications is then discussed.

Activities of Daily Living↗
PubMed1994

[Homeless on the streets of Copenhagen].

A group of homeless people living in the streets is described with the purpose of gaining the knowledge necessary to prevent development of homelessness and establishing programmes for the homeless. Out-reach work in the streets and cooperation with private and religious organisations was conducted during a two-year period and 59 homeless persons were interviewed. Fifteen were women and 44 were men. Upbringing, social conditions, daily living, physical and mental health and contact with health services, social security and private organisations were highlighted in a structured and semistructured interview. Compared with the background population the homeless had much more frequently childhood experience of parents' divorce or death of one of the parents. The women were significantly older than the men and the majority of the women were suffering from schizophrenia and had very little contact with network and public services. The majority of the men were abusing alcohol or drugs, many had had a troublesome childhood with stays in institutions. Many had had many contacts with different social institutions and a criminal record. Among the homeless in the streets of Copenhagen, the prevalence of mental illness, especially schizophrenia, is high. It is recommended that homelessness among the mentally ill is prevented by a special effort directed towards the patient group at risk of becoming homeless and through establishing different housing facilities with varying degrees of professional support. Out-reach work towards the homeless mentally ill should be carried out with the purpose of establishing contact with psychiatric services and securing the possibility of compulsory admission.

Adolescent↗
PubMed1997

[The clinical aspects and psychopharmacotherapy of adaptive neurotic disorders].

57 neurotic patients were included in the trial because they met the following criteria: no signs of psychic disorders before emergence of psychogeny, close relation of the disease with change in social condition, only minor psychic symptoms. The patients have suffered psychic traumas caused by loss of social significance of their job, loss of financial well-being, family problems. The reactive condition was associated with psychogenic complex. The patients developed neurotic depression rather early. It consisted of 3 stages: neurasthenic disorders, anxiety, depressive condition with distress affection. Adaptative disorders need both psychotherapy and psychopharmacotherapy. Inpatients were given bensodiazepines, antidepressants, mild neuroleptics, nootropes. It is shown than the duration of the treatment course and choice of chemotherapy depend primarily on the time of seeking medical advice and start of therapeutic measures.

Adaptation, Psychological↗
PubMed2004

[Psychosocial conditions of adult epileptic patients in Hungary].

Authors analyze the possible connections among psychosocial, more important epileptological and social conditions in the population of the Hungarian Epilepsy Database. The inclusion criteria were the presence of repeated epileptic seizures, the strict diagnosis of epilepsy and at least three registered control visits. Four hundred and fifty 30 or more years old patients fulfilled the criteria. Based on the answers to four questions in the database considering some conditions potentially modifying the way of life the patients were scored and distributed into 3 subgroups (good, average and bad) concerning their psychosocial conditions. In contrast to previous expectations they found that the type of epilepsy does not influence the attainable psychosocial conditions. Presence of generalized tonic-clonic or complex partial seizure did not exhibit influence either. Analysis of the seizure frequency showed that generalized convulsions, if occurred rarely were accompanied by good psychosocial level and if occurred frequently they were accompanied by a less acceptable level. Psychopathological symptoms independently from their nature and evidenced brain lesion as etiology also made the psychosocial conditions worse. No difference was found concerning the gender of the population. It contradicts the hypothesis that epilepsy has a greater impact on females. Psychosocial conditions are better in patients with higher education and living in pairs. Based on the study authors support the statements of the literature emphasizing that for achieving the best quality of life and psychosocial level an appropriate medical care is not enough. They need also the relative highest level of education and a stable partnership.

Adult↗
PubMed1998

Social determinants of psychiatric morbidity and well-being in immigrant elders and whites in east London.

OBJECTIVES: The social conditions under which migrants to the UK live may be more significant than the experience of migration itself in leading to increased risk of mental illness. We aimed to compare the prevalence of mental, physical and social health problems in elderly Somalis, Bengalis and whites living in a deprived inner London area and examine associations between environmental circumstances, social support, physical health status, mood and life satisfaction in these groups. In addition, we wanted to test the hypothesis that differences in mental health between immigrants and whites are explained by social disadvantages rather than ethnicity. DESIGN: Cross-sectional survey with participants drawn from age-sex registers of general practices, augmented by other sources. SETTING: East London--'first-generation' Somali and Bengali immigrants and white British. SUBJECTS: A total of 274 people aged 60+ years: 72 Somalis, 75 Bengalis and 127 whites. MAIN OUTCOME MEASURES: Symptoms of Anxiety and Depression Scale (SAD), Life Satisfaction Index (LSI). High SAD scores indicate more anxiety and depression symptoms; high LSI scores indicate greater life satisfaction. MAIN RESULTS: Highest SAD scores were found among Bengalis; lowest LSI scores were found among Bengalis and Somalis. The prevalences of depression (SAD score 6+) were 25% in Somalis, 77% in Bengalis and 25% in east London whites. Physical health status and SAD scores were associated in Somalis (r = +0.31, p < or = 0.01). Bengalis (r = +0.47, p < or = 0.001) and east London whites (r = +0.27, p < or = 0.01). Physical health problems also related to lower LSI scores in Somalis (r = -0.24, p < or = 0.05) and east London whites (r = -0.24, p < or = 0.01). Social factors (i.e. poor housing conditions, low family support and reported need of community services) were strongly associated with SAD scores among Somalis (r = +0.5, p < or = 0.001) and, to a lesser extent, among Bengalis (r = +0.33, p < or = 0.01). Ethnicity (i.e. being an immigrant as opposed to a non-immigrant) became a statistically non-significant risk factor for high SAD scores after adjusting for the effects of age, weekly income, physical health and social problems (OR = 0.71, 95% CI = 0.5-1.1, p = 0.09). A residual, but much attenuated effect for ethnicity on LSI scores persisted in the estimated model after controlling for the same set of independent risk factors (OR = 0.7, 95% CI = 0.4-1, p = 0.05). CONCLUSION: The marked variation in mental health between ethnic groups in east London might be a reflection of socioeconomic and health differentials acting concomitantly and adversely. Inequalities in housing, social support, income and physical health status accounted for variation in mood observed between immigrants and whites, and may partly explain differences in life satisfaction. These results seem to support a 'multiple jeopardy' theory of ageing in ethnic minorities in east London. Greater efforts are needed to recognize anxiety and depression in immigrant elders. Better social support and housing among 'minority ethnic' elders who live alone might be expected to alleviate social stress and improve mental health and psychological well-being.

Acculturation↗
PubMed2000

[Ecologic distribution of mental disorders in urban areas. Review of six decades of ecologic research in psychiatry].

In 1939, Robert Faris and Warren Dunham published their pioneering work on "Mental disorders in urban areas". They investigated the distribution of mental disorders in Chicago. In the following decades, a number of studies using a similar design were carried out in various cities in the United States and in Europe, which largely replicated Faris' and Dunham's findings. The concentration of most psychiatric disorders in certain problem areas indicates the existence of a relationship between their distribution and unfavorable social conditions. However, the intention of ecological studies to find strong evidence for the psycho-social cause of mental disorders, especially of schizophrenia, failed. In schizophrenia, social selection leading to a particular spatial distribution of schizophrenic patients as a consequence of their illness or premorbid condition seems to be the most important factor. Rather than making a substantial contribution to the search for the causes of mental disorders as has been assumed up to now, identifying high risk areas of psychiatric disorders may serve as a rational basis for service planning and the allocation of resources.

Asia↗
PubMed1975

The social play of two behaviorally disordered preschool children during four activities. A multiple baseline study.

The effect of contingent teacher attention on the social play of two behaviorally disordered preschool children was investigated. Using a multiple baseline design with reversal conditions, social play was measured on four activities: pegs and pegboard, athletic ball, blocks, and water pail. Baseline data indicated considerable variability in the amount of social play across the four activities. The initiation of the experimental contingency produced a dramatic increase in percentage of time in which the subjects engaged in social play. The implications of these results for the remediation of isolate behavior in young children with multiple behavioral deficits are discussed.

Attention↗
PubMed2001

Living arrangements and socio-demographic conditions of older adults in Cambodia.

Since the takeover of Cambodia by the Khmer Rouge in 1975, the social conditions within the country have been understudied. Only recently has dependable socio-demographic data become available. We use some these data to examine living arrangements and other socio-demographic conditions among Cambodia's older population. We compare results to those recently found in Thailand and Vietnam, two neighboring countries, in order to place Cambodia within a regional context. On balance, living arrangements in Cambodia are similar to those in neighboring countries. Older adults are likely to be living with a child and in a variety of diverse arrangements involving different family members. We attempt to get at gender preference for coresident children indirectly by adjusting living arrangement patterns for Cambodia's unique sex and marital status structure. We find a predominance of elders living with never married children of either sex and a slight daughter preference. Older adults in Cambodia may face particular challenges due to the influences of the past decades of instability and violence. We conclude our paper with a discussion of how future research might assist in developing a national policy for older adults.

Journal Article↗
PubMed2001

Efficacy of a preventive intervention for youths living with HIV.

OBJECTIVES: HIV transmission behaviors and health practices of HIV-infected youths were examined over a period of 15 months after they received a preventive intervention. METHODS: HIV-infected youths aged 13 to 24 years (n = 310; 27% African American, 37% Latino) were assigned by small cohort to (1) a 2-module ("Stay Healthy" and "Act Safe") intervention totaling 23 sessions or (2) a control condition. Among those in the intervention condition, 73% attended at least 1 session. RESULTS: Subsequent to the "Stay Healthy" module, number of positive lifestyle changes and active coping styles increased more often among females who attended the intervention condition than among those in the control condition. Social support coping also increased significantly among males and females attending the intervention condition compared with those attending the control condition. Following the "Act Safe" module, youths who attended the intervention condition reported 82% fewer unprotected sexual acts, 45% fewer sexual partners, 50% fewer HIV-negative sexual partners, and 31% less substance use, on a weighted index, than those in the control condition. CONCLUSIONS: Prevention programs can effectively reduce risk acts among HIV-infected youths. Alternative formats need to be identified for delivering interventions (e.g., telephone groups, individual sessions).

Adaptation, Psychological↗
PubMed1994

Growing up in Uppsala: the "new morbidity" in the adolescent period. A longitudinal epidemiological study based on school data and some external sources.

The study comprised all 1805 children, most born in 1967, who were in grade 9 of the compulsory school in Uppsala in the spring of 1983 (cross-sectional population) and all 1723 children born in 1967 and resident in Uppsala at ages 10 and 15 years (longitudinal population). The aims were (1) to describe and analyse a normal population of 9th graders in social, medical, educational and psychological respects, (2) to assess relationships between risk level at 10 years, school-identified difficulties at 15 years and psychosocial problems up to age 18, (3) to assess relationships between intervention in school at 15 years and psychosocial problems up to 18 years. Ten-year data had been collected through teacher interviews and analysis of school health records in grade 3. Fifteen-year data were collected through interviews with school health staff and analysis of school health records in grade 9. School marks were gathered at the end of grade 9. Psychosocial problems up to 18 years were assessed on the basis of all registered contacts with official institutions outside school (authorities for care of the handicapped, Department of Child Psychiatry, social agencies, legal authorities). CROSS-SECTIONAL POPULATION. Children older than the grade norm and children of lower social class manifested a more problematic school adjustment and had lower mean marks than younger children and those of higher social classes. Twenty-five per cent of the population had entries in official registers up to age 18, indicating psychosocial problems. Social conditions were related both to the learning process and to psychological health. Educational and psychological problems were mutually correlated. Social problems increased the risk of a number of medical conditions. There were certain relationships between medical and educational problems as well as between medical and psychological problems. LONGITUDINAL POPULATION. Both 10- and 15-year data, particularly the latter, contributed independently to the prediction of psychosocial problems up to age 18. There was a considerably increased risk of psychosocial problems if there had been numerous school difficulties at age 15. Children who had been offered intervention in school at 15 years did not escape psychosocial problems up to 18 years more frequently than children without interventions. In fact, the contrary was the case: with more interventions, the frequencies of psychosocial problems up to age 18 increased.

Adolescent↗
PubMed1988

Theoretical perspectives accounting for adolescent homosexuality.

Few topics in sexology elicit such a diversity of opinions and emotions as the question of etiology of homosexuality. Views frequently carry with them implicit or explicit messages concerning the psychologic health of this sexual orientation. Theories of sexual development usually portray adolescence as a critical time in the life course because of changes in: 1) anatomy and physiology; 2) psychologic functioning: the reawakening, renewal, and reliving of previously established sexual relations and drives; and/or 3) social conditions: an increased exposure and adherence to societal messages concerning appropriate and inappropriate social and sexual behaviors and relationships. This paper provides a brief overview of several major theories--evolutionary biology, psychoanalysis, and social processes--as they relate to the development of sexual orientation. In addition, an ethologic perspective that synthesizes various etiologic theories, as they relate to homosexuality during adolescence, is briefly reviewed. In these discussions, the issue of whether homosexuality is a normal or abnormal developmental state during adolescence is also addressed.

Adolescent↗
PubMed1986

Social influences on oestrous cycle length and plasma progesterone concentrations in the female lesser mouse lemur (Microcebus murinus).

Plasma progesterone concentrations were recorded during one breeding season in 19 lesser mouse lemur females living in different social conditions. The oestrous cycle length and the progesterone profile mainly depended on the social environment of the female. For totally isolated females, the oestrous cycle lasted 38 +/- 5.7 days and included a 25-30-days spontaneous luteal phase with a progesterone peak about 100 ng/ml between the 20th and 25th days after oestrus, and a prolonged preovulatory period of 10-15 days which could be considered equivalent to the follicular phase of a menstrual cycle. When females were able to communicate through olfactory, visual and auditory signals, the oestrous cycle was significantly lengthened (53.7 +/- 5.9 days). When females had tactile contacts, the oestrous cycle was further lengthened (62.7 +/- 0.8 days). This lengthening of the oestrous cycle was related to an extension of the luteal phase associated with a decrease in progesterone concentrations during this period. In females maintained with one male (paired) or with males and females (heterosexually grouped), large individual variations were shown in cycle lengths or in progesterone concentrations. In these females, cycle lengths and progesterone concentrations were inversely correlated to plasma cortisol concentrations.

Animals↗
PubMed2001

Assisted suicide as conducted by a "Right-to-Die"-society in Switzerland: a descriptive analysis of 43 consecutive cases.

BACKGROUND AND METHODS: The Swiss "Right-to-Die"-society EXIT enables assisted suicide by providing terminally ill members with a lethal dosage of barbiturates on request. This practice is tolerated by Swiss legislation. EXIT insists on its assumption that people with serious illness and suffering have the competency to take such a decision. The case of two patients who committed suicide a short time after their release from a psychiatric clinic raised some doubts about the practice of EXIT. The files of all 43 cases of suicide assisted by EXIT between 1992 and 1997 in the region of Basle kept in the Institute of Forensic Medicine were examined for accuracy of the medical data. This sample was compared for age, gender-ratio and prior psychiatric treatment with 425 ordinary suicides in the same region. An attempt was made to assess whether only terminally ill and people with intolerable suffering had been assisted with suicide and what efforts EXIT had made to rule out psychiatric illnesses or poor social conditions as the reason for the wish to die. RESULTS: A medical report of the treating doctor(s) was in the files in only five cases. The "EXIT" cases where older than the "ordinary"-sample. Among those over 65 years old there were almost twice as many women as men. 16 of the 24 women older than 65 years were widowed. There were 20 cases of cancer; but in eleven cases medical files revealed no apparent medical condition to explain a death-wish. Five of the patients declared a social loss or fear of such loss as the reason for their wish to die. Six persons had formerly been in psychiatric care, though this was not mentioned in the files. CONCLUSIONS: Due to the scarcity of information in the files as regards previous palliative care, the high proportion of old women and the high percentage of people not suffering from a terminal illness compared to the literature we conclude that psychiatric or social factors are not an obstacle for EXIT to assist with suicide.

Adult↗
PubMedDate not supplied

[Phobia or fear in rural communities].

In the following paper an attempt is made to demonstrate by means of phobia that neurotic subjective experience can only be understood in its social environment. Patients with phobic symptoms far more frequently come from rural communities and small towns, i.e. from towns which have a ruraltype structure. To support this thesis, empirical-statistical results based on surveys at the Medicopsychological Advice Centre for Students at the University of Göttingen are cited. Further, it is shown that a meaningful integration of this statistical data with psychodynamic and sociological findings is possible. The resulting explanatory model illustrates the attempt to make as comprehensive a statement as possible about the structure of the phobia and its cohesion to social mechanisms. The phobia is not only interpreted as an intrapsychic occurence, but at the same time the boundaries to the respective social conditions are also demonstrated and reference is made to the parallelism of social-historical development and corresponding psychic structure.

Adolescent↗
PubMedDate not supplied

[Does work cause illness? Thoughts from the viewpoint of social research].

The question as to whether work is responsible for a person's sickness is as old as the industrial working system and it has to be raised again and again, for despite the receding importance of purely gainful employment the well-being and health status of workers and often also of their relatives are determined by work. Purely medical data will not suffice to consider this problem, since the overall social conditions must be taken into consideration. Illness or health also become manifest as social behavioural patterns and must be studied as such. It is not work that makes a person sick, but rather the social environment in which he lives and works. The article shows that the conventional medical concepts of disease are often in need of being complemented by a social dimension. This becomes particularly evident by the fact that the undoubtedly grand successes of medicine based on natural sciences yield an increasing fund of knowledge confronted by an insufficiently developed system of social orientation. In this regard the system of lay knowledge which has always been characterised by knowledge oriented on the lines of action, is growing increasingly important. Effective health prevention in public health points towards the need for an increasingly intensified cooperation between the medical profession and the lay system.

Humans↗
PubMed1994

Disclosure of diagnosis to children with human immunodeficiency virus or acquired immunodeficiency syndrome.

This paper reviews research and clinical literature relevant to the question of disclosure of diagnosis to children with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The model of pediatric oncology, in which much research already exists, is evaluated for its applicability to HIV and AIDS. Although children seem to benefit from early disclosure of diagnosis of life-threatening illnesses, special cultural and social conditions complicate the question with regard to HIV and AIDS. These conditions include the parent-to-child transmission of HIV and the unique social stigma of having HIV because of its association with homosexuality, drug use, and sexual conduct. The paper presents existing treatment approaches and suggests avenues for further research.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Typhoid fever in Chile 1977-1990: an emergent disease].

The emergence of old and new communicable diseases is becoming an important public health problem in industrialized and developing countries worldwide. Chile experienced, at the end of the seventies and during the eighties, epidemics of several emergent communicable infectious diseases whose relevance as public health problems had steadily decreased in the previous 25 years. The most striking of these epidemics was a severe outbreak of typhoid fever that lasted at least 10 years. The majority of the cases occurred in the urban setting of Santiago. Several investigators suggested, in light of apparently good sanitation statistics, that factors responsible for this outbreak of typhoid were an increase in the number of chronic carriers of Salmonella typhi, the lack of microbiological food controls and the consumption of vegetables irrigated with waste water contaminated with S typhi. However, there is a dearth of epidemiological information and field work confirming the role of these factors in this typhoid outbreak. Moreover, the sudden, massive and urban characteristics of this epidemic, coupled to contemporary information regarding shortcomings on the preparation of drinking water and on decreased availability of drinking water to the population in Santiago regardless of good sanitation statistics, suggest that this outbreak may have been partially waterborne. The beginning of this typhoid outbreak also coincided with increased rain fall, with rapidly deteriorating economic and social conditions manifested in high rates of unemployment, and with decreased government investment on social services, including sanitation and health. All these factors are known to influence the epidemiology of typhoid and other emergent diseases worldwide.

Chile↗
PubMed2000

Social equality and dental conditions--a study of an adult population in Southern Sweden.

This study aimed to: describe dental conditions--focusing on prosthodontic variables--in relation to social conditions in the late 1990s in an adult population of Southern Sweden, evaluate if a change could be traced in the pattern of socioeconomic influences on dental conditions, and study if various attitudes toward dental care were associated with social as well as dental conditions. The study was based on questionnaire responses. Significant differences in dental conditions and denture prevalence were found for age and education. To a majority of the sample it was very important to have own teeth and/or fixed restorations and the opportunity to attend regular dental care. The cost for dental care was very important for 52% of the sample especially for men, those with low education, and those wearing removable denture. Need for dental care that could not be provided for because of the costs was experienced by 9%. Eighteen percent stated that they once or more had refrained from dental care because of the cost. Those with removable dentures and low education dominated. Besides socioeconomic differences in dental conditions, there were sociodental differences in attitudes concerning the importance of costs, self-estimated needs, and cost-barriers for dental care.

Adult↗