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PubMed1999

Patients' understanding of and adjustment to epilepsy: interim findings from a European survey.

The purpose of the study was to discover how much European patients with epilepsy and their carers understand about epilepsy. This article reports the interim results for the first four European countries recruited to the study and includes data collected from 1,920 people with epilepsy and 2,136 carers. Clinical and demographic details and data on understanding of epilepsy were collected using self-completed questionnaires mailed to members of epilepsy support groups. There were no significant differences between people with epilepsy and carers for scores on the Epilepsy Knowledge Questionnaire, although people with epilepsy were more likely to score in the higher ranges. Higher scorers on the questionnaire were more likely to be better educated, to have lower scores on the impact of epilepsy scales, to have higher scores on the adjustment to epilepsy scale, and were less likely to report feeling stigmatized. The study confirms the findings of previous studies that people with epilepsy are reasonably well informed, although some gaps in their knowledge were evident. A comparison of country differences will be made and multivariate statistical analysis will allow a better understanding of the contribution of knowledge to people's overall adjustment to their condition.

Adaptation, Psychological↗

PubMed2005

Gaze deviation from contralateral pseudoperiodic lateralized epileptiform discharges (PLEDs).

Pseudoperiodic lateralized epileptiform discharges (PLEDs) usually produce "negative" neurologic findings. This contrasts with seizures which typically induce cortical activation with "positive" clinical manifestations. Gaze preference may arise from ipsilateral frontal eye fields (FEFs) damage because of the unopposed action of an intact contralateral FEF. Epileptic nystagmus (EN) and gaze deviation (GD) can also occur with focal temporo-parieto-occipital or hemispheric seizures in awake or obtunded patients. A patient with old right frontal and parieto-temporal cerebral infarctions manifested leftward gaze preference and deviation (without nystagmus) while alert and talking. Digitized EEG demonstrated PLEDs at approximately 1 Hz over the right fronto-central region, without electrographic seizures. This report illustrates that PLEDs without seizures may excite frontal regions proximate to the FEFs to produce contraversive gaze preference in an awake patient, and discusses putative mechanisms. Gaze deviation, in this case, was the principal clinical feature of PLEDs.

Aged↗

PubMed1991

The ethics of pressure sore prevention and treatment in the elderly: a practical approach.

The management of pressure sores in elderly patients raises a number of ethical dilemmas for health care professionals. Aggressive treatment of advanced pressure sores is often inconsistent with the overall goals of therapy. Private and public funding for effective prevention and early treatment are restricted and constrained. Little information is available that proves treatment efficacy. Health care professionals and their institutions are often stigmatized by the occurrence of a pressure sore even though accountabilities may lie in the natural history of the disease. We use case analysis to identify ethical dilemmas in pressure sore prevention and management and suggest a framework for ethical decisionmaking so that health care professionals and public policy analysts can make informed judgments about patients and standards of quality care.

Aged↗

PubMed1996

On-site storage of high level nuclear waste: attitudes and perceptions of local residents.

No public policy issue has been as difficult as high-level nuclear waste. Debates continue regarding Yucca Mountain as a disposal site, and-more generally-the appropriateness of geologic disposal and the need to act quickly. Previous research has focused on possible social, political, and economic consequences of a facility in Nevada. Impacts have been predicted to be potentially large and to emanate mainly from stigmatization of the region due to increased perceptions of risk. Analogous impacts from leaving waste at power plants have been either ignored or assumed to be negligible. This paper presents survey results on attitudes of residents in three counties where nuclear waste is currently stored. Topics include perceived risk, knowledge of nuclear waste and radiation, and impacts on jobs, tourism, and housing values from leaving waste on site. Results are similar to what has been reported for Nevada; the public is concerned about possible adverse effects from on-site storage of waste.

Adult↗

PubMed1992

A "good enough" separation: some characteristic operations and tasks.

Perhaps there are advantages, at this stage of our knowledge, to be looking for the adaptive mechanisms of divorcing families where children are involved, rather than focusing primarily on concepts of risk, dysfunction, and disaster. Perhaps what is truly remarkable is that divorcing families are not more disturbed, given the stigmatization, the uncharted nature of this complex upheaval with little normative frame, and diminished financial resources. As a modest offering in this regard, a 3-year longitudinal study is presented of a nonclinical postseparation family with an adolescent who neither entered nor required treatment. Specifically, their successful resolutions invented for dealing with day-to-day divorce dilemmas and challenges are explored.

Adolescent↗

PubMed2001

Application of Leventhal's self-regulation model to Chinese immigrants with type 2 diabetes.

PURPOSE AND BACKGROUND: To demonstrate the application of Leventhal's Self-Regulation Model with a group of Chinese immigrants with type 2 diabetes. DESIGN AND METHODS: Using qualitative methods and a convenience sample of 30 Chinese immigrants, interviews were analyzed by categorizing data according to the components of the Leventhal model. Participants were recruited from a U.S. West Coast Chinatown health center and were interviewed to identify beliefs about health and illness that are shaped by cultural factors. FINDINGS: Application of the self-regulation model indicated that participants were unclear about the etiology and chronicity of diabetes and interpreted the illness as stigmatizing. Coping strategies included wishful thinking, belief in powerful others, keeping diabetes a secret, and avoiding social situations. Participants lacked the ability to appraise the effects of their coping strategies. CONCLUSIONS: Health care providers can help people with type 2 diabetes develop critical-thinking strategies instead of relying on sets of rules to gain control of blood glucose levels. The self-regulation model was useful in profiling a vulnerable group whose diabetes management, social environment, and self-image could be improved through thoughtful patient education strategies.

Adaptation, Psychological↗

PubMed2000

Leprosy in the emergency department.

OBJECTIVES: Los Angeles County-University of Southern California Medical Center, like many large urban hospitals, has a large immigrant population from regions of the world where leprosy is endemic. Emergency physicians (EPs) in these settings can expect to encounter leprosy patients. This study reviewed the emergency department (ED) course of patients with confirmed leprosy in an attempt to describe the most common presenting patterns so that future cases can be more easily recognized. METHODS: This was a retrospective chart review of all patients followed in the Hansen's disease clinic. Demographics, leprosy type, clinical presentations to the ED, and medications were recorded. RESULTS: Of the total number of patients (415), most were of Mexican (52%), Filipino (15%), Vietnamese (14%), and Chinese (5%) origin. Leprosy was classified as lepromatous (56%), borderline (40%), and tuberculoid (4%). There were a total of 118 ED visits by 74 patients. The mean age was 46 years, with 51% male and 49% female. Dermatologic (68%), neurologic (23%), and ophthalmologic (9%) complaints were the most common reasons for ED presentation related to leprosy. The EP did not elicit a history of leprosy in 34% of those patients followed in the leprosy clinic. The ED diagnosis of leprosy was made in 3 of 15 (20%) undiagnosed cases. Of the 63 patients prescribed medications in the leprosy clinic at the time of their ED visits, 22 (35%) ED charts did not report leprosy drugs. CONCLUSION: Patients with leprosy present to U.S. EDs, and new cases can be identified. Early recognition is important given leprosy's devastating consequences, major drug side effects of medications used for treatment, and improved prognosis with multidrug therapy. A history of leprosy and associated medications are often not documented in the ED chart, which may reflect a continued fear of stigmatization among these patients.

Emergency Service, Hospital↗

PubMed1979

Female alcoholics. V. Morbidity.

Data from the public health insurance societies regarding 66 female alcoholics, hospitalized for the first time for alcoholism at the Department of Alcohol Diseases, Karolinska Hospital, Stockholm, were studied, and the developmental pattern of morbidity was compared with that of 68 male alcoholics fulfilling the same criteria. The observation period was 15 years. The progress of the alcoholism was not reflected in data from the social insurance societies up to the time of the first clinical treatment. However, the morbidity increased in both sexes after the treatment period, with higher disability, severity, and frequency rates, a large number of persons with disability pensions and increasing social stigmatization. The proportion of women granted disability pensions increased to significantly higher values than that of men, and that of women in the general population. The women had significantly fewer registrations in social registers than the men during the whole period. Women and older patients had higher disability rates, more sick-days due to "mental diseases" and a higher severity rate before admission. All differences were equalized in the last part of the study.

Absenteeism↗

PubMed1987

Partner relations and the development of alcoholism in female psychiatric patients.

Sixty four consecutive female alcoholic psychiatric patients were interviewed about the causes to which they attributed the start of the abuse and the interaction between lifetime drinking career and partnerships. Thirty-three (51%) attributed the start to problems with partners (P-group): 21 drank to keep their partners, 12 drank when they were abandoned. Among the others (non P-group) four subgroups were identified: the social stigmatized group (n = 4), the parent abandoned group (n = 6), the teenage acting out group (n = 13), and the psychotic group (n = 7). Those who attributed the causes to a certain partnership (n = 33) were significantly older when the abuse started, more often divorced/separated, had more often had more than one alcoholic partner, less often a schizophrenic psychosis and more often a pure borderline personality disorder.

Acting Out↗

PubMed1989

Personality characteristics and epilepsy.

Patients with a long history of temporal lobe epilepsy or primary generalized epilepsy entered a questionnaire study of personality characteristics, based on a modification of the Bear-Fedio inventory for temporal lobe behavioural syndrome. Psoriasis patients and healthy volunteers served as controls. Four clinical meaningful dimensions of included personality traits were identified: ixoide, ideational, obsessive-compulsive and affective features. Analyses based on the Rasch model approved of all dimensions except for affective features. The epilepsy group obtained the highest scores on all 3 dimensions, healthy volunteers the lowest, while the psoriasis group repeatedly held an intermediate position in all sets of assessment (subjects, interviewers and relatives). A logistic regression analysis showed ixoide features being most important when the entire epilepsy group was compared with other study groups, while the dimension ideational features was significant when the temporal lobe epilepsy group was entered as target group and opposed to primary generalized epilepsy. The intermediate position of the psoriasis group, however, suggests that in addition to the presence of a cerebral dysfunction in the epilepsy group, the mere presence of a chronic disorder with potential social stigmatization influences personality.

Adult↗

PubMed2006

Public beliefs about and attitudes towards people with mental illness: a review of population studies.

OBJECTIVE: To provide a review of population-based attitude research in psychiatry during the past 15 years. METHOD: An electronic search using PubMed, Medline, and Academic Search Premier plus a hand search of the literature was carried out for studies on public beliefs about mental illness and attitudes towards the mentally ill published between 1990 and 2004. RESULTS: Thirty-three national studies and 29 local and regional studies were identified, mostly from Europe. Although the majority are of descriptive nature, more recent publications include studies testing theory-based models of the stigmatization of mentally ill people, analyses of time trends and cross-cultural comparisons, and evaluations of antistigma interventions. CONCLUSION: Attitude research in psychiatry made considerable progress over the past 15 years. However, there is still much to be done to provide an empirical basis for evidence-based interventions to reduce misconceptions about mental illness and improve attitudes towards persons with mental illness.

Attitude to Health↗

PubMed2004

Ethical issues in research on control of the HIV/AIDS epidemic: report from a workshop of the world federation of scientists, Erice, Sicily, Italy, 22-24 August 2003.

In research on control of the HIV/AIDS epidemic there are many ethical issues to be considered. The problem of personal autonomy versus the interest of society to prevent the spread of the disease in various settings makes it difficult to follow the regulations of the Declaration of Helsinki in all respects. This is particularly clear in the evaluation of trials aimed at preventing mother-to-child transmission of HIV. The interest of the child does not always conform to the policy of avoiding stigmatization of the mother. Programmes for the implementation of antiretroviral therapy and vaccine trials may differ in countries with different mean incomes of the inhabitants, and are also influenced by local patterns. For this reason, the Declaration of Helsinki should be changed in such a way that it conforms with the ways in which it may be possible to combat such a disastrous epidemic as that caused by HIV.

Developing Countries↗

PubMed2005

Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view.

Public health policy differs from programme insofar as the former is the expression of goals at a higher decision-making level (international, regional, national or provincial) and the latter involves the execution of intervention measures at the community or individual level. It has recently become fashionable to speak of "evidence-based" policy. There is now ample evidence to suggest that early nutritional influences on chronic disease risk in later life are contributing to the acceleration of the overall worldwide epidemic of obesity and non-transmissible diseases. In developing countries, in which 80% of the world's population resides, the opportunities for preventive policy must be balanced against needs, cost and effectiveness considerations and the intrinsic limitations of policy execution. Not everyone in the population is at risk of suffering from any given negative condition of interest, nor will everyone at risk benefit from any given intervention. Hence, decisions must be made between universal or targeted policies, seeking maximal cost-efficiency, but without sowing the seeds of either discrimination or stigmatization with a non-universal application of benefits. Moreover, although large segments of the covered population may benefit from a public health measure, it may produce adverse and harmful effects on another segment. It is ethically incumbent on policy makers to minimize unintended consequences of public health measures. With respect to the particular case of mothers, fetuses and infants and long-term health, only a limited number of processes are amenable to intervention measures that could be codified in policy and executed as programmes.

Cardiovascular Diseases↗

PubMed2005

The burden of premature ejaculation: the patient's perspective.

Premature ejaculation (PE) remains an underdetected and under-treated condition, despite the advances in available treatment options. Men with PE often feel stigmatized by the condition and embarrassment is a key barrier to discussing the problem with healthcare professionals. Men with PE perceive themselves as having little control over ejaculation and this lack of control is mirrored in diminished satisfaction with sexual intercourse. The burden of PE is both emotional and physical. Premature ejaculation is associated with low self-esteem, anxiety, and feelings of shame and inferiority. In some studies there is an association with depression. Premature ejaculation places a significant burden on the patient-partner relationship and there is evidence to suggest that there is a higher prevalence of female sexual dysfunction associated with PE. Patients with PE often view the condition as purely psychological or as a problem that will resolve with time and many are unaware that medical treatment could be of benefit. This endorses the particularly important role of healthcare professionals in recognizing the barriers to patient diagnosis and promoting the view that PE is not only a common but also a treatable medical condition.

Coitus↗

PubMedDate not supplied

Legal issues in nonrelated infant adoption: nursing implications.

PURPOSE: To highlight the legal issues surrounding nonrelated infant adoptions. POPULATION: Parties in the adoption triad--the infant, the biological parent(s), and the adoptive parent(s). CONCLUSIONS: Current adoption laws have been influenced by a historical stigmatization of adoption by society, states' sovereignty rights, and individual's constitutional rights. Controversies surrounding nonrelated infant adoptions have highlighted the inadequacies of the present system of adoption laws and regulations. Nurses can take a proactive role in their practice by acquiring a clear understanding of the legal issues surrounding adoption. PRACTICE IMPLICATIONS: Knowledge about state adoption laws, regulations, and resources, as well as the legal issues surrounding infant adoption, will allow the nurse to take a proactive role in formulating and providing supportive interventions that assist all parties through the process.

Adoption↗

PubMedDate not supplied

Connection and disconnection in abusive relationships.

TOPIC: The way in which women's need for connection can lead to destructive relationships in which emotional and physical paralysis is characteristic. PURPOSE: To demonstrate how a woman's sense of disconnection that occurs in abusive relationships may be misinterpreted or worse, labeled and stigmatized, by healthcare providers. SOURCE: Theories of growth and development that emphasize how a woman's sense of self and value derive from being able to maintain highly empathic affiliations. CONCLUSION: The behavioral manifestation of disconnection must be understood so that healthcare providers can provide the most effective care possible.

Adaptation, Psychological↗

PubMedDate not supplied

Stigma in psychiatric nursing.

TOPIC: Stigmatizing attitudes in psychiatric nursing. PURPOSE: To develop a greater awareness of the existence of stigma associated with psychiatric nursing. SOURCES: Published literature. CONCLUSIONS: Professional self-understanding and knowledge are methods by which psychiatric nursing can elevate its professional image and value.

Humans↗

PubMed2002

Exploring the association between body weight, stigma of obesity, and health care avoidance.

PURPOSE: To explore the stigma of obesity and its effect on health care utilization, associations between self-esteem, attribution for weight, body mass index (BMI), satisfaction with medical care and the behavior of delaying/avoiding health care were examined. DATA SOURCES: A convenience sample of 216 women recruited from church sites in Las Vegas completed self-administered questionnaires. CONCLUSIONS: The findings show an increase in BMI is associated with an increase in the delay/avoidance of health care. Weight-related reasons for delaying/avoiding health care included having "gained weight since last health care visit," not wanting to "get weighted on the provider's scale," and knowing they would be told to "lose weight." IMPLICATIONS FOR PRACTICE: The obese are a stigmatized and vulnerable population. Nurse practitioners are challenged to be aware of attitudes towards obesity and to identify ways to promote continuity of care and regular health maintenance. The goals of Healthy People 2010 to reduce obesity-related morbidity cannot be met if health care is delayed/avoided.

Adult↗