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PubMed2000

Who talks? The social psychology of illness support groups.

More Americans try to change their health behaviors through self-help than through all other forms of professionally designed programs. Mutual support groups, involving little or no cost to participants, have a powerful effect on mental and physical health, yet little is known about patterns of support group participation in health care. What kinds of illness experiences prompt patients to seek each other's company? In an effort to observe social comparison processes with real-world relevance, support group participation was measured for 20 disease categories in 4 metropolitan areas (New York, Chicago, Los Angeles, and Dallas) and on 2 on-line forums. Support seeking was highest for diseases viewed as stigmatizing (e.g., AIDS, alcoholism, breast and prostate cancer) and was lowest for less embarrassing but equally devastating disorders, such as heart disease. The authors discuss implications for social comparison theory and its applications in health care.

Chicago↗
PubMedDate not supplied

[A case report of pyridoxine-responsive homocystinuria].

INTRODUCTION: Homocystinuria is a rare, congenital, autosomal-recessive, metabolic disease biochemically characterized by homocysteinemia and homocystinuria and by multi-system clinical disorders. It is a biochemical abnormality of methionine metabolism caused either by transulfuration pathway disorders or by disorders of homocysteine remethilation into methionine and as such it can be a result of numerous specific and different genetic lesions. CASE REPORT: Homocystinuria is most commonly caused by deficiency of cystationine beta synthetase enzyme which catalyses the synthesis of cystathionine from homocysteine and serine in the methinione pathway. This results in accumulation of homocysteine and methionine in plasma and leads to excretion of excessive urinary homocysteine. Depending on specific property of the mutant enzyme molecule some patients respond to very high doses of pyridoxine with decreases of methionine and homocystine and some not. Pyridoxine responsiveness is based on the presence of small residual activity of cystathionine beta synthetase which is not present in nonresponsive patients. Homocystinuria due to cystathionine beta-synthase (CBS) deficiency is characterized by numerous different clinical abnormalities, but changes in four organ systems are dominant (eye, skeletal, central nervous and vascular system). CASE DESCRIPTION: Six years ago a six year-old boy was admitted to the hospital with vision problems. Ophthalmologic examination revealed a lens dislocation and because of many stigmates the child was sent to endocrinologist. The child had a marfanoid stature, with pectus carinatum and genu valgum, ataxic gait with motoric discoordination, muscle tone which ranged from hypotonia to hypertonia of extrapvramidal type and low intellectual abilities. A simple cyanide-nitroprusside test of patient's urine was positive suggesting homocystinuria. The diagnosis was established after plasma and urine amino acid analysis by HPLC. Concentration of homocystine and methionine were 52 mumol/l and 57 mumol/l in plasma and 249 mumol/du and 55 mumol/du in urine, respectively. After four months of treatment with pyridoxine there were not any significant changes in plasma homocysteine and methionine, but at the same time decrease in urine of these two amino acids were more than 2.5 times higher. This confirms that the patient has a pyridoxine-responsive type of homocystinuria and the dose was increased to 60 mg/day and 600 mg/day. This results in further decline of homocysteine and methionine in plasma and urine which persists up to now (for six years).

Child↗
PubMedDate not supplied

A name, what's in a name? The medicalization of hyperactivity, revisited.

Although attention-deficit hyperactivity disorder has in recent years become one of the most common psychiatric problems diagnosed in children, its status as a medical disorder remains controversial, especially in Britain. This study examines the experience of parents and doctors dealing with hyperactive children, focusing in particular on the process of medicalization. It alms at understanding what is at stake for families and doctors and asks about the role of a medical label in the therapeutic process. It uses an anthropologically informed methodology, in which qualitative semistructured interviews of 1-2 hours duration were held with 29 parents of hyperactive children and 10 general practitioners. Interviews were audiotaped; the content was transcribed and analyzed according to grounded hermeneutic theory. It was found that raising a hyperactive child can provoke a profound sense of alienation in parents. Family and social roles are affected, as are parents' views of themselves in their parental and social roles. Parents tended to experience medicalization and labeling as important aspects of validation and legitimation of their experience, which gave them a sense of control and led to improved parent-child relationships. Doctors felt more reluctant about such medicalization, fearing that it could lead to scape-goating the child and to self-fulfilling prophecies. It may be concluded that the medical framework, especially the medical diagnosis, can provide a powerful tool that has both advantages and disadvantages in the therapeutic process. In trying to avoid stigmatization, doctors can delegitimate parents' experience, thus increasing their suffering.

Adult↗
PubMed2000

Deinstitutionalization, social rejection, and the self-esteem of former mental patients.

Modified labeling theorists have long argued that the stigma of mental illness has important consequences for the lives of people with mental illness. We propose that social rejection is an enduring force in the lives of people with mental illness and that these experiences are central to understanding the poor self-concepts described by many former psychiatric patients. We explore changes in a cohort of recently deinstitutionalized mental patients' (N = 88) self-esteem and experiences with social rejection using data from a three wave panel survey conducted while institutionalized and over a two-year period following the patients' discharge from a long-term state hospital. Our results indicate that social rejection is a persistent source of social stress for the discharged patients. Moreover, these experiences increase feelings of self-deprecation that, in turn, weaken their sense of mastery. Where the patients' received their follow-up care--whether in a community setting or in another state hospital--had little impact on their self-related feelings or on their experiences of social rejection. Our results provide further support for modified labeling theory and underscore the need to consider the dynamic relationship between stigmatizing experiences and self-related changes.

Female↗
PubMed2000

Abortion in the United States: barriers to access.

The legalization of abortion in the United States has brought a dramatic improvement in women's health and reductions in maternal and infant mortality. For young women, low-income women, and women of color, however, access to abortion has been increasingly restricted. This article describes the obstacles to abortion access, including lack of federal funding; restrictive laws, encompassing those requiring parental consent or notification for a minor seeking an abortion, as well as those attempting to ban a certain procedure; stigmatization and marginalization of abortion; decreasing abortion services; and a shortage of providers. The article connects the erosions in rights relating to abortion to policies undermining poor women's rights in relation to having children.

Abortion, Legal↗
PubMed2000

The myth of peer pressure.

The construct of peer pressure was examined as part of a qualitative study of the determinants of mental health for 41 high-risk adolescents. While the concept of peer pressure enables adults to explain youths' troubling behaviors, content analysis of the participants' accounts of their lives revealed peer pressure to be a myth. The youths indicated that adoption of the behavior and appearance of peers was a consciously employed strategy to enhance personal and social power. Association with peers was used to construct and maintain health-promoting identities that challenged the stigmatizing labels given to them by others. Three developmental stages to this process of identity construction were identified. During stage one, vulnerable youths learn to maintain a singular self-definition through interaction with peers. In stage two, youths purposefully use their peer relations to experiment with multiple identities. During stage three, youths collaborate with peers as equal partners in the construction of one or more identities for which they find acceptance.

Acting Out↗
PubMed2000

Siblings of schizophrenic patients--a review.

The families of patients with schizophrenia carry an enormous emotional and social burden. This article is a historical review of the study of the well siblings of schizophrenic individuals. The early investigations (1950s-1970s) were based on the theory of familial transmission of schizophrenia and focused on siblings from the aspect of their susceptibility to the disease. Many claimed that even siblings who did not develop full blown schizophrenia still suffered from considerable psychiatric disorders that were attributable to pathological familial psychodynamics. Case control studies were used to explain how some well siblings "escaped" the pathological family network. With the introduction of the concept of family burden in the late 1960s, research shifted to the emotional impact of growing up with a schizophrenic brother or sister. This was accompanied by the emergence of self-help groups and published case histories of siblings themselves. In the early 1980s, the data were essentially descriptive. Investigators studied sibling shame, poor self-esteem and feelings of stigmatization. Different patterns of coping with the subjective burden were distinguished. More recently, greater efforts have been made to systematically define the variables associated with the burden experienced by siblings. To answer the many still outstanding questions, further studies are needed based on a longitudinal design and homogeneous samples. For example: Are sibling's personal relationships outside the family affected? Does the sibling place within the family affect his or her reaction to the sick brother or sister? Does guilt play a role? What type of intervention is needed? With the increasing role of the community in the management of the mentally ill, such research has become very important.

Adaptation, Psychological↗
PubMed2000

Absence of conspecific pollen advantage in the dynamics of an Ipomopsis (Polemoniaceae) hybrid zone.

The frequency of hybrid formation in angiosperms depends on how often heterospecific pollen is transferred to the stigma and on the success of that heterospecific pollen at fertilizing ovules. Even if heterospecific pollen is capable of effecting fertilization it may perform poorly when conspecific pollen is also available on the stigma. We applied pollen mixtures to stigmas to determine how pollen interactions affect siring success and the frequency of hybrid formation between two species of Ipomopsis (Polemoniaceae) in Colorado. Plants of both parental species and natural hybrids were pollinated with I. aggregata and I. tenuituba pollen in ratios of 100:0, 80:20, 50:50, 20:80, and 0:100 by mass. Plants were homozygous for different alleles at an isozyme marker, allowing us to distinguish the type of pollen parent for 2166 viable seeds from 273 fruits. In contrast to studies of many other hybridizing taxa, there was no evidence of an advantage to conspecific pollen, nor did composition of the stigmatic pollen load affect seed set. Instead, the frequency of seeds sired by a given species was proportional to its representation in the pollen load. In this hybrid zone, both the frequency of first-generation hybrid formation and the relative male fitness of the two parental species should be predictable from the rates of pollen transfer to stigmas.

Journal Article↗
PubMed2000

Vitiligo management update.

Vitiligo is an acquired skin disorder caused by the disappearance of pigment cells from the epidermis, and results in well defined white patches that are often symmetrically distributed. The lack of melanin pigment makes the lesional skin more sensitive to sunburn. Vitiligo can be cosmetically disfiguring and is a stigmatizing condition, leading to serious psychological problems in daily life. It occurs worldwide in about 1% of the population, mostly between the ages of 10-30 years, and as often in males as in females. The cause is unknown, but might involve genetic factors, autoimmunity, toxic metabolites, and/or a higher vulnerability of melanocytes. Some new treatments for this condition include corticosteroid + UVA treatment, UVB narrow wave band (311 nm) irradiation, and transplantation of autologous pigment cells. In widespread vitiligo, residual pigment can be removed by depigmentation agents. Sunscreens, camouflage products and good guidance may help the patient to better cope with this disease.

Adolescent↗
PubMed2000

[The perception of postoperative pain as a stigma on the patient who underwent cholecystectomy as well as on the attending nurses].

Through a descriptive research, we wished to investigate the perception by the patients who underwent a cholecysectomy and by the caregivers, of the post-operative pain in its sociological dimension. The question of the research is as follows: How far is the post-operative pain perceived as stigmata by the patients who underwent a cholecysectomy and by the nurses? The reference framework is built up on the basis of a theoretical approach of cholecystectomy and of the notions of pain and stigmata. We carried out interviews with ten patients and ten nurses. The sample size does not enable a scientific use of the enquiry results. Pain, such as it is perceived by the majority of the patients, as normal and acceptable, does not seem to bring them into disrepute. Stigmatization appears in the relation caregiver-patient. It contributes to disturbing the flow of interactions between the patients and the nurses. When the nurses do not meet the expectations of the patients, they are no longer considered as "initiate" but as "normal". The affectivity arising in the relationship caregiver-patient, seems to have an influence in the management of post-operative pain.

Aged↗
PubMed2000

[Schizophrenia and the quality of life].

This paper discusses opportunities and constraints for psychiatry to exert an influence on the quality of life of people suffering from schizophrenia. Using the example of neuroleptic drug treatment, the opportunities to both positively and adversely affect quality of life by means of psychiatric treatment are illustrated. De-institutionalisation was used as an example for demonstrating the effect of the quality of mental health services. The fact that efforts on the part of professional helpers to achieve improvements in their patients' quality of life are constrained by existing economic and socio-cultural conditions is shown by discussing the stigmatization of people with schizophrenia and their situation on the labour market.

Humans↗
PubMed2000

[A dissecting aortic aneurysm in a female patient with Turner syndrome].

Female phenotype, sexual infantilism, small stature and stigmatization are typical for patients with Turner's syndrome (TS). The most frequent cardiovascular manifestations in these patients are a bicuspidal aortal valve and coarctation of the aorta. In 5% patients dilatation of the aorta is found which can develop into a dissecting aneurysm. In the submitted case-history the authors describe a 34-year-old patient where the diagnosis of TS was proved only in adult age at the time when a dissecting aneurysm of the aorta was detected. The submitted case-history supports the recommendation of regular echocardiographic check-up examinations of patients with TS.

Adult↗
PubMedDate not supplied

[Overview of the geography of intestinal schistosomiasis in Brazil].

The distribution of schistosomiasis in Brazil is highly contrasted, with most cases concentrated in a large area in the North East, where the disease is endemic and considered a major threat to public health, and small isolated foci of disease scattered throughout the country seen as being of little epidemiological importance. The common interpretation of the history of this endemic disease (that it began in the endemic zone and has spread to the isolated foci) has added to the stigmatization of the North East. However, this interpretation is challenged by many examples of the recent establishment of the disease in the North-East and its more long-standing nature in the isolated foci. Besides, overstressing the role of recent migration simply obscures both social issues and the biogeography of vectors. Areas are not homogeneous in terms of schistosomiasis and we must therefore consider these factors if we are to understand the spread of the disease and its current distribution. Thus, in Amazonia, low human population pressure and the rarity of snails (mainly due to the acidity of the water) together account for the low level of transmission despite the high proportion of infected individuals among immigrants to this area. The converse is true for the city of Belém. Very similar reasons can be given for the limited impact of schistosomiasis in the central plateau and its high frequency around the federal capital, Brasilia. In contrast, the rate of infection is not very high around São Paolo due to the specific characteristics of urbanization of this city and its highly efficient control program. However, the enormous size of this city results in the number of cases reported being similar to that for Belém or Brasilia. These three cities are linked by a highway, which serves as a major axis for migration, particularly for those heading north from southern Brazil or São Paolo. This migration axis has increased in importance because there are now far fewer opportunities to settle in the West (Amazonia and the central plateau). The older "endemic territory" of the North East is experiencing a process of concentration of its cases of schistosomiasis in its larger cities, Recife and Salvador in particular. Thus, this endemic disease is becoming more urban and a network of five major cities, widely dispersed geographically, with high levels of infection, is emerging.

Brazil↗
PubMed2000

Critical issues in the management of depression. Based on a presentation by David Goodman, MD.

Primary care providers (PCPs) see patients with depression on a daily basis, but they frequently overlook signs and symptoms of this illness because they are looking for physical signs of illness. Even when they identify the symptoms of depressive illness in a patient, they are constrained by the fear of stigmatizing the patient. The general public is either unaware of the active symptoms of depression or they view them as a sign of weakness or a natural part of aging. Ineffective treatment of depression is expensive. Depressed patients use medical services 50% to 100% more frequently than those who are not depressed. By appropriately treating depression, PCPs can lower the unnecessary and ineffective utilization of medical services by depressed patients without increasing the cost of treating them.

Antidepressive Agents↗
PubMed2000

Antiretroviral interventions to reduce mother-to-child transmission of human immunodeficiency virus: challenges for health systems, communities and society.

This paper examines the ethical, economic and social issues that should be considered when antiretroviral interventions are being planned to reduce mother-to-child transmission of the human immunodeficiency virus. Interventions aiming to reduce mother-to-child transmission should be concerned with the rights of both the child and the mother. Women should not be seen as vectors of transmission but as people entitled to adequate health care and social services in their own right. For women accepting mother-to-child transmission interventions it is important to consider their medical and emotional needs and to ensure that they are not stigmatized or subjected to abuse or abandonment following voluntary counselling and testing. Seropositive women who do not wish to continue with pregnancy should have access to facilities for safe termination if this is legal in the country concerned. Problems arise in relation to the basic requirements for introducing such interventions via the health services in developing countries. A framework is given for making decisions about implementation of interventions in health care systems with limited resources where there is a relatively high prevalence of human immunodeficiency virus infection among pregnant women.

Anti-HIV Agents↗
PubMed2000

[HIV-positive refugee from Africa with low compliance. Interview about reasons for treatment failure].

Strict compliance is required for a sustained response to antiretroviral therapy for HIV. Several studies from the US have found that African-Americans are less compliant and are more liable to treatment failure than caucasians. We describe a young, male refugee from Africa with treatment failure after non-compliance. A qualitative interview shows that his main reason for non-compliance is fear of disclosure and stigmatization. There seems to be a need for research into the reasons for non-compliance among vulnerable groups and targeted interventions.

Adult↗
PubMed2000

Achievable standard of care in low-resource settings.

The gap between rich and resource-poor countries has continued to grow as reproductive care providers integrate interventions to limit mother-to-child transmission (MTCT) of HIV in a manner consistent with existing information. There are two major reasons for this difference: access to prophylactic antiretroviral therapy (ARV) for HIV-infected pregnant mothers and availability of alternative feeding for babies. In resource-poor settings, these options are beyond reach for the majority of the women. Infant and under-five mortality rates from other infections are high in these settings and breastfeeding remains the norm. Answering the question, What is an achievable standard of care in resource-poor settings? still remains a major challenge today. Dialogue has begun in most resource-poor settings to address the key elements in the package of interventions to reduce MTCT of HIV. These elements include the following: (1) overall prevention of HIV in mothers and fathers; (2) provision of good-quality voluntary testing and counseling (VCT) in antenatal clinics; (3) a comprehensive package of interventions during pregnancy, during labor, and after delivery, including screening for sexually transmitted diseases (STDs), family planning, and--where possible--ARVs; (4) provision of infant and maternal nutrition within the socioeconomic realities; (5) advocacy and program communication; and (6) other supportive measures, including community mobilization to address issues such as stigmatization of and violence against HIV-infected women. This paper discusses the challenges faced by most resource-poor settings in integrating some of these activities into reproductive care services.

Anti-HIV Agents↗
PubMed2001

American Academy of Pediatrics: Distinguishing sudden infant death syndrome from child abuse fatalities.

In most cases, when a healthy infant younger than 1 year dies suddenly and unexpectedly, the cause is sudden infant death syndrome (SIDS). SIDS is more common than infanticide. Parents of SIDS victims typically are anxious to provide unlimited information to professionals involved in death investigation or research. They also want and deserve to be approached in a nonaccusatory manner. This statement provides professionals with information and guidelines to avoid distressing or stigmatizing families of SIDS victims while allowing accumulation of appropriate evidence in potential cases of death by infanticide.

Autopsy↗