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PubMed2002

The three typical aspartic proteinase genes of Arabidopsis thaliana are differentially expressed.

Genomic sequencing has identified three different typical plant aspartic proteinases in the genome of Arabidopsis thaliana, named Pasp-A1, A2 and A3. A1 is identical to a cDNA we had previously isolated and the two others produce proteins 81 and 63% identical to that predicted protein. Sequencing of the aspartic proteinase protein purified from Arabidopsis seeds showed that the peptides are derived from two of these genes, A1 and A2. Using gene specific probes, we have analyzed RNA from different tissues and found these three genes are differentially expressed. A1 mRNA is detected in all tissues analyzed and more abundant in leaves during the light phase of growth. The other two genes are expressed either primarily in flowers (A3) or in seeds (A2). Insitu hybridization demonstrated that all three genes are expressed in many cells of the seeds and developing seed pods. The A1 and A3 genes are expressed in the sepals and petals of flowers as well as the outer layer of the style, but are not expressed in the transmitting tract or on the stigmatal surface. The A2 gene is weakly expressed only in the transmitting tissue of the style. All three genes are also expressed in the guard cells of sepals. These data suggest multiple roles for aspartic proteinases besides those proposed in seeds.

Amino Acid Sequence↗
PubMed1999

Collaborative education and social stereotypes.

The purpose of this paper is to present results from a two-year collaborative education project conducted with people with a serious mental illness and senior undergraduate students of nursing at the Centre for Mental Health Nursing Research at Queensland University of Technology. The study was funded by the Australian Commonwealth Government and was completed in June 1998. The results suggest that collaborative education is an effective means for breaking down social stereotypical thinking about people with a mental illness. A similar finding with respect to the stigmatization of undergraduates supports this hypothesis. Implications for psychiatric rehabilitation and the undergraduate education of students of nursing are explored.

Attitude of Health Personnel↗
PubMed2001

Stigma, social justice and the rights of the mentally ill: challenging the status quo.

People suffering from mental illness and other mental health problems are among the most stigmatized, discriminated against, marginalized, disadvantaged and vulnerable members of society. Although much has been done in recent years to improve the status quo, it is evident that a great deal more needs to be done to improve the moral standing of and to achieve social justice for the mentally ill. A key contention of this philosophical essay is that unless the stigma of difference that is attached to people with mental illness is overturned, their rights will continue to be marginalized, invalidated, violated and/or ignored.

Australia↗
PubMed2001

The mental and physical health of female sex workers: a comparative study.

OBJECTIVES: The objective of this study was to compare the mental and physical health, adult abuse experiences and social networks of female sex workers with data previously collected from two large community samples of age-matched women. METHOD: A convenience sample of sex workers were interviewed and completed two well-established questionnaires, the General Health Questionnaire (GHQ-28) and the Intimate Bond Measure (IBM). Sex workers were invited to reflect on their experiences of their work. RESULTS: There were no differences in mental health on the GHQ-28 or in self-esteem (measured by an item on the Present State Examination) between the two groups. Neither were there any differences in their assessment of their physical health or the quality of their social networks. Sex workers were less likely to be married and had been exposed to more adult physical and sexual abuse than the comparison group. They were more likely to smoke and to drink heavily when they drank. One-third said that their general practitioner was not aware of their work. A subgroup not working with regular clients or in a massage parlour had higher GHQ-28 scores and may be an at-risk group. Narrative information about the work, particularly its intermittent nature, is presented. CONCLUSIONS: No evidence was found that sex work and increased adult psychiatric morbidity are inevitably associated, although there may be subgroups of workers with particular problems. The illegal and stigmatized nature of sex work are likely to make usual public health strategies more difficult to apply, considerations which should give concern from a preventive health standpoint.

Adolescent↗
PubMed2002

Depictions of mental illness in print media: a prospective national sample.

OBJECTIVE: Because there are no published reports of depictions of mental illness in print media based on national samples, we set out to prospectively collect and analyse a near complete New Zealand sample of print media. METHODS: A commercial clipping bureau was contracted to provide cuttings of all items with any mental health or illness aspect over a four week period. These items were analysed for potentially positive and negative depictions and how mental illness was represented within each item. An independent search for additional newspaper items concerning one prominently featured topic indicated that the rate of identification of relevant stories was at least 91%. RESULT: The collection consisted of six hundred print items which were most commonly news or editorial pieces (n = 562, 93.7%). Negative depictions predominated, with dangerousness to others (n = 368, 61.3%) and criminality (n = 284, 47.3%) being the most common. Positive depictions, including human rights themes, leadership and educational accomplishments occurred in 27% (n = 164) of all items. Generic mental illness terminology without reference to specific diagnostic categories was present in 47% of all items (n = 284). CONCLUSIONS: Negative depictions that predominate confirm the stereotypic understanding of mental illness that is stigmatizing. These findings underscore the challenge facing us as mental health professionals attempting to change attitudes towards mental disorders when the stereotypes are so regularly reinforced.

Humans↗
PubMed2002

The social and cultural context of the mental health of Filipinas in Queensland.

OBJECTIVE: To describe the social and cultural context of risk surrounding the mental health of Filipino women living in Queensland, Australia and elicit the meaning and experience of mental health and illness for these women. METHODS: One hundred and thirty-nine in-depth interviews and 7 focus group discussions (FGDs) were nested within the baseline survey of the Filipina cohort of the Australian Longitudinal Study on Women's Health. Seventy-four in-depth interviews and 8 FGDs were conducted at follow-up. A semi-structured interview guide that included sections on emotional health, social support and changes guided these. A subset of responses was fully transcribed and analysed for ethnographic content and themes. RESULTS: "Mental" problems are highly stigmatized, in comparison to "emotional" problems that are believed to result largely from the absence of close family ties. The loss of these ties and the transition from a collectivist to individualist society are key themes related to emotional distress in Filipinas. CONCLUSIONS: This understanding of meaning and context of mental health and its risk factors in migrants is important for informing public health and clinical practice and for the improvement of quantitative research instruments.

Adult↗
PubMed2002

Psychiatrists as a moral community? Psychiatry under the Nazis and its contemporary relevance.

OBJECTIVE: In Nazi-occupied Europe, substantial numbers of psychiatrists murdered their patients while many other psychiatrists were complicit with their actions. This paper addresses their motivations and actions, and with particular reference to Australia, explores issues of contemporary relevance. METHODS: The events are reviewed in their historical context using mainly secondary sources. RESULTS: The assumption that the term "Nazi" denotes a closed and unrepeatable chapter is questioned. As with the Holocaust that followed, medical killing of psychiatric patients was an open secret with gradations of collective knowing. Perpetrators were impelled by pressure from peers and superiors, unquestioning obedience, racist ideology and careerism. Perpetrators and bystanders' denial was facilitated by use of deceptive language, bureaucratic and technical proficiency, and notions such as "a greater cause" or "sacred mission". Dissociation and numbing were common. Psychiatrists were the main medical specialty involved because Nazi race and eugenic ideology (accepted by many psychiatrists) targeted mentally ill people for sterilization and euthanasia, and because psychiatrists were state-controlled and tended to objectify patients. Few psychiatrists resisted. IMPLICATIONS: Nazi psychiatry raises questions about medical ethics, stigma and mental illness, scientific "fashions", psychiatry's relations with government, and psychiatrists' perceived core business. Psychiatric resistance to future similar threats should be based on commemoration, broad-based education and reflection on cultural values, strong partnerships between psychiatrists and patients, and willingness to question publicly policies and attitudes that disadvantage and stigmatize groups. The principle fundamental to all these practices is an orientation to people as subjects rather than objects.

Euthanasia↗
PubMed1999

Schizophrenia: is it time to replace the term?

The attitudes of Japanese psychiatrists toward their patients who suffer from schizophrenia were investigated. We were concerned specifically with whether the psychiatrists inform their patients of the suspected diagnosis. We discuss how the term 'schizophrenia' may influence a psychiatrist's decision to inform his patients of the diagnosis. A self-reported questionnaire was distributed to 150 executive board members of the Japanese Society of Psychiatry and Neurology and analysis of the data obtained from 110 respondents was carried out. The results showed that the concepts that psychiatrists use when they give a diagnosis of schizophrenia vary considerably. Fifty-nine per cent of the respondents informed their patients of a diagnosis of schizophrenia on a case-by-case basis, while 37% informed only the patients' families. A tree analysis showed that the most important predictors for informing the patients of the diagnosis were assumptions about the public image of schizophrenia and a negative impression of the term schizophrenia, translated as 'Seishin Bunretsu Byou' in Japanese. The results revealed that the Japanese term for schizophrenia influences a psychiatrist's decision to inform patients of the diagnosis and that, by changing the term to a less stigmatized one, the disclosure of information about schizophrenia to patients would be promoted.

Attitude of Health Personnel↗
PubMed1988

Cluster headache-like headache, Hageman trait deficiency, retrobulbar neuritis, and giant aneurysm. Autonomic function studies.

A 56-year-old, previously reported woman with cluster headache-like headache with bouts of unilateral (the side of predominance changing through the years) severe headache had a familial history (three generations) of partial Hageman factor deficiency and bleeding episodes. A giant aneurysm was found to be lodged in the anterior communicating artery on the left side. Clinically, the features were atypical for cluster headache: onset at a young age (14 years), episodes of retrobulbar neuritis appearing at the side of pain, etc. Studies of forehead sweating indicated that the right side was the pathologic one, from an autonomic point of view, as did pupillometric studies. However, during attacks, which were left-sided at the time, forehead sweating was marked laterally on the left side and on the upper eyelid, but not on the right. The "signal" usually reaching the autonomically stigmatized side during attacks of cluster headache, therefore, did not seem to reach the sweat glands on that (the right) side during the attack in the present case. This headache may, therefore, be distinct from cluster headache, both from a clinical and from an autonomic function point of view.

Autonomic Nervous System↗
PubMedDate not supplied

Reintegration after bone marrow transplantation.

OBJECTIVES: This study examines the problems of bone marrow transplantation (BMT) survivors in returning to "normal" life in the community after BMT. MATERIALS AND METHODS: Before being released from The Johns Hopkins Oncology Center, 84 recipients of BMT were interviewed regarding their quality of life and psychosocial adaptation. Survivors were reinterviewed at 6 months, and at 1 year post-BMT, producing considerable qualitative data regarding their problems in living. Eighty-four patients who had received BMT completed qualitative interviews and standardized measures before treatment, before the return home, and at 6 and 12 months post-BMT. The interviews were subjected to a content analysis methodology to establish units and categories to examine the body of material. RESULTS: Content analysis of these interviews from the first year after BMT identified three areas of psychosocial morbidity; 1) physical problems, which included fatigue, appearance, troubles in eating, and physical restrictions; 2) psychological problems, which included fears about the future, sense of loss of control, anxiety, and depression; and 3) community reintegration problems, which included difficulty in returning to former social roles, separation from home, family, and friends, difficulty in resuming social relations, dealing with stigmatization, problems with family and children, and financial and employment difficulties. CONCLUSIONS: Identification of these problems for BMT survivors can be used to guide the development of specific materials and services to prepare recipients of BMTs and their families for life after the transplant. These qualitative results can also be used to direct the development of assessment tools to identify potential patient and family problems.

Activities of Daily Living↗
PubMedDate not supplied

Gender differences for the predictors of depression in young adults with genital herpes.

Genital herpes is a chronic, stigmatizing, sexually transmitted disease (STD), which is increasing despite efforts to control its spread. Depression is commonly reported among people diagnosed with genital herpes and differences in depression by gender have been reported. Therefore, the purpose of this study was to identify gender differences in the predictors of depression in young adults with genital herpes by secondary analyses of baseline data from a randomized clinical trial (RCT). For the RCT, young adults (193 females, 59 males) with genital herpes were recruited from newspaper advertisements. Participants completed questionnaires measuring illness burden, attitudes toward herpes, stress symptoms, mood states, depression, self-concealment, self-disclosure, substance use, and demographics. Univariate analyses and multiple regression techniques were used to identify variables predictive of depression in this sample. In women, increased anger, decreased vigor, increased confusion, a negative attitude toward herpes, self-concealment, and stress symptoms from genital herpes predicted more depression (R2 = 0.63). In men, increased depression was predicted by increased anger, a negative attitude toward herpes, and a decreased willingness to share personal information with a stranger (R2 = 0.51). Findings suggest that future psychoeducational interventions should address anger as a predictor of depression in this population. Gender-specific interventions need to be developed in order to assist young adults who are living with genital herpes.

Adaptation, Psychological↗
PubMedDate not supplied

Crusted scabies in an immunocompetent child: treatment with ivermectin.

An 11-year-old girl presented to our clinic with recalcitrant crusted scabies despite repeated applications of topical scabicides. She had no history of corticosteroid use prior to onset of the eruption and no evidence of immunodeficiency. A combination of oral ivermectin, topical lindane, and keratolytics cleared the infestation. Our patient is exceptional in that she had no risk factors commonly associated with a propensity to develop crusted scabies. While topical therapy remains the first-line treatment for children with classic scabies, in the unusual instance of a child with recalcitrant, crusted scabies, ivermectin may offer an efficacious alternative, although it should be used with caution. We discuss the use of oral ivermectin for treatment of crusted scabies and the challenging comprehensive management needed for this socially stigmatizing condition.

Administration, Oral↗
PubMed2000

Palliative pharmaceutical care: a randomized, prospective study of telephone-based prescription and medication counseling services for treating chronic pain.

OBJECTIVE: To evaluate the effects of providing a unique telephone-based pharmaceutical care program to a sample of patients enrolled at a university pain clinic in Philadelphia, Pa. We hypothesized that in comparison to routine pharmaceutical care, the telephone-based pharmaceutical care program would have a positive impact on delivery of medication, quality of life, and overall satisfaction with the pain clinic program. PATIENTS: One hundred seven pain clinic patients were randomly assigned to the control and intervention groups. Seventy-four patients (control group, n = 36; intervention group, n = 38) met inclusion criteria. METHOD: The control group continued to receive care and prescription services through the same means as prior to the study. There were 2 components to the pharmaceutical care program offered to the intervention group. The first component consisted of a palliative care pharmacy company, PainRxperts, providing specialized prescription services tailored to the needs of a pain medicine clinical practice. The second component involved the palliative-trained pharmacist's proactive monitoring of patient pharmacotherapy for potential or actual drug related problems (DRPs). RESULTS: Intervention patients perceived that they had better access to medication, more efficient processing of prescriptions, and fewer stigmatizing experiences. They also endorsed pharmacists' behavioral interventions such as medication counseling, availability to answer medication-related questions, and non-judgmental attitudes when managing opioid prescriptions. CONCLUSION: This study suggests that the palliative-trained pharmacist can play an important collaborative role in managing chronic pain. Application of the pharmaceutical care model in pain medicine centers can improve satisfaction and remove some of the barriers to good pharmaceutical care facing patients with chronic pain disorders

Clinical Trial↗
PubMed1991

Human immunodeficiency virus type 1-infected blood donors: behavioral characteristics and reasons for donation. The HIV Blood Donor Study Group.

Between May 1988 and September 1989, 829 human immunodeficiency virus type 1 (HIV-1)-seropositive donors were identified from 3,919,000 units of blood donated at 20 United States (US) blood centers. Of the 829,512 (62%) were interviewed to assess behavioral characteristics of the largest subgroup, men reporting sex with men, use of the confidential unit exclusion (CUE) and reasons for donation among all donors. Among 216 men reporting sex with men, 97 percent had male and 72 percent had female sexual contact since 1978. The majority identified themselves as bisexual (29%) or heterosexual (26%). Although 61 percent of 512 donors were aware of their risk behavior at donation, including 57 percent of those infected through heterosexual transmission, only 5 percent used the CUE. Reasons for donation included failure to read carefully (46%) or comprehend (15%) the deferral materials, pressure to donate (27%), a desire to be tested for HIV-1 (15%), and a reliance on screening to identify infected blood (10%). Reasons given for a perception of being at low risk included no recent risk behaviors, infrequent risk behaviors, or modification of risk behaviors. To reach high-risk donors, centers should assess whether referral materials provide necessary medical information and are clearly written for persons with diverse cultural and language backgrounds. Staff should be encouraged to avoid the use of culturally stigmatized terms and behaviors that may be perceived as high pressure.

Blood Donors↗
PubMed2001

Disability, chronic illness, and risk selection.

As high-cost users of health care, people with disabilities or chronic conditions are particularly vulnerable to risk selection. Preferred risk selection, in which insurers avoid enrolling high-risk people, threatens their access to coverage. Adverse selection, in which high-risk people enroll in the most generous plans, compromises the financial viability of plans that are most responsive to their specific needs. The Americans with Disabilities Act prohibits some forms of risk selection, but does not prevent all disability-based distinctions in insurance practices. From a disability perspective, risk selection must be addressed in a manner that: (1) adequately reflects the health care costs of such individuals; (2) eliminates their need to engage in adverse selection; (3) does not stigmatize them; (4) preserves confidentiality of information; (5) uses substantial outcome measures to ensure quality; and (6) creates market conditions that discourage disability-based discrimination. A risk adjuster based on prior use/expenditures or on a diagnostic indicator sensitive to disability issues may be effective. Failure of reform to address risk selection may threaten the viability of a market-based health care system.

Chronic Disease↗
PubMed2001

Help-seeking for parents of individuals experiencing a first episode of schizophrenia.

The purpose of this triangulated study was to understand parents' experience of help-seeking in response to their child's first episode of schizophrenia. Twenty participants completed questionnaires related to stigma, parental caregiver burden, uncertainty in illness and help-seeking. Findings indicated: (1) as stigmatized attitudes towards mental illness and feelings of ambiguity increased, so did burden; (2) as parental education increased, uncertainty regarding their child's illness decreased; (3) as the number of symptoms causing distress increased so did burden and lack of clarity regarding their child's illness. A significant amount of time passed before parents were able to access help. No relationships were found between indicators of parental help-seeking and the study variables. A subset of five participants described their help-seeking experience. Three overarching themes emerged: (1) Evolving change: What does it mean? (2) Continuous help-seeking, and (3) The help-seeking experience: Impact on parents.

Adaptation, Psychological↗
PubMed2006

A history of obesity, or how what was good became ugly and then bad.

Chronic food shortage and malnutrition have been the scourge of humankind from the dawn of history. The current worldwide epidemic of obesity, now recognized as a public health crisis, is barely a few decades old. Only after the technological advances of the eighteenth century did a gradual increase in food supply became available. The initial effect of these advances in improved public health and amount, quality, and variety of food was increased longevity and body size. These early favorable outcomes of technological advances notwithstanding, their incremental effect since the Second World War has been an overabundance of easily accessible food, coupled with reduced physical activity, that accounts for the recent increased prevalence of obesity. Obesity as a chronic disease with well-defined pathologic consequences is less than a century old. The scarcity of food throughout most of history had led to connotations that being fat was good, and that corpulence and increased "flesh" were desirable as reflected in the arts, literature, and medical opinion of the times. Only in the latter half of the nineteenth century did being fat begin to be stigmatized for aesthetic reasons, and in the twentieth century, its association with increased mortality was recognized. Whereas early reports listed obesity as a risk factor for mortality from "chronic nephritis," the subsequent recognition of the more common association of obesity with diabetes, hypertension, and heart disease altered the listings and questioned its being a risk factor for kidney disease. An enlarging body of evidence, accrued over the past decade, now indicates a direct association of obesity with chronic kidney disease and its outcomes.

Beauty↗
PubMed2004

The perspective of the patient.

The International Foundation for Functional Gastrointestinal Disorders (IFFGD) is a nonprofit education and research group. Founded in 1991, the IFFGD provides information and advice to patients around the world with fecal incontinence and other gastrointestinal disorders, educates physicians through medical symposia and other activities, funds and undertakes research, and provides testimony to Congress about the necessity of furthering research activities related to fecal incontinence through the National Institutes of Health. The IFFGD advocates research directed toward more comprehensive identification of quality-of-life issues associated with fecal incontinence and improved assessment and communication of treatment outcomes related to quality of life, standardization of scales to measure incontinence severity and quality of life, assessment of the utility of diagnostic tests for affecting management strategies and treatment outcomes, development of new drug compounds offering new treatment approaches to fecal incontinence, development and testing of strategies for primary prevention of fecal incontinence associated with childbirth, and further understanding of the process of stigmatization as it applies to the experience of individuals with fecal incontinence.

Fecal Incontinence↗