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PubMedDate not supplied

Emotional distress in infertile women in Kuwait.

OBJECTIVES: Although previous studies conducted in the Western countries have reported that psychological factors are implicated in the experience of infertility, no study has assessed this relationship in Arab women. We postulate that with all important causal "confounders" such as age, gender, education and general health status controlled, any significant difference in psychological profile can be attributed to infertility. METHODS: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. RESULTS: Compared with an age-matched pregnant control sample, the infertile women exhibited significantly higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes, such as evil spirits, witchcraft and God's retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness resulted in social stigmatization for infertile women and placed them at risk of serious social and emotional consequences. CONCLUSIONS: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicate the appropriateness of referring these patients for psychological evaluation. Programs successful in dealing with infertility in Kuwait need to include establishment of a community-based intervention strategy to educate people about infertility and to give guidelines for treatment.

Adaptation, Psychological↗
PubMed2004

Attitudes towards HIV-antibody testing and people with AIDS among university students in India, South Africa and United States.

CONTEXT: Stigmatizing attitudes toward persons with AIDS (PWAs) may reduce people's willingness to have themselves tested for Human Immunodeficiency Virus (HIV)--thereby increasing the risk of transmission. AIMS: To examine attitudes towards (HIV) testing and determinants of attitudes towards PWAs. SETTINGS AND DESIGN: A cross-sectional. MATERIAL AND METHODS: 600 first-year university students from South India, South African and America filled in a self-administered questionnaire. Main outcome measures included an Attitudes towards HIV-Antibody Testing Scale and Readiness to engage in personal forms of contact with People With AIDS. RESULTS indicate that the majority of American and South African students and only 10 percent of the Indian students had been sexually active in the past 12 months. Almost one fifth of the American and South African participants but only 10% of the Indian students admitted to having had an HIV test. American students had a much more positive attitudes toward HIV testing than South African and Indian students. Regression analysis for the Indian student sample identified blaming, irritation and negative attitudes toward homosexuals as independent predictors of readiness to engage in personal contact with PWAs, while the regression analyses for both South African and American students identified pity and irritation as independent predictors of contact readiness with PWAs. Positive HIV testing attitudes were positively associated with contact readiness with PWAs. CONCLUSION: The findings are important for the role of HIV testing and counselling in campus AIDS programmes. The findings reveal important factors related to HIV testing and suggest strategies for developing effective HIV/AIDS counselling programmes in universities.

AIDS Serodiagnosis↗
PubMed2004

HIV prevention nongovernmental organizations in Central and Eastern Europe: programs, resources and challenges.

HIV incidence is rising more rapidly in some areas of Central and Eastern Europe than anywhere else in the world. Carrying out effective HIV prevention programs requires the presence of "bridges" that can reach community populations most vulnerable to the disease. Nongovernmental organizations (NGOs) are in a natural role to conduct HIV prevention programs. The Directors of 29 HIV prevention NGOs representing almost all countries in Central and Eastern Europe participated in in-depth interviews by telephone. The broad topics of these interviews included descriptions of the three largest programs conducted by each NGO during the past six months, at-risk target populations served, major barriers faced, and funding sources that sponsored HIV prevention activities. NGO programs most often targeted injection drug users (IDUs); other stigmatized groups were less frequently served by NGOs in the sample. The most common types of prevention activities were needle exchange, HIV prevention peer education, and delivering AIDS presentations and distributing educational materials. Among the major barriers that hampered effective conduct of HIV prevention programs were a shortage of available financial resources, governmental indifference or opposition, and AIDS-related stigma. National governments rarely provided substantial funds for NGO programs, and most funding came from United Nations agencies or private foundations. The information sources reported to be most helpful in assisting NGOs in program development were sharing ideas with other NGOs, participating in conferences, and accessing information from the Internet. A number of programs reported by the NGO Directors were innovative, outstanding, and comprehensive. Five such exemplary programs are described in this article. HIV epidemics in the region are still potentially controllable. NGOs need immediate support so that they can carry out their community-based activities on a larger scale.

Communicable Disease Control↗
PubMed2004

Depressive status of leprosy patients in Bangladesh: association with self-perception of stigma.

Stigmatization by the general population and their negative attitudes towards leprosy negatively impacts on patients' mental health, and so too does patients' perception of that stigma. The objective of this present study is to assess the depressive status of leprosy patients, the patient perception of that stigma, and its association with their depressive status in Dhaka, Bangladesh. Subjects were 140 patients, and a selected comparison group of 135 local people without any chronic diseases. To evaluate depressive status, the Center for Epidemiologic Studies Depression scale (CES-D) Bengali version was applied. The patient group's depressive status was significantly more severe than that of the comparison group. Depressive status of those who answered affirmatively was significantly more severe than that of those who answered negatively for three responses to questions: 1) 'I have been physically attacked by people', 2) 'I feel people regard me as strange' and 3) 'I have been refused the purchase of something by a shopkeeper'. The results showed that the depressive status in leprosy patients was greater than that of the general public. Further, actual experiences of discrimination based on stigma associated with the depressive status of leprosy patients. Mental health care for patients, regulation of discriminatory action and education that would decrease social stigma among the general population, especially people who might often have contact with patients, seem necessary to improve the mental health of Bangladeshi leprosy patients.

Adolescent↗
PubMed2003

Supporting persons with developmental disability--a new model.

The way we think about and care for people with developmental disability has changed. Twenty-five years ago, society believed that caregivers always knew what was best for their individual and that he or she must be shielded, even shut away from, the harms that could occur in society. Now, people with disability participate in all aspects of community life. They are educated in local schools, live at home or in their own home, and compete with others in the job market. Caregiving for people with developmental disability is no longer modeled on medicine or stigmatizing labels. Instead, caregivers have become support persons who focus on identifying community resources and making the environment friendlier and safer for persons with disability.

Adolescent↗
PubMed2004

Sialorrhea: a management challenge.

Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.

Humans↗
PubMed2004

Media frenzy greets release of Newfoundland man from prison.

Sensationalist media coverage greeted the release of a man convicted more than a decade ago for spreading HIV in Conception Bay North. Concerns have been expressed that the extensive coverage of the release will further stigmatize all people living with HIV/AIDS.

HIV Infections↗
PubMed2004

Eastern Europe and Central Asia: report identifies human rights gaps.

Criminalization and stigmatization of the high-risk behaviours that promote the spread of HIV are fuelling the HIV/AIDS epidemic in Eastern Europe and Central Asia and placing millions of people at risk. This is one of the findings of a report from the United Nations Development Programme released in February 2004. The report, which is the first comprehensive profile of the epidemic in the 28 countries of the region, includes a significant focus on human rights issues.

Asia↗
PubMed2004

[Clinical application of multifocal intraocular lens].

OBJECTIVE: To study the results of using multifocal intraocular lens (MIOL) for the treatment of cataract. METHODS: After the small incision phacoemulsification, MIOL was inserted into the eye in 30 cases (36 eyes, test group); single-focal intraocular lens (SIOL) was inserted in 32 cases (40 eyes, control group). Visual acuity, focal depth, corneal astigmatism, contrast sensitivity, glare sensitivity, operative complications and untoward visual symptoms were observed. The follow-up period was 6.0 approximately 18.0 months. RESULTS: Percentage of patients with uncorrected near visual acuity 0.5 or better accounted was 80.6% (29/36) in the test group and 25.0% (10/40) in the control group, there was a significantly statistical difference between these two groups 6 months postoperatively (P < 0.05). There was no significantly statistical difference between the corrected near and far visual acuity and uncorrected far visual acuity of these two groups (P > 0.05). In patients with +1.00 - -1.00 D accommodation power, the percentage of patients with visual acuity 0.5 or better was 97.2% (35/36) in the test group and 97.5% (39/40) in the control group, there was no significantly difference between these two groups (P > 0.05). In patients with -1.50 D and -2.50 - -3.50 D accommodation power, the percentage of patients with visual acuity 0.5 or better was 97.2% (35/36) and 88.9% (32/36) in the test group, respectively; which was significantly greater than those in the control group [0.0% (0/40) and 0.0% (0/40), respectively] (P < 0.05). In patients with visual acuity 0.5 or better, the depth of focus was 4.50 D in 86.11% cases of the test group and was 2.00 D in 97.5% cases of the control group. There was no statistically significant difference between the preoperative corneal stigmatism and corneal astigmatism 1 week, 1 month, 3 months and 6 months after the operation in both groups (P > 0.05). Low frequency contrast sensitivity and glare sensitivity (28.49 +/- 6.45 and 16.97 +/- 4.40, respectively) in the test group were significantly lower than those of the control group (36.20 +/- 7.45 and 24.05 +/- 6.08, respectively) (P < 0.05). There was no significantly statistical difference in medium and high frequency contrast sensitivity and glare sensitivity between these two groups (P > 0.05). Two eyes needed Nd:YAG laser posterior capsulotomy in both groups. Two patients (5.6%) with unilateral MIOL complained glare at night. CONCLUSION: MIOL implantation is a safe and effective method for the treatment of cataract. MIOL has a distinct advantage in providing a full-distance visual acuity.

Female↗
PubMedDate not supplied

Low vision rehabilitation: basic concepts and terms.

1. Ophthalmic professionals should avoid using the term "blindness' when referring to lesser levels of vision loss. Vision loss describes any type or degree of change in vision; blindness is total loss of sight. 2. Ophthalmologists deal with anatomy and organ function whereas rehabilitation counselors address the socioeconomic and skills aspects of vision loss. Successful visual rehabilitation must be a team effort with good communication between all professionals. 3. The replacement of the simple dichotomy between "legally sighted" and "legally blind" by normal vision, low vision, and blindness provides a more accurate and less stigmatizing classification.

Attitude of Health Personnel↗
PubMed2004

[Diagnosis and follow-up of HIV/AIDS by the general practitioner].

HIV-infections are often diagnosed in the setting of primary health care. Increased awareness of sexuality and sexually transmissible diseases facilitates identification of patients at risk. Patients with newly diagnosed HIV-infection should be referred to an HIV-specialist for counselling and further evaluation of disease progress. In addition to a regular follow-up in an HIV-priority practice or outpatient clinic, additional as well as HIV-associated diseases should be treated by the general practitioner. He should be informed concerning the patient's treatment situation and discuss therapeutic decisions with the HIV-specialist. Protection of HIV-infected individuals from discrimination and stigmatization remains critically important.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Discrimination as a consequence of genetic testing.

Genetic discrimination refers to discrimination directed against an individual or family based solely on an apparent or perceived genetic variation from the "normal" human genotype. We describe here the results of a case history study designed to assess whether or not genetic discrimination exists. Using the above definition of genetic discrimination and applying stringent criteria for case selection, we find that genetic discrimination exists and is manifested in many social institutions, especially in the health and life insurance industries. Stigmatization, and denial of services or entitlements to individuals who have a genetic diagnosis but who are asymptomatic or who will never become significantly impaired, is noted. Follow-up comprehensive studies on the significance and varieties of genetic discrimination are needed. In order to avoid creating a new social underclass based on genetic discrimination (the "asymptomatic ill"), existing and future genetic testing or screening programs need review by medical, scientific, legal, and social policy experts, as well as the public, and may require modification.

Adult↗
PubMed2004

Measurement in clinical vs. biological medicine: the Rasch model as a bridge on a widening gap.

In the dominant Bio-medical paradigm Medicine is mostly Biology applied to Man. Measurement in Biology stems from physical sciences and has established validity. This is not the case for whole-person variables such as behaviors and psychic conditions (disability, pain, knowledges). The very existence of these variables can only be inferred by observing samples of representative behaviors. The quantity of the inferred variable may only come from subjective and discrete counts (scores) of events (coming in a questionnaire). Contemporary statistics demonstrated that raw scores intrinsically lack fundamental properties for scientific measurement, whatever their algebraic manipulations. This adds to the stigmatization of Clinical Medicine as "soft science", compared to Bio-medicine. In the 1960s Georg Rasch inaugurated a new statistical approach allowing transformation of raw scores into objective linear measures comparable to physical measures. This may help the Bio-medical paradigm to redirect resources from laboratory bench back to bedside.

Biology↗
PubMed2004

Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon.

SETTING: Households of TB patients in the Peruvian Amazon. OBJECTIVE: To investigate how knowledge and beliefs of household contacts about TB affected health seeking behavior. DESIGN: Interviews with 73 patients finishing treatment and 79 of their adult household contacts. RESULTS: Contacts were knowledgeable about free screening and treatment, but contacts who noted weight loss, not cough, were more likely to be screened for TB (P = 0.03). Forty-two per cent reported that TB was prevented by nutrition, 28% by separating eating utensils, and only 19% by avoiding a coughing patient. Only one household contact reported being stigmatized. Stigma centered upon nutrition, and only 12% knew of the association between TB and HIV. Only 14% had a BMI < 20, yet 30% reported regularly going to sleep hungry. Free food packages were reported to be the most important reason for treatment adherence by 33% of patients. CONCLUSION: Contacts misperceived TB as a nutritional disease and did not fear airborne transmission, which should be corrected by public health education. Weight loss, and not cough, led to screening. Stigma appeared to be minimized because risk was perceived as personal, through malnutrition, rather than exposure-based. Nutritional incentives that utilize these beliefs may reduce diagnostic delay and enhance treatment adherence.

Adolescent↗
PubMed2005

[Design, development and successful application of safe and effective HIV therapeutic and prophylactic vaccines].

It is generally held that HIV, the causative agent of the rampaging global HIV/AIDS pandemic, is incurable and uniformly fatal. Since the discovery and isolation of the virus over two decades ago, global efforts at producing preventive and curative vaccines against it have so far resulted in failure. Working single-handedly with only his family's meagre resources and against the tide of universally accepted dogmas on HIV/AIDS, the author designed, developed and applied new HIV therapeutic and preventive vaccines in Nigeria, and has been using them on willing HIV-infected and normal persons respectively with their informed and written consent since their development. In many cases, the therapeutic vaccine produced rapid improvement not only in the symptoms and signs attributable to HIV infection, but also in various laboratory parameters with a sustained seroconversion to HIV antibody negative status in a number of the patients. In those HIV-infected patients with concomitant hepatitis B (HBV) and/or C (HCV) infection(s), the therapeutic vaccine has resulted in maintained seroconversion to negative (normal) for the HBsAg and HCV antibodies also. No significant adverse or side effect has been observed yet with the use of these vaccines. The vaccines do not cause the production of any detectable levels of stigmatizing anti-HIV antibodies. It is postulated that the vaccines elicit effective but selective cell-mediated cytotoxic immune responses against HIV, HBV and HCV-infected cells.

AIDS Vaccines↗
PubMed2005

Understanding pain and improving management of sickle cell disease: the PiSCES study.

Until recent decades, sickle cell disease (SCD) was associated with recurrent, disabling pain, organ failure and death in childhood or early adulthood. SCD treatment advances have now decreased pain and prolonged survival, but episodic or chronic pain may still require substantial analgesic use and frequent hospitalization for pain episodes. This pain is poorly characterized and often poorly treated. Adult patients may face barriers to comprehensive SCD care, stigmatization of their care-seeking behavior by providers and lack of family support, forcing them into maladaptive coping strategies. The Pain in Sickle Cell Epidemiology Study (PiSCES) attempts to develop and validate a biopsychosocial model of SCD pain, pain response and healthcare utilization in a large, multisite adult cohort. PiSCES participants complete a baseline survey and six months of daily pain diaries in which they record levels of SCD-related pain and related disability and distress as well as responses to pain (e.g., medication use, hospital visits). PiSCES will advance methods of measuring pain and pain response in SCD by better describing home-managed as well as provider-managed pain. PiSCES will assess the relative contributions of biological (disease-related), psychosocial and environmental (readiness to utilize) factors to overall pain and pain response in SCD, suggesting targets for biobehavioral interventions over time. Importantly, PiSCES will also identify "triggers" of SCD pain episodes and healthcare utilization in the moment of pain, suggesting targets for timely care that mutes pain episodes.

Adaptation, Psychological↗
PubMed2004

[Hyperkinetic disorder--etiology, diagnosis, therapy, doubts].

Hyperkinetic Disorder is the most common psychiatric condition diagnosed in children. It is also the most controversial one and gives rise to extreme differences of opinions. Hipercinetic Disorder is viewed as a stigmatizing and harmful label attached to children who are difficult to handle. The opponents indicate the source of popularity of the syndrome in the crisis educational system and the marketing activity of pharmaceutical companies. According to supporters, the lack of diagnosis and treatment of Hyperkinetic Disorder may produce serious, life devastating emotional and social dysfunctions in suffering from the condition children. Most probably the Hyperactivity subject will became more and more popular in our country in the future, especially because two drugs prescribed in this condition are now in the process of registration in Poland. The article is an attempt to make a critical analysis of the current scientific knowledge on prevalence, diagnosis, etiology and therapeutic schemes of Hyperkinetic Disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Separating predictive genetic testing from snake oil: regulation, liabilities, and lost opportunities.

This article explores the extent to which completion of maps of the human genome, coupled with the introduction of technology that will accelerate the identification of gene and protein function, have introduced immeasurable potential to advance life science and health care through genetic profiling. In light of definitional uncertainty, the regulatory and legal environment surrounding predictive genetic testing threatens to impede clinical utilization of genetic profiling technologies that could significantly improve human health. Especially given that genetic testing technologies have been stigmatized in the public and medical community, they must enter the marketplace with a regulatory framework that assures safety, efficacy, and market responsibility.

Biotechnology↗