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PubMedDate not supplied

Urban U.S. hospitals and the mission to provide HIV-related services: changes and correlates.

In 1988, the vast majority of urban U.S. hospitals (84 percent) exhibited some formal response to the demand for HIV-related services. Despite the fact that HIV-related care is now normative in many respects and the demand for inpatient care has decreased, nearly half of hospitals surveyed in 1997 (42 percent) report no formalized service provision, suggesting a heightened distinction between hospitals in terms of their varying commitments to providing HIV-related services. Certain organizational variables (such as ownership, size, system affiliation, and stigmatized services and post-acute care services indices) were connected to HIV-related services provision. When the sample was controlled for other variables, the study found that changes in teaching status, changes in bed size, and changes in post-acute services from 1988 to 1997 did influence the provision of HIV-related services. Despite significant changes over the study period in the treatment of persons living with HIV/AIDS, and structural changes in the delivery of U.S. healthcare, the organizational-level predictors of HIV-related service provision have remained remarkably stable among U.S. hospitals in urban settings. These data also suggest that organizational missions consistent with serving indigent and socially marginalized populations continue to influence the ways that the pluralistic U.S. hospital system organizes HIV-related care.

American Hospital Association↗
PubMedDate not supplied

[Psychological factors in psoriasis: review of literature].

Psoriasis is an inflammatory and proliferative disease, which is seen in most classifications of psychocutaneous disorders as being mainly due to genetic and environmental factors. Over decades of observation, physicians and patients have learned that it's course is strongly influenced by psychological stress. Review of literature shows, however, that this relationship is multifactorial. Psoriasis itself may cause depression as a stigmatizing disease. Also there is evidence that depression and anxiety disorders can be the cause of psoriasis. Because of this fact, additional treatment with psychotherapy and/or medication may be advisable and worth further exploration.

Antidepressive Agents↗
PubMed2001

Social reactions to sexual assault victims from various support sources.

This study examined positive and negative social reactions received by 323 victims disclosing sexual assaults to informal and formal support providers. Analyses of both quantitative and qualitative data indicated that both positive and negative reactions are commonly received by victims disclosing their assaults to others, but that victims seeking help from formal support sources are more commonly faced with negative reactions of victim blame, stigmatizing responses, and controlling reactions from others. Qualitative analysis of written responses provided by respondents also revealed other less common but unhelpful reactions of assault disclosure such as rape myths, violations of the victim's confidential disclosures, and revictimization. Preliminary analyses of the effects of specific reactions on adjustment from different types of support providers suggested that reactions of friends are particularly important for recovery. Positive reactions from friends appear to be more helpful, whereas negative reactions appear to be harmful from both informal and formal support sources. Implications for research and treatment of sexual assault victims are discussed.

Adaptation, Psychological↗
PubMed2002

Public health and peace.

The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, or any other social organization. Durkheim coined the term anomie for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is important. The vital interplay between the informed public and efficient administration, however, can only exist in an open society. The link between democracy and health of the people, and between public health and economic welfare is real. The Public Health Collaboration in South Eastern Europe (PH-SEE) evolved just in time to reconnect and strengthen disrupted professional networks in the region as a prerequisite of effective public health action.

Croatia↗
PubMed2001

HIV/AIDS: impact on the African American community.

The human immunodeficiency virus (HIV) infection has had a devastating impact on the lives of African Americans. In the United States, it is estimated that almost half of all cases of HIV infection in men occur among black men and almost 70% of the cases in women occur among black women. Acquired immunodeficiency syndrome (AIDS), which results from HIV infection, has become a leading cause of death of African Americans between the ages of 25 and 44. Denial regarding how the disease is spread, particularly among heterosexuals, and stigmatization about the disease continue to be barriers to effective prevention campaigns within African American communities. Aggressive cultural and ethnic-specific educational campaigns, focusing on prevention, are needed to curb the current spread of HIV within this population.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Chronic alcoholics' knowledge regarding tuberculosis.

INTRODUCTION: CA are under high risk of developing active TB, very extended forms of TB (with possible lethal outcome) etc. AIM: To investigate CA's KN and social stigmatization (ST) regarding TB. METHOD: A questionnaire with 22 items (general KN, ST) completed by 115 CA treated for chronic alcoholism on the ward of psychiatry during the year 2000: 97% male, 74% aged 26-45 years, 62% urban, education level (low-35%, middle-59%, high-6%), 8% refugees, 79% smokers. RESULTS: 72% know that TB mainly affects the lungs, 75% that TB can be cured, 79% that there is a vaccine against TB, 57% that blood in the sputum is not the only symptom of TB, 22% that there is a connection between TB and AIDS, 33% that there are forms of TB which cannot be cured by standard anti-TB treatment (rural, lower educated/urban, middle educated CA: p = 0.03). 19% would not visit a close friend suffering from TB, 26% would prevent their child from marrying someone who suffered from TB, only 80% would not divorce their spouse if he/she suffered from TB (rural, lower educated/urban, middle educated CA: p = 0.005). Only 35% of the sample know that CAs are under higher risk of developing TB than the general population. CONCLUSIONS: 1. KN on TB is not sufficient among CAs. 2. ST of TB is high among CAs. 3. Health education of CAs during hospital treatment must include: information on the danger of tobacco, on the natural history of TB, on high risk of developing TB, on the importance of early self referral when suspected TB symptoms appear, on personal and community related responsibility of each human being regarding TB.

Adult↗
PubMed2001

Attitudes regarding tuberculosis among Samoans.

The research reported here examines knowledge, attitudes, and practices related to tuberculosis (TB) among Samoan immigrants through the use of a focus group. Samoan health workers to discuss participants' explanatory models regarding TB convened a focus group of eight Samoan living in Hawaii. The participants expressed a belief in the extreme contagiousness of TB. This leads to social stigma and isolation. Most agreed that biomedical treatment is necessary. Traditional herbal medicine was seen as adjunct to biomedical treatment. Focus group participants were found to subscribe to largely biomedical explanatory models regarding TB, but belief in traditional medicine also persists. TB was believed to be more transmissible than it actually is. TB continues to be a stigmatized disease.

Attitude to Health↗
PubMed2002

[Enigma of Lenin's illness].

A difficult problem that arises periodically involves the physical and psychological problems of political leaders. Unlike the ordinary person, where the presence of physical or psychiatric disability that interferes with functioning will be revealed and will result in suspension from work responsibilities (e.g. pilot, bus driver, physician), the situation is different with regard to political leaders. Concerning the latter, the information may remain concealed because it is conceived of as stigmatizing, e.g., mental illness, and sexual disorder. The result of hiding such information is that sick leaders may continue to hold their positions of vast power in spite of their disability. Examples of world leaders who suffered from sustained disability as a result of incapacitating neurological or psychiatric illnesses, physical problems or medication effects include Woodrow Wilson, Franklin Roosevelt, Dwight Eisenhower, Winston Churchill and Conrad Adenauer. In the present article we will discuss in detail Lenins severe illness--whose differential diagnosis and real facts were kept hidden from the public--and the consequences of this cover-up.

Attitude to Health↗
PubMedDate not supplied

Working with families having parents who are gay or lesbian.

Families in which one or both parents are gay or lesbian are becoming increasingly common as social acceptance of this lifestyle increases and legal barriers slowly erode. Despite past concerns and occasional reports to the contrary, the bulk of research has shown no evidence that children of parents who are gay or lesbian suffer any greater physical or mental pathology than children of heterosexual parents. However, research does suggest that there may be ways in which health care providers can be more respectful and supportive of homosexual parents and their families. Health care providers should examine their own attitudes toward these families and consider how to provide a welcoming environment and presence. Using gender neutral language about spouses, displaying posters and publications related to varied family types, and acknowledging both parents as participants in care are some examples. Health care providers who are aware of the special concerns these parents and their children may have, including stigmatization, the issue of disclosure, teasing, feeling different, and the stress resulting from challenges faced due to anti-homosexual social attitudes, can demonstrate sensitivity to the involved children and provide families with anticipatory guidance, support, suggested reading material, and referrals to appropriate organizations.

Adult↗
PubMed2002

Mutual mistrust in the medical care of drug users: the keys to the "narc" cabinet.

OBJECTIVE: Caring for patients who are active drug users is challenging. To better understand the often difficult relationships between illicit drug-using patients and their physicians, we sought to identify major issues that emerge during their interactions in a teaching hospital. DESIGN: Exploratory qualitative analysis of data from direct observation of patient care interactions and interviews with drug-using patients and their physicians. SETTING: The inpatient internal medicine service of an urban public teaching hospital. PARTICIPANTS: Nineteen patients with recent active drug use, primarily opiate use, and their 8 physician teams. RESULTS: Four major themes emerged. First, physicians feared being deceived by drug-using patients. In particular, they questioned whether patients' requests for opiates to treat pain or withdrawal might result from addictive behavior rather than from "medically indicated" need. Second, they lacked a standard approach to commonly encountered clinical issues, especially the assessment and treatment of pain and opiate withdrawal. Because patients' subjective report of symptoms is suspect, physicians struggled to find criteria for appropriate opiate prescription. Third, physicians avoided engaging patients regarding key complaints, and expressed discomfort and uncertainty in their approach to these patients. Fourth, drug-using patients were sensitive to the possibility of poor medical care, often interpreting physician inconsistency or hospital inefficiency as signs of intentional mistreatment. CONCLUSION: Physicians and drug-using patients in the teaching hospital setting display mutual mistrust, especially concerning opiate prescription. Physicians' fear of deception, inconsistency and avoidance interacts with patients' concern that they are mistreated and stigmatized. Medical education should focus greater attention on addiction medicine and pain management.

Adult↗
PubMed2002

[Genetic aspects of tuberculous infection in adolescents].

Comparative study of the distribution of antigens of HLA-A, B, and C, as well as somato- and phenotype in 234 adolescents has revealed that HLA-A11 and HLA-B12 antigens may indicate a predisposition to tuberculosis and HLA-A28, HLA-B8, and HLA-B51 antigens are involved in its prevention. It has been found that there is predominance of persons having severe forms of somatotype (dolychobrachymorphic) and that there is also a high phenotype stigmatization in adolescents with different manifestations of tuberculous infection.

Adolescent↗
PubMed2002

Repulsion or attraction? Group membership and assumed attitude similarity.

Three studies investigated group membership effects on similarity-attraction and dissimilarity-repulsion. Membership in an in-group versus out-group was expected to create initially different levels of assumed attitude similarity. In 3 studies, ratings made after participants learned about the target's attitudes were compared with initial attraction based only on knowing target's group membership. Group membership was based on political affiliation in Study 1 and on sexual orientation in Study 2. Study 3 crossed political affiliation with target's obnoxiousness. Attitude dissimilarity produced stronger repulsion effects for in-group than for out-group members in all studies. Attitude similarity produced greater increments in attraction for political out-group members but not for targets with a stigmatic sexual orientation or personality characteristic.

Affect↗
PubMedDate not supplied

[May Medically Assisted Procreation (MAP) be relevant for homosexual women? Study among 147 gynaeco-logists involved in MAP techniques].

The second part of the twentieth century has seen societal modifications as well as evolution of medical techniques allowing now thinking human procreation in terms of choices or even rights. Certain voices require sometimes Medically Assisted Procreation (MAP) for lesbians. Even though society did not allow such a possibility in France, it seemed interesting to question about it professionals actively involved in the use of MAP techniques. Through systematic internet queries, we obtained a list of one hundred private or public french medical institutions with a unit for the treatment of sterility. A telephone call to their secretary allowed us to individualize those doctors who did practice MAP. A sample of 147 medical doctors practicing MAP was then drawn. They were questioned with a clinical instrument including 20 ended-questions in order to assess their opinions on: homosexual women with a desire of a child; possibility for these clinicians to intervene with a donor insemination in such situations; developmental risk for such children. One hundred twenty five (85%) accepted to answer. Nine percent of these gynaecologists still consider homosexuality as pathological, and 10% as deviant - contrary to international classifications of mental disorders - and 5% deny good maternal abilities to homosexual women. Before the so-called french laws of bioethics in 1994, none of them had practiced a donor insemination for a lesbian couple, though 4% had realized some for single homosexual women. Two third of them do not agree opening donor insemination to homosexual women though for half of them, the anonymity of a donor is not perceived as prejudicial to the child. Eighty-seven percent of these gynaecologists think that a child brought up by homosexual parents is at risk for developmental disorder, the configuration supposed the most pathogenic being when the birth results from a donor insemination. The supposedly most important risk factors are thought to be the marginality of an homosexual family and the lack of a paternal figure at home. However, for 68% of the clinicians, this role can be taken by another male figure. These reasons make the gynaecologists reluctant to participate actively in the constitution of such a kind of family by the practice of a donor insemination. Even though demands of lesbian couples were not listed as an indication of donor insemination in the laws of bioethics, this does not seem to lessen the number of these demands in this population, and moreover if the law would allow this indication, half of these doctors would agree to practice it. The expression of the desire of a child by homosexual women and their request for its realization through medical techniques places the clinicians at the center of an ethical reflexion fed more by personal affects rather than scientific studies - however available - on the development of children brought up by an homosexual couple. Indeed, these studies indicate that these children suffer more from a societal view than parental sexual orientation, and it seems therefore appropriate to shed light on it in order to alleviate the weight of a stigmatization without any clinical argument founding it until now.

Adult↗
PubMed2002

Social stigma: a comparative qualitative study of integrated and vertical care approaches to leprosy.

Integration of leprosy into the general health system is very much emphasized by health care planners. One prime reason stated for this is to reduce stigma attached to this disease. This study was conducted in the state of Maharashtra, India, to compare the level of social stigma towards leprosy in communities with a vertical and an integrated programme. The data were collected in three areas of five villages each. The first two areas were in an integrated programme to test for internal consistency and the third in a vertical programme. All the leprosy patients with visible deformities in these villages were enrolled in the study, and an in-depth stigma measurement scale was administered. In addition, focus group discussions were conducted among the family members of leprosy patients and participative rural appraisal was done in the communities. The data were analysed using qualitative methods. A total of 24 leprosy patients with visible deformities participated in the in-depth stigma measurement exercise from 15 villages. Fifteen focus group discussions were conducted with families of leprosy patients and an equal number of participatory rural appraisals with communities were done. The results show that social stigma was virtually non-existent among the communities with the integrated approach and minimally experienced by leprosy patients in this model. However, a high level of self-stigmatization among leprosy patients was observed in the vertical approach and equally a high level of social stigma was found in their communities, which led to reduced interaction between the leprosy patients and their communities. The integrated approach to community-based primary health care is effective in reducing leprosy stigma in society.

Attitude to Health↗
PubMed2002

An integration of three approaches to addiction and methadone maintenance treatment: the self-medication hypothesis, the disease model and social criticism.

The two models which have most affected theory and practice of addiction medicine have been the disease model and the self-medication hypothesis. The disease model's fundamental concept is that the addicted individual is sick and suffers from a disease. The self-medication hypothesis proposes that drug and alcohol users are attempting to cope with an underlying psychological or social disorder by means of self-medication. These two viewpoints are presented in the light of a number of specific methadone maintenance treatment and drug abuse related issues such as the question whether drug abuse is an illness of the body, the mind or society; whether the disease model really de-stigmatized drug abuse; what the correct methadone dosing policy should be; the place of psychotherapy in methadone maintenance treatment and drug abuse and how polydrug abuse should be treated. These issues are discussed and an integrated approach is suggested stressing the need for social criticism and a renewed social policy towards drug abuse in general and its treatment in particular.

Heroin Dependence↗
PubMed2002

Removal and insertion of pollinia in flowers of Oxypetalum (Asclepiadaceae) in southeastern Brazil.

Pollinarium removal and pollinium insertion of seven Oxypetalum species (O. alpinum var. alpinum, O. appendiculatum, O. banksii subsp. banksii, O. jacobinae, O. mexiae, O. pachyglossum and O. subriparium) were recorded in Viçosa. Minas Gerais. They presented a tendency of one or two pollinarium removals and one pollinium insertion (single insertion), except O. appendiculatum. In this species, mainly, two pollinia of the same pollinarium were inserted per stigmatic chamber (double insertion), resulting exceptionally in 6-10 inserted pollinia in a flower, an unusual occurrence among the Asclepiadaceae. No association between removal and insertion was found, e.g., O. subriparium and O. banksii subsp. banksii had the highest pollinarium removal (1.78 and 1.45, respectively) and one of the lowest pollinium insertions (0.02 in both species), per flower. Oxypetalum mexiae showed the lowest pollinarium removal and pollinium insertion per flower (0.09 and 0.01, respectively) among the studied species and other Asclepiadaceae. Oxypetalum subriparium, O. banksii subsp. banksii and O. mexiae might be having reproductive limitations. Pollinarium removal and pollinium insertion per flower of the studied species varied from site to site, similarly to what was recorded for other Asclepiadaceae.

Apocynaceae↗
PubMed2002

Addiction and the Americans with Disabilities Act.

On July 26, 1990, the U.S. Congress enacted the Americans with Disabilities Act (ADA), which was intended as a broad, national, civil rights-oriented mandate "for the elimination of discrimination against individuals with disabilities," both physical and mental. ADA protection is extended, in limited form, to those with addiction disorders. However, many addicted individuals are denied ADA protection because of exclusionary criteria in the ADA itself and because of increasingly restrictive interpretations of the ADA in recent cases. The benefit to the addicted persons, and to the larger society, is lost when unfair discriminatory practices preclude employment of otherwise qualified, though stigmatized, individuals. The ADA currently falls short, in many respects, of preventing such discrimination against those with addictions.

Behavior, Addictive↗
PubMed2002

[Facial lipodystrophy in patients with HIV infections troublesome to treat].

HIV-infection is now a treatable chronic disease. The lipodystrophy syndrome, which is a common complication of treatment, is characterized by peripheral lipoatrophy, central lipohypertrophy, hyperlipidemia and insulin resistance. The underlying mechanisms are still poorly understood, but the combination of protease inhibitors with nucleoside analogs seems to induce complicated metabolic disturbances. From the patient's point of view, facial atrophy is the most stigmatizing aspect of the syndrome and might badly influence treatment adherence, crucial for long term antiviral efficacy. We propose a topographical classification and grading of facial lipoatrophy, and describe local treatment with injectable hyaluronic acid in gel form. The problem with such injections is their high cost. Since hyaluronic acid injections are not covered by the usual government subsidy for prescription medicines, ways of financing such treatments should be sought.

Adult↗