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PubMed2002

Facial atrophy in HIV-related fat redistribution syndrome: anatomic evaluation and surgical reconstruction.

The use of highly active antiretroviral therapy (HAART) with protease inhibitors can result in a syndrome of peripheral wasting, facial fat atrophy, and central adiposity in as many as 64% of patients infected with human immunodeficiency virus (HIV) who are treated with this regimen for 1 year. In this study the authors evaluated 9 consecutive patients who presented with this disease to define further its anatomic features and to explore techniques for surgical correction. Three of these patients presented with severe facial atrophy, and underwent surgical exploration and reconstruction with submalar silicone implants. Two patients required additional soft-tissue augmentation with synthetic fillers and/or autologous fat. Outcomes were determined through clinical impressions of the patient and surgeons, and comparison of pre- and postoperative photographs. No extrusion or infection was encountered, although 1 patient required repositioning on one side. Both surgeons and patients were satisfied with the results at the long-term follow-up. Detailed anatomic evaluation revealed the presence of a fat pad of Bichat in all patients. Facial atrophy in HIV-related fat redistribution syndrome (HARS) is secondary to atrophy of the subcutaneous fat, but not of the deeper fat pads, as has been described. Durable surgical reconstruction is achieved with a combination of submalar silicone implantation and augmentation of the nasolabial fold. HARS causes noticeable disfigurement that stigmatizes the HIV-infected patient. Given the overall benefit of decreased morbidity and prolonged survival associated with HAART therapy, it is beneficial to attempt surgical correction of these debilitating sequelae before discontinuation of these drugs.

Antiretroviral Therapy, Highly Active↗

PubMed2002

Psychosis: conceptual and ethical aspects of early diagnosis and intervention.

PURPOSE OF REVIEW: Interest in the early identification and treatment of incipient first-episode psychosis is rapidly expanding. In the present review we discuss the major conceptual and ethical problem areas related to research and clinical work in detection and treatment of prepsychosis. RECENT FINDINGS: The recent literature shows that conceptualization of early psychosis is often inconsistent and even misleading. Ethical discussions mostly concern 'false positives' risk assignments, stigmatization, informed consent and acceptability of treatment procedures. SUMMARY: At present there is a lack of consensus regarding which concepts to use in describing prepsychosis in prospective studies, and new concepts are needed for prospective description of emergent psychosis.

Early Diagnosis↗

PubMedDate not supplied

The role of hepatitis C support groups.

Chronic hepatitis C infection has become the most common blood-borne pathogen in the United States, affecting an estimated 4 million Americans. The diagnosis of chronic hepatitis C carries with it threats to quality of life and life expectancy. Furthermore, the label of chronic hepatitis C encumbers the individual with concerns about contagiousness, social isolation, altered role function, stigmatization, loss of control, and the uncertainty and anxiety inherent in any chronic illness. These factors have a significant emotional effect on the affected individual and his or her family. Although biomedical research continues to seek new therapies for hepatitic C virus and methods of prevention and control, our health and social systems also must develop strategies to facilitate adjustment, provide education and caring, and enhance well-being. Abundant research supports the premise that social support facilitates patient well-being and contributes to health and health promotion through interpersonal interactions. Gastroenterology nurses are well positioned to facilitate improved outcomes in patients with chronic hepatitis C virus by initiating interventions designed to enhance existing sources of social support or to promote new ones. Development of psychosocial interventions, such as support groups, aimed at maintaining or fostering social support, may improve health outcomes and promote a higher health-related quality of life for persons living with chronic hepatitis C virus.

Adaptation, Psychological↗

PubMed2004

Augmentation by autologous adipose tissue in cleft lip and nose. Final esthetic touches in clefts: part I.

Although patients with a cleft lip and palate undergo many surgeries and other therapeutic procedures in the course of their treatment, many are still deeply concerned with their handicap and continue searching for perfection in their appearance. Augmentation using the subject's own fat cells involves minor invasion, is readily available, is an unpretentious method regarding time and cost, and has no contraindications. This method can serve to supplement a hypotrophic scarred upper lip and nasal columella, and by improving the volume, it induces a more natural contour, which reduces the stigmatizing deformity as well as the visibility of externally apparent scars. Using this approach, five patients with a complete cleft have been treated. The median follow-up interval is 22 months (through January 2003). The procedure and postoperative course had a pleasing outcome and were without any complications. The disadvantage was the temporary effect of the outcome, which necessitated repeated application every 7 months on average.

Adipose Tissue↗

PubMed1987

Medical students' attitudes toward AIDS and homosexual patients.

More than most diseases, acquired immune deficiency syndrome (AIDS) appears to elicit highly negative, fearful, and prejudicial attitudes. In the study reported here, medical students read one of four patient vignettes. The vignettes were identical in content except that the patient was identified as having either AIDS or leukemia as either homosexual or heterosexual. The students then completed a set of objective measures that assessed their attitudes toward the patient portrayed in the vignette. Multivariate and univariate analyses of variance of their responses revealed that the students held negative and prejudiced attitudes toward both the AIDS and homosexual patients. This finding suggests that medical educators should recognize that many students have stigmatizing, negative attitudes toward homosexuals and patients with AIDS. These educators should promote greater sensitivity, knowledge, and understanding among medical students of those at risk for AIDS and AIDS patients.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Using experiential training to enhance health professionals' awareness of patient compliance issues.

PURPOSE: To educate health care practitioners about medication compliance by having them play the role of patients who have been placed on a medication regimen. METHODS: In 1988, ten physicians and ten nurses working in the Acquired Immune Deficiency Syndrome Clinical Trials Unit of Tulane University and Louisiana State University participated in a compliance protocol designed to enable them to better understand the experience of their patients, who were involved in a three-year controlled trial of azidothymidine (zidovudine) for asymptomatic persons infected with the human immunodeficiency virus. Over the three-year trial, the patients were expected to take three pills five times a day at four-hour intervals every day. To gain experiential understanding of this prolonged, intensive medication regimen, the physicians and nurses agreed to follow their patients' pill-taking schedule by using placebos for seven days, and they kept diaries of their reactions to the seven-day experience. Two years later, a follow-up assessment was done to ascertain the participants' opinions about whether the seven-day experience had had a lasting, positive influence on the way they addressed compliance issues with patients. RESULTS: The primary barriers to medication compliance recorded by the participants were time-related difficulties in following such a strict, unvarying schedule (e.g., frustration at having to repeat the pill-taking five times a day at regular intervals). Other frequently recorded difficulties were social barriers to public pill-taking (e.g., being stigmatized as ill or different). The follow-up results indicated that the participants felt that the seven-day experience was a relatively fast, painless, and helpful means of educating themselves about the problems their patients face. CONCLUSION: By playing the role of patients, the physicians and nurses learned to recognize sources of patient noncompliance with medication regimens, and, as the follow-up indicated, they were able to generalize the role-playing experiences to later interactions with patients.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Misconceptions about transmission of AIDS and attitudes toward prevention in the French general public.

A survey of the social perception of AIDS and its prevention was carried out in December 1987 in a representative sample of the adult population of the Paris region (France). A significant part of the general public still holds misconceptions about transmission by casual contact and blood donation. Misbeliefs about modes of transmission clearly encourage individuals' willingness to stigmatize AIDS patients and to support the most coercive measures of prevention (such as quarantine). Advertizing efforts to promote use of condoms, sexual education in schools, and systematic HIV screening for pregnant women are the only measures which create a broad consensus independently of sociocultural differences. Socioeconomic status and even religious or political beliefs strongly influence public opinions toward other preventive measures.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Injecting drug use and female street-working prostitution in Glasgow.

There are considerable difficulties associated with calculating the prevalence of covert, illegal and stigmatized activities. This paper outlines new methods we have developed for calculating the prevalence of both drug-injecting street prostitution and non-injecting street prostitution in Glasgow. Our data indicate that Glasgow has a much higher level of injecting drug use than has been reported among prostitutes in other British cities.

Female↗

PubMed2001

HIV surveillance in complex emergencies.

Many studies have shown a positive association between both migration and temporary expatriation and HIV risk. This association is likely to be similar or even more pronounced for forced migrants. In general, HIV transmission in host-migrant or host-forced-migrant interactions depends on the maturity of the HIV epidemic in both the host and the migrant population, the relative seroprevalence of HIV in the host and the migrant population, the prevalence of other sexually transmitted infections (STIs) that may facilitate transmission, and the level of sexual interaction between the two communities. Complex emergencies are the major cause of mass population movement today. In complex emergencies, additional factors such as sexual interaction between forced-migrant populations and the military; sexual violence; increasing commercial sex work; psychological trauma; and disruption of preventive and curative health services may increase the risk for HIV transmission. Despite recent success in preventing HIV infection in stable populations in selected developing countries, internally displaced persons and refugees (or forced migrants) have not been systematically included in HIV surveillance systems, nor consequently in prevention activities. Standard surveillance systems that rely on functioning health services may not provide useful data in many complex emergency settings. Secondary sources can provide some information in these settings. Little attempt has been made, however, to develop innovative HIV surveillance systems in countries affected by complex emergencies. Consequently, data on the HIV epidemic in these countries are scarce and HIV prevention programs are either not implemented or interventions are not effectively targeted. Second generation surveillance methods such as cross-sectional, population-based surveys can provide rapid information on HIV, STIs, and sexual behavior. The risks for stigmatization and breaches of confidentiality must be recognized. Surveillance, however, is a key component of HIV and STI prevention services for forced migrants. It is required to define the high risk groups, target interventions, and ultimately decrease HIV and STI transmission within countries facing complex emergencies. It is also required to facilitate regional control of HIV epidemics.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Assessment for addiction in pain-treatment settings.

The identification of the disease of addiction is important to safe and effective clinical management of pain in persons with addictive disorders. The disease of addiction affects approximately 10% of the general population, and its prevalence may be higher in subpopulations of patients with pain. The presence of active addiction may facilitate the experience of pain. Both active and recovering addiction may complicate the use of medications, such as opioids, important to the management of pain. There is, further, persistent misunderstanding among health care providers, regulators, and the general population regarding the nature and manifestations of addiction that may result in undertreatment of pain and stigmatization of patients using opioids for pain control. The author seeks to clarify understanding of addiction, to underscore the importance of identifying addiction in the context of pain treatment, and to provide a rational approach to assessment for addiction in patients with pain. Current scientific understanding of addiction as a chronic illness is briefly reviewed. Recent definitions related to addiction are presented. The impact of addictive disorders on pain and pain treatment are explored. The roles of medical interview, physical examination, laboratory studies, and standard addiction screening tools in assessing for addiction are outlined. Differential considerations in distinguishing therapeutic use of opioids for analgesia from addictive or other nontherapeutic use of opioids are discussed. In summary, the article provides salient background and a detailed approach to assessment for addictive disorders in the context of pain treatment.

Chronic Disease↗

PubMedDate not supplied

Ethical perspectives: opioid treatment of chronic pain in the context of addiction.

The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.

Chronic Disease↗

PubMed2002

Pain management autobiographies and reluctance to use opioids for cancer pain management.

Although pain management education results in improved pain control for some patients, it does not work for all patients because some patients remain reluctant or unwilling to use prescribed analgesics to their optimal effect. In a randomized clinical trial that tested the effectiveness of the PRO-SELF Pain Control Program, 11 patients declined to increase their analgesic use despite moderate to severe pain. These patients were selected for a qualitative analysis of their audiotaped discussions about pain management with their intervention nurses. This analysis revealed that these patients often spontaneously provided detailed explanations about why they were reluctant or unwilling to take analgesics in general or opioids in particular. We termed these explanatory accounts pain management autobiographies because of their narrative character and multilayered, richly detailed quality. Pain management autobiographies included stories about (1) previous experience with chronic pain management, including stigmatizing interactions with clinicians and family members; (2) bad experiences with cancer pain management, including severe constipation; and 3) strongly held conventions about medication use, including the belief that all medications are "toxins" that should be avoided. The study findings suggest that a small subset of patients with cancer pain may need interventions such as individual or family counseling or alternative pain management strategies to augment education about opioids.

Adult↗

PubMed1994

Dermatography as a modern treatment for coloring leucoma corneae.

Since antiquity many attempts were made and hence many methods were devised to minimize the disfiguration and stigmatization caused by leucoma corneae. Dermatography, a refined, modified tattooing technique, was used successfully in three cases of leucoma corneae. The materials and method are safe and simple. Over a 3-year follow-up period, no negative reactions were found. The cosmetic results were very satisfactory.

Adult↗

PubMed2003

Sources of burdens on families of individuals with mental illness.

Families of individuals with mental illness face a range of practical and emotional stresses. Studies that have addressed the sources of these burdens are limited. Literature suggests that burdens could come from the stigmatizing attitudes towards individuals with mental illness and inadequate public resources. Nevertheless, how public attitudes and availability of public resources have affected the burden on patients' families remains to be studied. This study set out to explore the relationship between stigma, accessibility of mental health facilities and family burden through individual interviews of patients' relatives in order to understand the burden on mentally ill patients' relatives from their perspectives. Ten interviewees from two out-patient psychiatric clinics were recruited and interviewed. Each interviewee had at least one family member receiving out-patient psychiatric services. Altogether 11 mentally ill patients were involved. Data analyses showed that much of the burden was related to stigma and to lack of mental health and rehabilitation services. Consequences included social isolation of the families, difficulties experienced by the mentally ill patients when trying to obtain competitive employment and financial difficulties. Subjective burden resulting from social stigma included frustration, anxiety, low self-esteem and helplessness. Implications of the findings to social policy and development of mental health services were discussed.

Adolescent↗

PubMed1991

Autism associated with marker chromosome.

Six boys who all showed the combination of moderate-severe mental retardation, autistic behavior, and mild-moderate physical stigmatization are described. Muscular hypotonia, epilepsy, and kyphoscoliosis were associated features in several cases, as were extremes of short stature and low weight. A supernumerary chromosome was found in all six cases, and it appears that there may be a separate syndrome associated with partial trisomy of chromosome 15.

Adolescent↗

PubMed1996

Case study: sex reassignment in a teenage girl.

The etiology of gender identity is explored through the case history of a teenager with intersex raised without stigmatization as a girl but who declared himself male at age 14 years. Psychological ramifications of such complex medical anomalies as ambiguous genitalia demand a role for child psychiatry.

Adolescent↗

PubMed1998

Implications of genetic testing of children and adolescents.

Advances in genetic technology increase the ability to test children and adolescents for late-onset conditions, disease susceptibilities, and carrier status. Genetic tests may offer medical or psychologic benefits but may also create harm; alteration of the child's self-concept or parent-child bonds and risk of stigmatization are examples of the latter. The article examines developmental theories concerning children's ability to make choices as well as informed consent and ethical considerations in genetic testing. Because optimal care requires awareness of the complex psychosocial and ethical issues involved in childhood genetic testing, nurses must be prepared to acknowledge and discuss such issues with families.

Adolescent↗

PubMed2002

Staying alive: a client with chronic mental illness in an environment of domestic violence.

This case study of a young, African American mother with chronic mental illness demonstrates the impact of domestic violence on a vulnerable population. The client was economically disadvantaged, socially isolated, stigmatized, and victimized by repeated abuse from her live-in male partner of 7 years. With this overlay of violence in the home, the client experienced a downward trajectory in health, self-esteem, economic status, personal freedom, social relationships, and legal standing. Using a public health model in the context of an urban nursing center, an advanced practice nurse provided case management and outreach services for the client.

Adult↗