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PubMed2005

Is it possible to reduce AIDS deaths without reinforcing socioeconomic inequalities in health?

BACKGROUND: The wide use of highly active antiretroviral therapy has led to an impressive improvement in AIDS survival after the mid-1990s in cities and countries with a high access to these medications. Notwithstanding its beneficial overall effect, antiretroviral therapy was also reported as a factor for the increase in socioeconomic inequalities in health, because AIDS patients have unequal access and adherence to these medications. METHODS: We assessed trends AIDS mortality in districts of Sao Paulo, Brazil, from 1995 to 2002, in order to test their association with area-level socioeconomic indices in a city with a large-scale and cost-free distribution of highly active antiretroviral therapy. We gathered information on yearly death rates due to AIDS, adjusted for gender, age group, income, instruction, living standards, and the human development index. Trend estimation used the autoregression procedure of exact maximum-likelihood estimation for time-series analysis. Regression analysis was used to study the association between the annual percentage decrease in AIDS deaths and socioeconomic indices. RESULTS: AIDS mortality decreased in Sao Paulo from 32.1 deaths (per 100 000 inhabitants) in 1995 to 11.2 deaths (per 100 000 inhabitants) in 2002. District-level figures of social development did not show an association with the annual percentage decrease in AIDS mortality, with all correlation coefficients corresponding to P-values >0.27. CONCLUSIONS: This observation indicates that the perspective of public policies addressed to the entire population contribute to reducing inequalities in health, while attaining an overall reduction in AIDS deaths, may have been feasible in the Brazilian context.

Acquired Immunodeficiency Syndrome↗
PubMed1979

[The future of nursing in Latin America].

The authors take up the subject with a retrospective review of the concepts of economic and social development, the health policy that has emerged in the last 25 years, and the salient characteristics of health practice and the training of nursing personnel. They interpret development in the health field and various approaches to the extension of the health services coverage that have been taken in the countries of Latin America through implementation of the strategies of primary care and community participation. Finally, they present several considerations on the future of nursing, with emphasis on a comprehensive view of the profession as an occupation and a social practice, after which they formulate a series of propositions that can serve as a basis for training of the nursing personnel that will be needed to serve society adequately.

Education, Nursing↗
PubMed1994

The concept of the Second Generation program in the treatment of post-traumatic stress disorder among Vietnam veterans.

The concepts of First and Second Generation treatment programs for Vietnam veterans with post-traumatic stress disorder are presented, based on a developmental theoretical model of adaptation. First Generation programs focus on accessing and then working through the effects of the war trauma and aim to diminish the intensity of core PTSD symptoms. Second Generation programs focus on reintegrating veterans into the social context of family and work, and aim to improve their ability to function in society. Both types of treatment may be required in order to help veterans resume their psychological and social development. The need to develop sophisticated models of comprehensive inpatient treatment in order to support scholarly discourse and outcome research is emphasized.

Adaptation, Psychological↗
PubMed2006

Social relationships, stigma and adherence to antiretroviral therapy for HIV/AIDS.

Research on adherence to combination antiretroviral therapy has up to now focused largely upon problems of definition and measurement, and on the identification of barriers and supports. This paper examines the intersection between taking HAART and building a life with HIV/AIDS. Data consist of 214 qualitative interviews with 52 HIV-positive, active illegal drug users. A interpretive analysis drawing upon stigma and fear of disclosure as analytical constructs was applied to explain working tensions between efforts to develop social relationships on the one hand, and attempts to safeguard health through adherence on the other. The analysis specifies a mechanism through which stigma as a social process results in marginalization and exclusion. The hierarchical organization of multiple stigma is also noted. Loneliness and the desire for relatedness is intensified by drug use. Results suggest that persons with HIV/AIDS will not consistently subordinate other interests to prioritize adherence. Interventions aimed at supporting long-term adherence must address experienced conflicts between 'health' and 'life'.

Activities of Daily Living↗
PubMed1994

[The physician facing the evolution of ethical concepts in our times].

Medical ethics institutionalized with clinical activities being determined by the patient's interests as they developed in the doctor-patient relationship. The ethical nature of the health concept was emphasized in the positive definitions of health such as the one by the W.H.O.. The established goals for clinical intervention surpass the effective medical capabilities. The curricula of medical schools will have to be reviewed in light of these goals. We characterized the contemporary values and the way medicine has adapted to them: superspecialization and doctors' change in social image brought about by the impact of technocracy in clinical activities, increasing costs of medical care, the interference of non medical managers in the process of clinical decision, litigation and breaches of confidentiality. Technical and social developments lead to new ethical problems in which the moral principles of the doctor can be confronted with patients' demands in situations of difficult choice. Contraception, abortion, genetic engineering, transplants, allocation of scarce resources, the expansion of drug dependency and euthanasia are examples of problems that clinicians frequently face today.

Ethics, Medical↗
PubMed1977

Can we identify a group of children at age 2 who are at high risk for the development of behavior or emotional problems in kindergarten and first grade?

A group of 198 children were followed from age 2 through first grade to see how consistent their behavior was across time and across settings. Measures of child behavior in the home were obtained when the children were ages 2, 4, and 5. Classroom behavior was ascertained when the children were in nursery school, kindergarten, and first grade. Correlations between early home and school behavior patterns were all quite low. Only when home and school measures were made close to the same point in time did relationships reach even a moderate level. Behavior within the same setting was more consistent over time than behavior across settings but even here relationships were not strong enough to be clinically useful for making predictions about individual children. It is concluded that early behavior in the home, as measured by these methods and for this population, is not be itself sufficiently predictive of later home or school behavior to warrant identifying the child or his family as being at "high risk" for future problems. Pediatrics 59.971-981, 1977, SOCIAL DEVELOPMENT, SCREENING, BEHAVIOR, CHILD DEVELOPMENT, HIGH RISK.

Aggression↗
PubMedDate not supplied

The home environments of children in the United States part II: relations with behavioral development through age thirteen.

This study examined the frequency with which children were exposed to various parental actions, materials, events, and conditions as part of their home environments, and how those exposures related to their well-being. Part 1 focused on variations by age, ethnicity, and poverty status. In Part 2 of the study, relations between major aspects of the home environment (including maternal responsiveness, learning stimulation, and spanking) and developmental outcomes for children from birth through age 13 were investigated. The outcomes examined were early motor and social development, vocabulary development, achievement, and behavior problems. These relations were examined in both poor and nonpoor European American, African American, and Hispanic American families using hierarchical linear modeling. The most consistent relations found were those between learning stimulation and children's developmental status, with relations for parental responsiveness and spanking varying as a function of outcome, age, ethnicity, and poverty status. The evidence indicated slightly stronger relations for younger as compared with older children.

Adolescent↗
PubMed2001

Malocclusion, orthodontics and bullying.

Bullying is endemic among schoolchildren, and the effects can be devastating and long lasting. The persistently bullied child appears to represent a certain psychological type, with poorly developed social skills and a submissive nature. Physical appearance does appear to play a role, which includes facial and dental appearance, although these tend not to be primary factors. Teasing related to dental appearance appears to be particularly hurtful. There is little evidence of a marked increase in self-esteem following orthodontic treatment in children, but in adults following treatment there is an improvement of body concept. The long-term psychological benefits of orthodontic treatment are difficult to measure but there is an increasing awareness of malocclusion with age.

Adolescent↗
PubMed1992

[Rehabilitation of the aged].

It is common knowledge that in the light of demographic and social developments in the years to come our society will have to rise to the enormous challenge of medical care for the old, sick and needy. In order to shorten long-time nursing periods for old people in need of medical care preventive treatment and medical rehabilitation must be the main priority of all measures. Geriatric rehabilitation is subdivided into prophylactic rehabilitation (medical care, social sector), general rehabilitation and target-specific rehabilitation. Both the rehabilitation team and the motivation to rehabilitate are of particular importance during geriatric rehabilitation. On the whole, it has to be reckoned that older people need a distinctly longer period of recuperation, in which the clinical picture rather than the age is the decisive factor of a successful rehabilitation. As for Germany, that is only the beginning of stationary geriatric rehabilitation.

Activities of Daily Living↗
PubMed1981

Follow-up study of phototreated fullterm newborns.

A follow-up study including examinations made by a paediatrician, an ophthalmologist and a psychologist and complemented with EEG-recordings and a number of laboratory determinations was performed at the age of 3 years on 41 children who had received phototherapy during the first week of life and on 42 control children of the same age. No differences were found in growth, development, social maturity, neurological or ophthalmologic disorders, EEG-recordings or laboratory determinations between both groups. It seems unlikely that phototherapy causes any harmful longterm effects provided that the eyes are shielded.

Brain Diseases↗
PubMed2004

School readiness and factors that influence decision making.

Occupational therapists are frequently asked to make recommendations regarding a child's school readiness. The primary objective of this study was to investigate the factors that influence the decision making of parents and teachers regarding this issue. The home environments and developmental status of 215 preschool children (age: M = 62.2 months, SD = 4.65) were assessed. Parents and teachers completed questionnaires about each child's behaviour, temperament, and readiness for school. Their perceptions were analysed separately. Results showed that chronological age, and the presence of adaptability, well-developed social skills, and the ability to persist with an activity until completed influenced parents' as well as teachers' perceptions of school readiness. In addition, teachers' decisions were influenced by gender (girls were perceived as being more ready for school than boys), and the presence of the temperament characteristic of inhibition (withdrawn, shy behaviours). These results indicated that factors other than a child's developmental status influenced parental and teacher decision making, challenging occupational therapists to adopt a broader focus when consulting with parents and teachers about school readiness. Limitations of the study included the self-selected sample resulting in potential bias owing to the over-representation of families from higher socioeconomic backgrounds. It is suggested that future research take the form of a matched pairs design, and focus on a comparison between a population of children perceived to be ready to progress to school and a group perceived not to be ready.

Child↗
PubMed1981

Sex-role patterns, paternal rearing attitudes and child development in different social classes.

Sex-role patterns, the father's rearing attitude and the child's intellectual and emotional development in different social classes were studied in a randomly selected sample of 58 Swedish unbroken families of a small child. Working class men and women married younger and the women were more often house-wives. Working class men had more often been reared in an "authoritarian" way and more often reared their children in the same way. Upper middle class men had taken a more active part in the care of the child. Working class children scored lower on the intelligence tests, especially the verbal ones and were more often estimated as socially immature.

Adult↗
PubMed2004

Long-term human response to uncertain environmental conditions in the Andes.

Human interaction with the physical environment has increasingly transformed Earth-system processes. Reciprocally, climate anomalies and other processes of environmental change of natural and anthropogenic origin have been affecting, and often disrupting, societies throughout history. Transient impact events, despite their brevity, can have significant long-term impact on society, particularly if they occur in the context of ongoing, protracted environmental change. Major climate events can affect human activities in critical conjunctures that shape particular trajectories of social development. Here we report variable human responses to major environmental events in the Andes with a particular emphasis on the period from anno Domini 500-1500 on the desert north coast of Perú. We show that preindustrial agrarian societies implemented distinct forms of anticipatory response to environmental change and uncertainty. We conclude that innovations in production strategies and agricultural infrastructures in these indigenous societies reflect differential social response to both transient (El Niño-Southern Oscillation events) and protracted (desertification) environmental change.

Agriculture↗
PubMedDate not supplied

Sustained nurse home visiting in early childhood: exploring Australian nursing competencies.

Abstract There is strong evidence that a comprehensive model of sustained nurse home visiting (SNHV) in early childhood can improve child and family outcomes for vulnerable and at-risk families. There is also evidence that nurse home visitors experience challenges in delivering SNHV. This article aims to identify the nursing competencies needed for delivering a comprehensive model of SNHV and highlight the areas where further competency development is required. Qualitative analysis compared the content and language of published registered generalist and child and family nursing competency statements for Australian nurses with the work experiences of a team of community-based nurses delivering SNHV. Development of competencies is needed in the areas of (a) enhanced knowledge of child development, social determinants of health, and broader outcomes for individuals and populations; (b) advanced skills in fine observation, anticipatory guidance, negotiating, modelling and experimentation, holistic case management, and working in interdisciplinary teams; and (c) attitudinal competency for working "with" and supporting risk taking. The current published competencies for general and child and family nurses do not encompass the different and advanced competencies required for performing SNHV. Competency development and associated nurse training and support are needed for delivery of quality SHNV services.

Attitude of Health Personnel↗
PubMedDate not supplied

Stabilising the USSR's rural population through development of the social infrastructure.

This study is concerned with the problems caused by rural-urban migration in the USSR and with the policies that have been developed to deal with those problems. The author suggests that "the increase in the material prosperity of collective farmers since the Revolution, although a necessary condition for discouraging rural migration, has not in itself been sufficient to prevent the occurrence of rural manpower shortages. He points to the need for an all-round approach to improving conditions of life in the countryside, with due regard for cultural/utilitarian and socio-psychological factors, and suggests that the solution to the problem lies in agro-industrial integration, the improvement of public transport and the extension of the all-weather road network."

Demography↗
PubMedDate not supplied

HIV-AIDS in Nepal: the coming crisis.

The number of officially reported cases of HIV infection and of AIDS in Nepal remains low in comparison with numbers in many other Asian countries. But Nepal's open border with India (where HIV infection rates are rapidly rising) and the high level of physical mobility within Nepal and abroad, associated with widespread labor migration and encouraged by the recent development of road transport, means that there is a real danger of a rapid spread of HIV within Nepal. The major means of infection is through heterosexual encounters involving male clients and female sex workers, but other sections of the population are also at risk from infection. Media attention has focused on female sex workers, particularly those who have worked in India, but the issue is far broader than this. Social and economic factors forcing or encouraging young men and women to seek employment away from home underlie the widespread growth of ¿the sex industry¿ and the ¿trafficking¿ of girls and young women. The state's capacity to respond effectively is limited, in part through lack of resources; international agencies are supporting local nongovernmental organizations in a variety of activities designed to ¿educate¿ and to ¿support¿ those at risk; but in the last analysis, it is the local communities from which young men and women migrate and to which they return that are obliged to find ways of coping. Sometimes these communities are supportive of the victims, sometimes not. The spread of HIV-AIDS is not just a ¿health¿ issue, but an issue of economic and social development, of gender relations and of human rights.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Responses to music and movement in the development of children with Down's syndrome.

Physical responses to rhythmic stimuli and music, of different degrees of complexity were registered from 25 children with Down's syndrome and 25 other mentally handicapped children. Required performances were taught and then recorded on video-tape, after which they were assessed by experienced teacher/judges. Whilst there were no overall significant differences between the groups, important differences were detected between the children in different schools with attendant implications for differential treatment. Apart from an overall and general assessment of performance, analysis was made of demographic variables, for example, sex, intelligence, age and social development. It is concluded that specific teaching approaches can significantly effect the development of children with Down's syndrome in such creative aspects of the curriculum as music, movement and dance.

Adolescent↗
PubMed1978

[Rehabilitation - results since 1969 and prospects for the future (author's transl)].

The article reviews the rehabilitation legislation in the Federal Republic of Germany since the social-liberal coalition took office in 1969. It shows that for the first time legislation attempts have been made to realise a uniform socio-political concept for the disabled in which rehabilitation is considered an important and independent socio-political task. With the gradual improvement of the legislative provisions the aim has been to try to remove the negative effects brought about by structural weaknesses of a historically developed social security system for the disabled,--especially the unequal treatment of the disabled, varying according to the origin of the disability, and the disadvantages brought about by the organisational and legislative disunion of rehabilitation services. At the same time, the article makes clear that more reforms are necessary in the future, e.g., a further standardisation of rehabilitation services, the elimination of architectural barriers, reform of the benefit system, improvement of the social security for people in need of care and the guaranty of a regular income for those disabled from birth or childhood.

Architectural Accessibility↗