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PubMed2002

Pollination modulates expression of the PPAL gene, a pistil-specific beta-expansin.

Using differential screening we isolated a pistil-specific cDNA clone corresponding to a 1.2 kb mRNA and encoding a 32.5 kDa protein. The amino acid sequence shared similarity with that of group-I grass pollen allergens, which are known to have expansin activity. This clone, which later showed to share homology also with beta-expansins, was named PPAL. The PPAL mRNA was specifically expressed in the secretory zone of the stigma and in the epidermal layer of the placenta. The accumulation level of the transcript increased during pollination, and the protein was secreted in the stigmatic exudate of the tobacco flower. We suggest here that PPAL is a new expansin, acting as a cell-wall-loosening agent during pollination.

Amino Acid Sequence↗
PubMed2002

The Human Genome Project and the future of diagnostics, treatment and prevention.

The Human Genome Project, the mapping of our 30,000-50,000 genes and the sequencing of all of our DNA, will have major impact on biomedical research and the whole of therapeutic and preventive health care. The tracing of genetic diseases to their molecular causes is rapidly expanding diagnostic and preventive options. The increased insights into molecular pathways, gained from high-throughput 'functional genomics', using DNA-chip and protein-chip approaches and specially designed animal model systems, will open great prospects for pharmacological and genetic therapies. Powerful bioinformatics and biostatistics will further improve our pattern recognition and accelerate progress. A rapidly expanding area of high expectations is that of 'pharmacogenomics': the design of more effective drugs with lower toxicity through tailoring of drug treatment to individual, genetically determined differences in drug metabolism. Not only will this decrease the cost of health care through reduction of adverse drug reactions, but a better stratification of populations will also provide more statistical power farther upstream in drug trials. However, the optimal benefits from the current explosion of 'data mining' will only be realized when the basic data are made and kept publicly accessible, while at the same time safeguarding the protection of intellectual property arising from downstream inventions. This is one of the goals of HUGO, the international Human Genome Organization, established 13 years ago to assist coordination of data acquisition and exchange and societal implementation of the genome project. Additional points of attention in this historic endeavour are the prevention of stigmatization and discrimination and the safeguarding of a worldwide balance in the contribution by--and benefits to--different populations, while respecting the diversity in cultures and traditions.

Ethics, Medical↗
PubMed2002

Violence prevention and safety training for case management services.

Violence inflicted by individuals with mental illness towards healthcare workers has received significant media attention. Though such incidents are relatively infrequent, they inspire reactive responses and contribute to further stigmatization of the mentally ill. Prevention of violence is an important challenge for those who train and supervise mental health workers. Project Link is an outpatient treatment program designed to reduce jail and hospital recidivism among severely mentally ill adults with histories of criminal justice system involvement. Utilizing a Safety and Violence Education (SAVE) curriculum, Project Link has successfully transitioned high-risk mentally ill individuals from the criminal justice system into the community since 1995. The SAVE curriculum uses a preventative strategy to train case managers to identify warning signs of impending violence, and to safely engage patients in community settings. This paper will present an overview of the SAVE curriculum and its development, as well as results from a preliminary evaluation of trainee satisfaction.

Case Management↗
PubMed2002

Empowerment and serious mental illness: treatment partnerships and community opportunities.

The health goals of persons with serious mental illness are greatly improved when their personal power is advanced. Two targets of empowerment are discussed in this paper: treatment partnerships and community opportunities. Strategies that enhance treatment partnerships include provider endorsement of recovery rather than promoting an approach that suggests poor prognoses, treatment plans that are collaborative rather than unilateral decision making that is perceived as coercive, and treatment services provided in the person's community rather than geographically or psychological distant institutions. Approaches that focus on the person and treatment relationship are not sufficient however. Stigma and discrimination are significant barriers to the kind of community opportunities that are necessary to help people attain life goals. Communities that substitute stigmatizing attitudes and discriminatory behaviors with realistic views of mental illness are more likely to provide the kind of reasonable accommodations that some people need for work and independent living opportunities.

Attitude of Health Personnel↗
PubMed2001

Negative and supportive social interactions and quality of life among persons diagnosed with severe mental illness.

This study examined the relative importance of negative and supportive social interactions in predicting different aspects of quality of life (QOL) in a sample of persons diagnosed with severe mental illness (n = 104). Controlling for other variables that might explain such a relationship, we found that negative social interactions were significantly related to lower QOL in three subjective domains, while supportive social interactions were related to higher QOL in four objective domains and one subjective domain. We found negative social interactions that are stigmatizing to be particularly important in predicting QOL; additional analyses suggested that perceived stigma partially mediated the relationship between negative social interactions and QOL. We discuss the implications of the present findings for the study of the link between social relationships and QOL among persons with mental illness.

Community Mental Health Centers↗
PubMed2002

The changing face of breast cancer--past, present and future perspectives.

Breast cancer used to be perceived as a stigmatized disease and rates of early diagnosis were poor because women were often reluctant to present to their physician. Once a diagnosis had been made, there was no adjuvant therapy and little in the way of palliative treatment for advanced disease. Fortunately, the situation today is much improved and although breast cancer remains the most common form of cancer in women, changing attitudes have helped to ensure improved awareness and earlier presentation of patients, leading to earlier diagnosis and better prognosis. Improved detection and treatment regimes have begun to impact on breast cancer mortality; important long-term treatment goals include the prevention of both disease recurrence and the development of advanced disease. This will necessitate improvements in systemic therapies based on the biological properties of the tumor rather than relying on early diagnosis and chemo-prevention. Significant progress has been made over the last 30 years, and the future of breast cancer treatment should be faced with optimism.

Antineoplastic Agents↗
PubMed1998

The stigma of severe mental illness: some potential solutions for a recalcitrant problem.

Despite recent advances in the treatment of individuals with severe mental illness (SMI), their full integration into society is hindered by lingering negative attitudes towards them. In this paper, a brief overview is provided on stigmatization towards individuals with SMI, including its' impact on quality of life and self-esteem, as well as the factors which likely underlie it. Research is reviewed showing that lowered negative perceptions towards persons with SMI are associated with previous contact with this population and with presentation of empirically-based information on the association between violence and SMI. Limitations of these findings are discussed with an eye towards developing improved techniques for reducing stigma.

Humans↗
PubMed1997

Psychological distress and help seeking in rural America.

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.

Adult↗
PubMed2001

Older immigrant Tamil women and their doctors: attitudes toward breast cancer screening.

Cultural beliefs have been hypothesized to be powerful barriers to breast cancer screening in minority women and physician recommendation is consistently reported to be the strongest incentive. This study investigated (1) beliefs regarding breast cancer and (2) the perception of barriers to mammography and clinical breast examination in a sample of immigrant Tamil women, as well as in a sample of primary care physicians. Three focus groups, each consisting of 10 immigrant Tamil women from Sri Lanka aged 50 years or over were conducted and 52 primary care physicians who serve this population completed mailed surveys. The most common barriers to screening reported by the women were (1) lack of understanding of the role of early detection in medical care, (2) religious beliefs and, (3) fear of social stigmatization. Physicians reported the most common barriers to their screening recommendations for this group of women to be (1) women's episodic care, (2) unrelated presenting problems and, (3) women refusing to be screened. Interventions to increase screening in this and other minority groups requires an elaborated understanding of utilization barriers for both women and their doctors.

Journal Article↗
PubMed2004

Rewarding results: Improving the quality of treatment for people with alcohol and drug problems.

Substance use disorders are the nation's number one health problem, and lie at the root of many public safety and workplace issues. Improving quality of treatment is as important as improving access to treatment. Leadership for improvement must come from many sources: Congress, SAMHSA, state legislatures, state and local treatment agencies, criminal justice, welfare and other public agencies, employers and managed care organizations, providers, and community leaders. We hope that our report helps leaders see ways to improve treatment quality. Our recommendations can be summed up in a single phrase: reward results. We recognize that there are many avenues for treatment quality improvement, including training, credentialing, best practice dissemination, work force development, facility licensing standards, improvement and implementation of new models for treatment of dual diagnosis patients. We believe, however, that rewarding results is essential to motivating action for improvement. We also believe that if providers receive rewards for improved results, they will creatively open new avenues for improvement--a focus on results gives greater freedom than more detailed mandates for change. Finally, we believe that rewards for result may lead to a restructured treatment system with greater stability and correspondingly greater capacity to improve. While we have placed central emphasis on the role of institutional buyers and managers of care, we believe that the voices of patients and families must be heard. People who have progressed to the stage of recovery, and their families, often have essential insight into what did and did not work for them--their personal stories are frequently compelling and persuasive. We also believe that providers of treatment for substance use disorders are profoundly committed to serving their patients, and often have great understanding of what works. Wise managers will listen very carefully and systematically to the voices of consumers, their families, and their providers. We have advocated that buyers reward results as a central strategy for improving quality. We believe that this is the best long-term strategy, not only to effect quality improvement, but also to end stigmatization and increase resources. We wish, in closing, to reemphasize our shared beliefs that adequate resources are essential, that treating persons with substance use disorders is always emotionally challenging and often profoundly frustrating and alienating, and that those on the front line deserve our unequivocal support and our profound gratitude for their service. Legislators should adequately fund public treatment and mandate parity in insurance reimbursement for treatment of substance use disorders.

Health Planning Councils↗
PubMed2004

Factors influencing social distance toward people with mental illness.

BACKGROUND: When identifying ways to reduce stigmatization because of mental illness it is crucial to understand contributing factors. Social distance-the willingness to engage in relationships of varying intimacy with a person--is an indicator of public attitudes toward persons with mental illness. METHODS: Multiple linear regression analysis of the results of a vignette-based opinion survey conducted on a representative population sample in Switzerland (n = 594). RESULTS: The level of social distance increases if situations imply 'social closeness.' The vignette describing a person with schizophrenia, attitudes to general aspects of mental health (lay helping, community psychiatry), emotions toward those affected, and the attitude toward consequences of mental illness (medical treatment, medication side effects, negative sanctions, e.g. withdrawal of the driver license) were found to predict social distance. Demographic factors such as age, gender, and the cultural background influence social distance. The explained variance (R2) is 44.8%. CONCLUSIONS: Social distance is a multifaceted concept influenced by, e.g., socio-economic and cultural factors, but also by the respondent's general attitude toward (mental) health issues. These results suggest that more knowledge about mental illnesses, especially schizophrenia, may increase social distance. The findings presented here may help to focus anti-stigma campaigns not only on transmission of knowledge, but on integrating different approaches.

Adolescent↗
PubMed2004

Genomic research and data-mining technology: implications for personal privacy and informed consent.

This essay examines issues involving personal privacy and informed consent that arise at the intersection of information and communication technology (ICT) and population genomics research. I begin by briefly examining the ethical, legal, and social implications (ELSI) program requirements that were established to guide researchers working on the Human Genome Project (HGP). Next I consider a case illustration involving deCODE Genetics, a privately owned genetic company in Iceland, which raises some ethical concerns that are not clearly addressed in the current ELSI guidelines. The deCODE case also illustrates some ways in which an ICT technique known as data mining has both aided and posed special challenges for researchers working in the field of population genomics. On the one hand, data-mining tools have greatly assisted researchers in mapping the human genome and in identifying certain "disease genes" common in specific populations (which, in turn, has accelerated the process of finding cures for diseases tha affect those populations). On the other hand, this technology has significantly threatened the privacy of research subjects participating in population genomics studies, who may, unwittingly, contribute to the construction of new groups (based on arbitrary and non-obvious patterns and statistical correlations) that put those subjects at risk for discrimination and stigmatization. In the final section of this paper I examine some ways in which the use of data mining in the context of population genomics research poses a critical challenge for the principle of informed consent, which traditionally has played a central role in protecting the privacy interests of research subjects participating in epidemiological studies.

Computational Biology↗
PubMed2004

Quality of life in tuberculosis: patient and provider perspectives.

Tuberculosis (TB) is a persistent problem in the United States; however, little is known about its impact on functioning and quality of life (QOL) among people with TB. The purpose of this study is to describe the impact of TB on patients' QOL by using focus groups to assess the domains of QOL that are affected. Participants included patients (n = 10) who received treatment for active TB and physicians (n = 4) and nurses (n = 9) caring for patients with TB at a public health clinic in Baltimore, Maryland. TB affected all predicted domains of QOL, including general health perceptions, somatic sensation, psychological health, spiritual well-being, and physical, social and role functioning. Social stigmatization, isolation, pill burden, long duration of therapy, sexual dysfunction, loss of income, and fear were additional specific problems related to TB. Surprisingly, 11% (33) of the comments described benefits of TB illness, including increased spirituality and improved life perspectives. In addition, four additional QOL domains and three elements of treatment specific to TB which substantially impact QOL were identified. While patients and clinicians both identified issues in many areas of QOL, only patients mentioned the impact on sexual function, spirituality and improved life perspectives. Despite available curative therapy, TB and its treatment still have significant short and long-term consequences on patients' QOL.

Adult↗
PubMed2001

[HIV/AIDS family care-giving in Switzerland in the context of silence].

Based on critical hermeneutics, this qualitative study presents insights about care giving experiences of HIV affected families in the German speaking part in Switzerland. Eleven families (12 women, 5 men) were interviewed, and members of different families participated in group-conversations. Critical reflection of the results highlighted that these HIV-families offered family caregiving in a context of silence. Two perspectives of this silence are presented: 1. HIV-families do not share their experiences in their closer and larger environments because of stigmatization, changing family constellations, and traditional images of family care. Instead, HIV-families create silent circles. 2. Professional discourses about family care are almost absent in the Swiss health care system because of its focus on the needs of individual patients with health care providers, in particular nurses, offering no systematic health services tailored to family caregivers. The results highlight, that it is paramount for nurses to take responsibility and to create programs that will better serve HIV-families.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Elevated rates of suicidal behavior in gay, lesbian, and bisexual youth.

Both clinical and epidemiological literature point to elevated rates of suicidal behaviors in gay, lesbian, and bisexual youth (GLBY). Recent North American and New Zealand studies of large populations (especially the US Youth Risk Behavior Surveys from several states) indicate that gay, lesbian, and bisexual adolescents (males in particular) can have rates of serious suicide attempts at least four times those of apparently heterosexual youth. There are various reasons why this figure is likely to be an underestimate. Reasons for these elevated rates of suicidal behavior include a climate of homophobic persecution in schools, and sometimes in family and community--values and actions that stigmatize homosexuality and that the youth who has not yet "come out" has to endure in silence.

Adolescent↗
PubMed2002

Suicide on the Indian subcontinent.

The Indian subcontinent comprises eight countries (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan, Bhutan, and the Maldives) and a collective population of more than 1.3 billion people. 10% of the world's suicides (more than 100,000 people) take place in just three of these countries, viz. India, Sri Lanka, and Pakistan. There is very little information on suicides from the other four countries. Some differences from suicides in Western countries include the high use of organophosphate insecticides, larger numbers of married women, fewer elderly subjects, and interpersonal relationship problems and life events as important causative factors. There is need for more and better information regarding suicide in the countries of the Indian subcontinent. In particular, studies must address culture-specific risk factors associated with suicide in these countries. The prevention of this important public health problem in an area of the world with myriad socio-economic problems, meager resources, and stigmatization of mental illness poses a formidable challenge to mental health professionals, policy makers, and governments of these countries.

Age Factors↗
PubMed2003

Suicidal behavior in patients diagnosed with cancer of the cervix.

There is a paucity of literature on suicide and cancer, especially cancer of the cervix. This study reports on suicidal behavior in these patients. The sample consisted of adult, black, Zulu-speaking women from palliative and radical oncology treatment groups who volunteered for the study. There were more patients in the palliative group who were younger, and had a more significant delay between cancer symptom presentation and seeking oncology treatment. Patients experienced: significant depression, anxiety, stress, hopelessness/helplessness, anxious preoccupation about their disease, poor current or delayed social support, feelings of being a burden to their significant others, beliefs that they would be better off dead, perceptions that they were stigmatized by society or that their communities suspected them of being HIV-AIDS positive, and suppressed anger. More patients in the palliative, compared to the radical treatment, group were inclined toward suicidal ideation with serious intent. Overall, most patients coped inadequately with their disease and its management. These patients are a high risk group for suicidal behavior and should be identified in time for appropriate psychological intervention.

Adolescent↗
PubMed2002

Functional symptoms confused with allergic disorders in children and adolescents.

The diagnosis of a functional respiratory disorder is sometimes difficult and time-consuming, because the symptoms often resemble those of organic diseases. The most common entities are hyperventilation syndrome, psychogenic cough, sighing dyspnea, and vocal cord dysfunction. Typical signs are heavy breathing or dyspnea, cough or sneezing, various breathing sounds, tightness of the throat or chest, pain, and fear. Criteria for differentiation include the lack of nocturnal symptoms, the sudden occurrence, no typical trigger factors, the variable duration, a quick regression, and that symptoms do not respond to adequate pharmacotherapy and finally normal results of diagnostic work-up. Therapeutic options comprise psychological intervention (by reassurance, relaxation techniques, and behaviour therapy) and physiotherapy (e.g. breathing therapy, voice training). Intensive efforts should be made to diagnose functional symptoms at an early stage because this will prevent stigmatization and fixation of symptoms and disease, and also prevent children from undergoing unnecessary and potentially harmful therapies.

Adolescent↗