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PubMedDate not supplied

Children's feeding programs in Atlantic Canada: reducing or reproducing inequities?

This study analyzed, through case studies of day-to-day observations and interviews with recipients and operators, the operations of nine children's feeding programs in Nova Scotia, New Brunswick, and Newfoundland. We found that children's feeding programs result in the stigmatization of participants and families, despite an ideology of equality. Most programs adopt a family substitution role in the lives of children they serve and function in a way that excludes parental participation. Programs also transmit a hidden curriculum to children that teaches them how to behave and how a 'proper' family functions. We found that the professionalization of food and nutrition, a desire for an expanded client base, and dependency creation through the provision of other material goods, permit programs to exert increasing institutional control over recipients, a process we, following Illich, call the dragnet. While these programs may be meeting some nutritional needs in a few poverty-stricken children, they ultimately reproduce, rather than reduce, inequities.

Attitude to Health↗
PubMed1999

Genetic testing for cystic fibrosis. National Institutes of Health Consensus Development Conference Statement on genetic testing for cystic fibrosis.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of the optimal practices for genetic testing for cystic fibrosis (CF). PARTICIPANTS: A nonfederal, nonadvocate, 14-member panel representing the fields of genetics, obstetrics, internal medicine, nursing, social work, epidemiology, pediatrics, psychiatry, genetic counseling, bioethics, health economics, health services research, law, and the public. In addition, 21 experts from these same fields presented data to the panel and a conference audience of 500. EVIDENCE: The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Genetic testing for CF should be offered to adults with a positive family history of CF, to partners of people with CF, to couples currently planning a pregnancy, and to couples seeking prenatal care. The panel does not recommend offering CF genetic testing to the general population or newborns. The panel advocates active research to develop improved treatments for people with CF and continued investigation into the understanding of the pathophysiology of the disease. Comprehensive educational programs targeted to health care professionals and the public should be developed using input from people living with CF and their families and from people from diverse racial and ethnic groups. Additionally, genetic counseling services must be accurate and provide balanced information to afford individuals the opportunity to make autonomous decisions. Every attempt should be made to protect individual rights, genetic and medical privacy rights, and to prevent discrimination and stigmatization. It is essential that the offering of CF carrier testing be phased in over a period to ensure that adequate education and appropriate genetic testing and counseling services are available to all persons being tested.

Consensus↗
PubMedDate not supplied

Education of advanced practice nurses. Serving vulnerable populations.

Vulnerable populations are camouflaged, stigmatized, and often lacking in health care services. They may also be distrustful of assistance from traditional health care providers. To better serve vulnerable populations, professionals guiding intervention programs need specialized knowledge and skills as well as problem-solving abilities.

Community Health Nursing↗
PubMed1999

The right to the highest attainable standard of health: public health's opportunity to reframe a human rights debate in the United States.

A right to health is not recognized in the United States Constitution. This article examines the right to health and to health care in the U.S. in terms of expert definitions of health, international human rights instruments, U.S. individualism, the U.S. Constitution, and the impact of stigmatization on health status as a violation of dignity. It argues that establishing a right to health care is a necessary but insufficient condition to protect health. A historically rooted ethos of individualism, in combination with a dominant biomedical paradigm of disease causation, underlies the resistance of the private and public sectors to the concept of health as a human right. Emerging public health knowledge about social causes of disease provides a valuable locus of intervention from which a coalition of public health and human rights advocates can advance the debate and build political will for government action.

Civil Rights↗
PubMed1999

Quantitative evaluation of stigma polymorphism in a tristylous weed, Lythrum salicaria (Lythraceae).

Tristyly involves three different forms of flowers that differ reciprocally in the heights of stigmas and anthers within flowers. Apart from the style and stamen lengths, heterostylous species also demonstrate pollen and stigma polymorphisms. We quantified stigma polymorphism in tristylous Lythrum salicaria by measuring the stigma diameters, structure of papillae, and density and distribution of papillae on the stigma from flower samples of 201 individuals belonging to three morphs. The diameter of the stigma and the distribution of papillae were quantified using a scanning electron microscope, and the structure of papillae was determined using a light microscope. The stigma diameter in the long morph was significantly greater than in the mid and short morphs. While the density of stigmatic papillae was significantly greater in the mid and short morphs than in the long morph, the total number of papillae per stigma did not differ across morphs. The length and diameter of papillae at the apex, neck, and base were significantly greater in the long morph followed by the mid and short morphs. A discriminant function analysis separated the long morph from the mid and short morphs based on the canonical scores of measurements of papillae structure. The stigma polymorphism coupled with those of pollen may play a functional role in self-incompatibility mechanisms.

Journal Article↗
PubMed1999

Emotional reactions to the mentally ill are positively influenced by personal acquaintance.

UNLABELLED: The study sought to evaluate whether personal acquaintance with a psychiatric patient increases or decreases stigmatization. MATERIAL AND METHOD: The research was carried out in a Turkish university. The Social Distance Scale and the Affective Reaction Scale were completed by final year students. The subjects were then asked whether they have ever been acquainted with a patient with a mental disorder. RESULTS: Subjects who had not been acquainted with a patient with mental disorder had a higher score on the Affective Reaction Scale than subjects who had been acquainted. CONCLUSION: This finding suggests that acquaintance with a psychiatric patient reduces negative emotions towards people with mental disorders. It is suggested that this result is related to the resolution of sensitization.

Adolescent↗
PubMed1999

Advantages of the psychiatric liaison-attachment scheme in a family medicine clinic.

BACKGROUND: The study presents the advantages of the psychiatric liaison-attachment scheme, by analyzing the psychiatric consultations of a 12 months period (1995), in an urban family medicine clinic in Israel. METHOD: Family physicians filled a questionnaire about all patients who had been seen at the consultation. RESULTS: The consulting psychiatrist saw 46 patients. The reasons for consultation were mostly to confirm a diagnosis and to decide upon medications. Medical diagnoses most often made were depression and personality disorder. The psychiatrist referred 35% of patients for further therapy in the psychiatric clinic. The family physicians would have referred 45% of patients to psychiatric clinics, if they had no psychiatric consultation available. All patients referred complied with the recommended referral. Family physicians saw accessibility as the main advantage of this consultation strategy. LIMITATIONS: This study was done in a unique setting, a teaching family medicine clinic, with nine specialized family physicians working in the psychiatric liaison-attachment scheme for as long as 10 years and more. Therefore the results of this study may not be generalized to other clinics. CONCLUSIONS: We conclude that the advantages of the psychiatric liaison-consultation method were for the patients, the family physicians and the psychiatric consultant. The main advantages for the family physicians, as stated by them, were the accessibility, the non-stigmatic availability of a psychiatrist in the clinic, and the good compliance with referral to psychiatric therapy. For the consulting psychiatrist, the advantages were the valuable information from the family physicians and the social worker, the better follow-up of patients and the team work with the family practice team.

Adult↗
PubMed1998

Help-seeking pattern of psychiatric outpatients in urban China.

The subjects of this study (N = 1297, male = 600, females = 697) were first time adult patients (aged 20 to 59 years) who sought psychiatric treatments at a mental health centre in Shanghai over a period of 12 months. Compared with adult population in Shanghai, the patients were of higher educational levels and were over-represented by the unmarried, separated, or divorced. A higher proportion of the patients were in their early adulthood. The most common presenting problems were sleep disturbance, somatic symptoms, and paranoid ideation. About 25% of the patients took their own initiative to seek psychiatric treatments and more than half (55.2%) were referred by their spouse or relatives. Decision for psychiatric treatments was made after a long delay since the first onset of illness (average = 2.7 years). Consistent with findings reported in other Chinese communities, their paths to seeking psychiatric treatments were diverted primarily through Western-style or traditional Chinese physicians. Stigmatization associated with psychiatric illness and lack of trust in psychiatric services were major deterring factors in seeking psychiatric treatments.

Adult↗
PubMed1999

Genetic information and genetic discrimination how medical records vitiate legal protection. A comparative analysis of international legislation and policies.

This study compares currently enacted and pending legislation and policies concerning genetic information and genetic discrimination in Europe and the USA. The emergence of a multi-disciplinary scientific field comprising genetically-related areas and the discovery of new genetic factors have improved our ability to predict genetic risks associated with illness. Early detection and preventive healthcare thus hold promise for improving public health, but much remains unknown about the actual risks deriving from genetic testing. Positive (not-normal) test results may give little certainty of the actual severity of a disease. Genetic information could thus be used for social stigmatization and genetic discrimination. Western laws have been enacted in a context of unknown potential risks and benefits, and an increased number of regulatory initiatives is to be expected. Yet, there is currently no comprehensive US or European legal approach concerning genetic information and genetic discrimination and, despite legislation thus far enacted, the protection of individuals remains uncertain, and this could have a negative impact on attitudes to genetic testing, with important consequences for public health strategies to prevent disease.

Confidentiality↗
PubMed1999

[Diagnosis and therapy of alcohol-withdrawal symptoms in the elderly: a case report].

The incidence and prevalence of alcoholism in the elderly population are tendentially underestimated. There are some reasons for this fact. The pathway to the diagnosis of alcoholism may be considerably compromised in the often comorbid or multimorbid patient. To live up to an advanced age seems to be a good argument against chronic substance abuse. Elderly people and their relatives are often still more reluctant to report about socially stigmatizing disorders. On top of that, the amount of social control is reduced after the end of employment and upon entering retirement. Yet, if alcohol-withdrawal symptoms occur, e.g., following an admission of the addicted patient to a hospital, the missed diagnosis of alcoholism means a delay of the correct interpretation of such complications and of the necessary treatment. Aged patients with reduced physical and mental reserve capacity are at special risk of developing further serious complications. Progressive, sometimes irreversible decay of the cognitive functions in long lasting delirious states or, as an aftermath of withdrawal, epileptic seizures are of particular importance.

Diagnostic Errors↗
PubMed1999

The mechanism of delayed selfing in Collinsia verna (Scrophulariaceae).

Collinsia verna, blue-eyed Mary, has floral attributes of an outcrossing species, yet most flowers readily self-pollinate under greenhouse conditions. Here we describe the mechanism of self-pollination in C. verna via changes in relative positions of the stigma and anthers and late timing of receptivity, resulting in delayed selfing. Each flower contains four anthers that dehisce sequentially over ∼1 wk. Pollen that is not collected by pollinators accumulates in the keel petal and retains high viability (>80% pollen germination) up to the time of corolla abscission. The stigmatic surface does not become receptive until after the third anther dehisces. This overlap in the sexual phases is concurrent with a change in herkogamy during floral development. In most flowers (70%), the stigma has moved to the front of the keel and is positioned near the anthers when the third anther dehisces. Under field conditions, fruiting success of plants within pollinator exclosures was ∼75% of the fruiting success in open-pollinated plants (33% fruiting success via autogamy vs. 44% fruiting success, respectively). Collinsia verna plants in pollinator exclosures exhibit variation in autogamy rates within natural populations (range 0-80%). In addition, only half of naturally pollinated, receptive flowers examined had pollen tubes growing in their styles. In contrast, shortly after corolla abscission, nearly all flowers examined (96%) had pollen tubes in their styles. Thus we find that in C. verna, autogamy occurs late in floral development, which has the potential to provide substantial reproductive assurance, and that individuals vary in their ability to set fruit through this mechanism. We suggest that delayed selfing mechanisms may be overlooked in other species and that variable pollinator availability may play a significant role in the maintenance of mixed mating in species with delayed selfing, such as C. verna.

Journal Article↗
PubMed1999

Survivors of suicide do grieve differently: empirical support for a common sense proposition.

Previous empirical investigations have produced mixed results on the question of whether mode of death differentially affects grief. To further investigate the influence of suicide on grief, 350 previously bereaved university students completed a questionnaire package consisting of several standardized measures. Participants were separated into four groups based on the mode of death experienced as either survivors of suicide (n = 34), accident (n = 57), unanticipated natural (n = 102), or anticipated natural (n = 157) deaths. Hierarchical multiple regression analyses indicated that suicide survivors, compared against the other groups, experienced more frequent feelings of rejection, responsibility, "unique" reactions, and more total grief reactions. Trends indicating increased levels of shame and perceived stigmatization were also evident. Aggregate factors of death "naturalness" and "expectedness" showed less influence than mode of death in influencing grief. Overall, results support previous clinical and research findings and intuitive logic in demonstrating that the grief experienced by suicide survivors includes elements that are less frequently seen in the case of nonsuicidal deaths.

Adolescent↗
PubMed1999

National probability samples in studies of low-prevalence diseases. Part II: Designing and implementing the HIV cost and services utilization study sample.

OBJECTIVE: The design and implementation of a nationally representative probability sample of persons with a low-prevalence disease, HIV/AIDS. DATA SOURCES/STUDY SETTING: One of the most significant roadblocks to the generalizability of primary data collected about persons with a low-prevalence disease is the lack of a complete methodology for efficiently generating and enrolling probability samples. The methodology developed by the HCSUS consortium uses a flexible, provider-based approach to multistage sampling that minimizes the quantity of data necessary for implementation. STUDY DESIGN: To produce a valid national probability sample, we combined a provider-based multistage design with the M.D.-colleague recruitment model often used in non-probability site-specific studies. DATA COLLECTION: Across the contiguous United States, reported AIDS cases for metropolitan areas and rural counties. In selected areas, caseloads for known providers for HIV patients and a random sample of other providers. For selected providers, anonymous patient visit records. PRINCIPAL FINDINGS: It was possible to obtain all data necessary to implement a multistage design for sampling individual HIV-infected persons under medical care with known probabilities. Taking account of both patient and provider nonresponse, we succeeded in obtaining in-person or proxy interviews from subjects representing over 70 percent of the eligible target population. CONCLUSIONS: It is possible to design and implement a national probability sample of persons with a low-prevalence disease, even if it is stigmatized.

Data Collection↗
PubMed1999

[Therapeutic strategies in the first psychotic episode].

A first psychotic episode includes a wide range of disorders with different outcomes: schizophrenia, bipolar disorder, schizophreniform disorder, schizoaffective disorder, drug-induced psychosis, brief reactive psychosis, organic psychoses and delusional disorder. The course and outcome of a first psychotic episode is greatly dependent on its initial management. Major clinical, etiopathogenic and therapeutic advances have been achieved in this field and have allowed specific management strategies to be adopted. The primary task of therapists involved in the management of patients who have experienced a first episode of psychosis is promotion of recovery and prevention of secondary morbidity, relapse and persistent disability. The main guidelines of an early psychosis management are:--to keep in mind that early psychosis is not early schizophrenia. Thus, clinicians and therapists should avoid an early diagnosis of schizophrenia. Diagnosis in early psychosis can be highly unstable. A diagnosis of schizophrenia, with its implications of pessimism, relapse and disability, does not contribute anything positive in terms of guiding treatment. On the contrary, such a diagnosis may damage the patient and family by stigmatizing them and affecting the way they are viewed and managed by healthcare professionals.--To integrate biological, psychological and social interventions: effective medications is useful in reducing the risk of relapse, but is not a guarantee against it. Psychological and social interventions can greatly help promote recovery.--To tailor the various strategies to met the needs of an individual: as an example, it is important to formulate appropriate strategies for the different stages of the illness (prodromal phase, acute phase, early recovery phase and late recovery phase) because patients have different therapeutic needs at each stage.--In the acute treatment, not to concentrate on short-term goals in indicating antipsychotic treatment: prescribing principles for first-episode psychosis are to maximise benefit and minimise side effects because the first experience of medication may influence a patient's future attitudes of therapy of all types. Effective strategies which may reduce long-term morbidity and improve recovery are currently available but their implementation is too often delayed. The time lag between the onset of symptoms and the start of treatment can be many months or years and this delay can have serious consequences. The critical period of the first 2-5 years after the first psychotic episode is a time of maximum vulnerability and of maximum opportunity. Consequently, actions should be undertaken to promote early recognition and assistance in psychotic disorders: understanding of the factors that may cause delay in treatment can help minimise this problem and lead to the initiation of appropriate treatment at the earliest opportunity. Training the general practitioners who have an important part to play in the early recognition is also of crucial importance.

Acute Disease↗
PubMedDate not supplied

Children with mental retardation: stigma and stereotype images are hard to change.

Societal attitudes and perceptions of children with mental retardation have stigmatized and stereotyped generations of youngsters. Deinstitutionalization and mainstreaming most of these children in our schools and general communities require that we recognize and reevaluate many long-held beliefs and how they serve as obstacles to implementing and ensuring needed health and social services. The background and current status of these attitudes are reviewed in an effort to 1) increase practitioner understanding of the population of youngsters with mental retardation that increasingly will be seeking the services of community dentists and 2) encourage legislative efforts and grass-root initiatives (such as the Special Olympics) to change/improve attitudes relative to children with mental retardation.

Attitude of Health Personnel↗
PubMed1998

Pollen-stigma interactions in Brassica.

The pollen grain coating of Brassica oleracea contains a polymorphic family of highly charged small proteins (PCP-A, pollen coat protein, class A) related to the defensin class of seed proteins. On pollination these proteins are released from the grain and in vitro data suggest that at least one member of the family (PCP-A1) interacts specifically with elements of the stigmatically-expressed S(self-incompatibility) receptor complex. A new in vivo bioassay has demonstrated the male determinant of the self incompatibility system to be contained within the pollen coating, and this determinant to be a low molecular mass protein. A combination of data from interspecific studies and molecular analysis of PCP-A proteins indicates that the primary interaction between PCP-A1 and the receptor complex may be involved in establishing compatibility, while other molecular interactions, perhaps involving other PCP-A class proteins, are responsible for regulating S-specific rejection of self grains. The evolution of the self incompatibility system on the dry sigma of Brassica is discussed in the context of these data.

Brassica↗
PubMedDate not supplied

Alcohol, drugs and stigma.

Alcohol and drug-related problems are common in clinical populations but are often stigmatized by the public and the professions. These attitudes may interfere with patients obtaining effective help. The reasons for these barriers are explored, including the views that these problems are self-inflicted--and therefore less worthy of help--and the stereotypes and resistances that abound in working with those who have become addicted. Training and public education may go some way to improve this situation.

Adolescent↗
PubMed1999

What high-risk women are telling us about access to primary and reproductive health care and HIV prevention services.

Focus group discussions on barriers to health care and attitudes toward family planning, reproductive health services, and condom use were conducted with 63 women at high risk for HIV due to their own injection drug use, sex with injection drug users, sex industry work, or a history of multiple sexually transmitted diseases. Barriers identified include the high cost of health care, perceived poor quality of care and experiences of discrimination and stigmatization, geographic accessibility, fear of legal/social services punitive actions, misperceptions about the efficacy of birth control methods and condom usage, lack of sterilization services, and lack of male involvement. Where possible, findings from the focus groups are supported with quantitative survey data from a sample of high-risk women (n = 723). Recommendations are made for improving care for high-risk women.

Adult↗