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PubMed2005

Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings?

OBJECTIVES: To explore patient and health worker perspectives on adherence to tuberculosis preventive therapy (TBPT), and to derive lessons for improving access to care amongst human immunodeficiency virus (HIV) infected individuals in resource-poor settings. DESIGN: Both quantitative and qualitative methods were employed. Patient records were reviewed for HIV-positive individuals attending a hospital-based HIV clinic between January 2000 and March 2002. Eighteen patients and two health care workers underwent in-depth interviews exploring perspectives around adherence. RESULTS: Of 229 HIV-positive clinic attendees, 94 (41.0%) were eligible for TBPT. Of 87 patients initiating a 6-month TBPT course of isoniazid 300 mg daily, 41 (47.1%) completed TBPT. Of the 46 interrupters, 16 (34.7%) did not return to the clinic after receiving their first dose of TBPT. Barriers to adherence included fear of stigmatization, lack of money for food and transport, the belief that HIV is incurable, competition between Western and traditional medicine, and a reluctance to take medication in the absence of symptoms. Disclosure of HIV status, social and family support, and a supportive clinic environment positively influenced adherence. CONCLUSION: Interventions to improve the accessibility and quality of the care delivery system have the potential to support adherence to TBPT and other HIV care regimens, including antiretroviral therapy.

Adult↗
PubMed2005

[Social rehabilitation experiences of people with a history of Hansen's disease: interviews of readmitted residents in a sanatorium].

PURPOSE: This study focused on the reflections of people with a history of Hansen's disease who once experienced social life and then returned to their sanatorium again. The purpose was to clarify what they think about their experiences of social life outside of institutions. METHOD: Study participants were people with a history of Hansen's disease who had experienced social life outside of the sanatorium and are now living in a national sanatorium with good ADL. The study was based on a semi-structured interview, the data being categorized with the focus on "situations or topics affect by Hansen's disease". Thirteen people agreed to participate in the study. RESULTS AND DISCUSSION: Six categories were abstracted: "maintaining a good condition," "anxiety about relapse or illness," "medical service," "coping with Hansen's disease in social life," "relationships with others," and "means of livelihood." Hansen's disease affected their lives in 2 aspects; one was "sawagu (recurrence of the disease)" and the other "kakusu (concealing the disease)." "Sawagu" was related to "anxiety of the disease" and "intention of maintaining a good condition." "Kakusu" affected the way of "coping with the disease in social life" and "the relationship with others." "Medical service" was important for both "sawagu" and "kakusu." Patients were visiting hospitals and taking medicine to avoid "sawagu," while trying to "kakusu" when they consulted with physicians. Similarly, both "sawagu" and "kakusu" interacted with each other when the participants needed to work and earn a living. All participants looked back at their social life as a "good experience" because they were satisfied with the sense of accomplishment or fulfillment the experience had given them. CONCLUSION: Participants of the study looked back at their social life as a "good experience." Hansen's disease affected their social life in 2 aspects; "sawagu" and "kakusu." It is necessary to alleviate difficulties with both of these so that people with stigmatized disease such as Hansen's disease can maintain normal lives in society.

Adaptation, Psychological↗
PubMed1999

[Transmission grating spectrograph for soft X-ray spectrum measurements with a pre-optics].

A novel diffraction spectroscopic instrument consisting of a large area transmission grating and a grazing-incidence pre-optics comprising of a toroidal mirror, a slit and a cylindrical mirror has been implemented. A nearly perfect stigmatism and a medium spectral resolution are due to the separation of the focusing and dispersing function. The experimental results show that it is possible to construct large area transmission grating spectrograph with high collecting efficiency and good spatial resolution.

English Abstract↗
PubMed1992

Intelligence and educational level in relation to body mass index of adult males.

In this study we explore the relationships between intelligence test score, educational level, and degree of body fatness. We collected data on intelligence test score, educational level, height, and weight from a sample of 26,274 young Danish men and computed body mass index (weight/height2) as a measure of fatness. Both intelligence test score and educational level had maximum values below the median for body mass index and declined monotonically thereafter. The decline was equal for test score and educational level and above 32 kg/m2 corresponded to almost half a standard deviation. These results are not readily explained by stigmatization of frank obesity, and other mechanisms, possibly genetic, may be responsible.

Adult↗
PubMed2005

Ethical considerations in rural health care: a pilot study of clinicians in Alaska and New Mexico.

To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed.

Adult↗
PubMed1992

[Ethical and social issues on the human genome analysis].

The modern technologies for human genome analysis raise a variety of ethical and social questions. The pre-symptomatic diagnostic of diseases of late expression is becoming possible for a rapidly increasing number of situations. The use of that knowledge by employers, insurance companies, schools, and society in general, could lead to discriminations and stigmatizations, in addition to adverse psychological reactions. DNA fingerprinting raises questions of privacy and personal autonomy in its applications to paternity proof, criminal proceedings, and establishment of data banks. The project of the immediate and complete sequencing of the human genome will lead to questions of economical ethics, as well as of access, commercialization and property rights of scientific information and materials obtained. It also favours a reducionistic mentality and international unbalances. The molecular biology of humans, which will follow the complete sequencing of the genome, may foster a rethinking of the concepts of freedom of self-determination (basic for moral responsibility) and of equality. The gene therapy and its possible extension to the betterment of the human species, pose questions of ethical limits to this technology. All these problems will have to be answered in terms of the application of the principle of ethical freedom for self-fulfillment, as a right of the human person, as well as of science and society. Scientific, economic and social interests have to be subordinated to the dignity of the human person.

DNA Fingerprinting↗
PubMed2004

Violence and HIV/AIDS prevention among female out-of-school youths in southwestern Nigeria: lessons learnt from interventions targeted at hawkers and apprentices.

Between 1997 and 2003, four studies on hawkers and apprentices in motor parks and work shops in south west, Nigeria were carried out to evaluate the effectiveness of interventions aimed at preventing HIV infection and gender based violence (GBV). The studies were in 3 phases namely baseline survey, intervention and end line survey. Interventions consisting of:--development and distribution of education materials and training programmes for the police, judiciary, instructors, drivers, traders and apprentices/hawkers, including micro-credit facilities were implemented in some of the studies. The major lessons learnt were that: Young girls working in the informal sector of the Nigerian economy face dual risks of HIV infection and GBV and yet they are seldom targets of intervention; Many had been victims of GBV and did not seek redress either because they accept it is their lot, are afraid of being stigmatized or are put off the prolonged legal system; Perpetrators tend to deny their involvement in violence; Despite the challenges involved, interventions implemented among female apprentices and hawkers, especially those that involve multiple stakeholders, made a difference in protecting this group from dual risks of GBV and HIV/AIDS infection. We recommend more intervention programmes for this population, and regulation of activities in the informal sector of the Nigerian economy.

Adolescent↗
PubMed2005

Workplace discrimination and HIV/AIDS: the national EEOC ADA research project.

This article utilizes data from the Equal Employment Opportunity Commission's Integrated Mission System database to document the levels of employment discrimination involving individuals with HIV/AIDS. The researchers explore the theory that the nature of HIV/AIDS related employment discrimination is rooted in deeper stigmatization than discrimination against other disability groups. Researchers compare and contrast key demographic characteristics of Charging Parties and Respondents involved in HIV/AIDS related allegations of discrimination and their proportion of EEOC merit resolutions to those of persons with other physical, sensory, and neurological impairments. Findings indicate that, in contrast to the general disability group, HIV/AIDS was more likely to be male, ethnic minorities, between the ages of 25-44, in white collar jobs, in the South and West and to work for businesses with 15 to 100 employees. Additionally, the allegations in HIV/AIDS were more likely to receive merit resolution from the EEOC by a large difference of ten percent.

Adult↗
PubMed2005

[Identification process in hemodialysis patients: impact of the technique on the life trajectory].

The haemodialysis is a palliative technical treatment relatively recent which makes it possible insufficient renal to continue to live. Those indefinitely follow in weekly time three meetings of extra-renal purification as long as they are not transplanted. Within the framework of the research task realized for obtaining the licence and the diploma of framework of health, I was interested in the trajectory of life and the identity of these patients by questioning the processes which lead it to be qualified by its treatment and becoming one "haemodialysis". I chose a step of sociological investigation of nature by leading a comparative analysis between two centres of haemodialysis. The trajectory of the patient is defined by a process in stages: the initial shock precedes the adaptation by the sick person and supports the emergence of a profane knowledge which will be or not recognized by the professionals of dialysis according to centres'. The technique structure also the identity process of the patients, process marked by signs of entry in the deviating career and/or stigmatization, which take part to build in return a singular identity, i.e. defined by a deficit of specific identity. This deficit could explain the request for training and the emergence of a technical skill among certain patients, whereas they attend heavy centres of haemodialysis. The recognition of the patient as an actor of the process of care as well as looking after redefines the place of the nurses who can find a benefit for their professional identity there.

Adaptation, Psychological↗
PubMed2005

HIV infection and risk characteristics among female sex workers in Hanoi, Vietnam.

The prevalence of HIV/sexually transmitted diseases (STDs) was determined, the risk characteristics examined, and factors associated with HIV infection identified among noninstitutionalized female sex workers (FSWs), using a cross-sectional survey with 2-stage cluster sampling. Four hundred FSWs were interviewed face to face using a structured questionnaire and tested for HIV, syphilis, Chlamydia infection, and gonorrhea. HIV seroprevalence was 12%, syphilis 17% (using the treponemal pallidum hemagglutination assay), Chlamydia infection 3.8% (using polymerase chain reaction [PCR]), and gonorrhea 6.3% (PCR). Lower-class FSWs averaged 2 clients per day, and middle-class FSWs about 1.2. Median duration in sex work was 2.3 years. Consistent condom use was 63% with irregular clients, 41% with regular clients, and only 4.8% with "love mates." Fifty-five percent had had sex with a drug user(s). Thirty-eight percent used drugs, of whom 83% injected. Factors associated with HIV included being young, having a low level of education, longer residence in Hanoi, being a lower-class FSW, having higher income compared with peers, perception of self being at low risk for HIV, poor knowledge of HIV, and sharing injecting equipment. Intervention strategies should include reduction of both stigmatization and sharing of drug paraphernalia, promotion of nonstigmatizing voluntary testing and counseling, and aggressive marketing and promotion of condoms.

Adult↗
PubMed2005

Relationship between lipoatrophy and quality of life.

An informal yet comprehensive literature review of abstracts published in Medline was undertaken to identify papers that reported on how facial aging, lipodystrophy, and facial lipoatrophy affect quality of life. Facial lipoatrophy can erode self-esteem, cause psychological distress, and lead to depression. Persons with HIV infection encounter both stigmatization and marginalization as a result of facial lipoatrophy. In addition to exploring novel antiretroviral therapies that do not result in lipodystrophy, clinicians should consider treatments that correct the appearance of lipoatrophy for patients who feel adversely affected by the condition.

Age Factors↗
PubMed2005

The specificity of torture as trauma: the human wilderness when words fail.

The author attempts to situate the specificity of torture--understood as the product of political violence and of totalitarian states--within the historical framework of the concept of trauma in psychoanalysis. When the mind and social ties are simultaneously affected, the intrapsychic and transpersonal aspects of the suffered damage intertwine in a complex and unique web. The author aims to dismantle the notion of victim, considering it both stigmatizing and inaccurate. The goal is not just to identify the after-effects and the disabilities suffered by those affected by torture, but also to integrate their experiences and their narratives into a life project. Rather than individual psychopathology, this essay reflects upon those phenomena of suggestion and hypnosis that are at work in human groups under ordinary conditions and that are exacerbated under social crises, following the Freudian axis developed in Group psychology and the analysis of the ego.

Communication↗
PubMed2005

Sulpiride addition for the treatment of clozapine-induced hypersalivation: preliminary study.

BACKGROUND: Hypersalivation is a common, troublesome side effect of clozapine treatment. It occurs in 31-54% of clozapine treated patients. Management of this stigmatizing side effect may reduce noncompliance. Reports in the literature have shown beneficial clinical effects of combined clozapine-sulpiride therapy as measured by the Brief Psychiatric Rating Scale, and we found that this treatment combination also has very strong antisalivatory activity for clozapine-induced hypersalivation. METHODS: 18 patients (12 female, 6 male) with clozapine-induced hypersalivation received sulpiride (150-300 mg/day) in addition to ongoing clozapine treatment (from 100 mg/d to 800 mg/d). Baseline, 7 day and 21 day follow-up values were recorded for the 5-point Nocturnal Hypersalivation Rating Scale. RESULTS: At the end of the trial only 3 patients complained of minimal sialorrhea, and the mean Nocturnal Hypersalivation Rating Scale scale values showed a significant reduction in sialorrhea (delta baseline-endpoint -.2.78 +/- 0.87). CONCLUSIONS: Our findings support reports of the beneficial effect of clozapine-sulpiride combination therapy and suggest that sulpiride addition may contribute to the amelioration of clozapine-induced hypersalivation.

Adult↗
PubMed1992

Sexual and intimacy dysfunction among homosexual men and women.

Homosexually active men and women are no more immune than anyone else from various types of sexual dysfunction and underlying psychopathology. Intimacy fears and conflicts, ignorance, alcohol and drug dependence and relationship issues exemplify the type of issues influencing dysfunction regardless of sexual orientation, although membership of a stigmatized minority sexuality may exacerbate causes of sexual dysfunction. The effects of discordant lifestyle and identity, homosexual identity formation, dysphoria and internalized homophobia on sexual functioning are three examples of these factors of specific relevance to being homosexual in this culture. The effects of AIDS, difficulties arising from the mechanics of safer sex and the psychosexual effects of oppression on healthy sexual functioning all indicate how factors important to (but not caused by) minority sexuality status may influence sexuality functioning. The importance of neither perceiving homosexuality solely in terms of pathology on the one hand, nor refusing to recognize unhealthy sexual functioning on the other, is emphasized throughout. Models of sexuality must be inclusive, positive and communicated to the client if future sexual dysfunction is to be limited. Finally, the role of the therapist in community development, as well as individual intervention, is addressed. Primary health care interventions are required not only to address the specific issues affecting homosexual men and women, but also to promote a more positive approach to sexuality for all.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[From Kosovo to Switzerland: mental health perceptions and practical implications for health professionals].

A survey was conducted in Kosovo between 2002 and 2003 among 57 health professionals. Covered topics encompassed mental health and disease representations and access to mental health care in Kosovo following the war. At the time of the survey, health services were still widely disorganized and uncoordinated at the local level, with poor access to health care. This work shows that mental disorders remain very stigmatizing for patients and their relatives. Benzodiazepines are the first choice medication, to the detriment of other psychotropic categories. Traditional and religious representations of mental disease prevail in the general population. A few recommendations addressed to professionals taking care of Kosovar patients, in Switzerland or elsewhere, are drawn from these results.

Cultural Characteristics↗
PubMed2005

Understanding of senile dementia by children and adolescents: why grandma can't remember me?

BACKGROUND: The present study sought to determine the knowledge and attitudes concerning senile dementia among children and adolescents in Taiwan with the intent of using the results in the design of an educational program about senile dementia for this population. METHODS: A 10-item questionnaire was distributed to all students aged 10 to 15 at 7 geographically selected public schools in Taiwan. The teachers in these schools and a group of 20 health professionals who were specialists in dementia were also invited to complete questionnaire for comparison. RESULTS: The majority of children, adolescents and teachers worried that their parents and grandparents might develop dementia in the future. Seven percent of all the student respondents felt that they would be embarrassed to invite classmates to their homes either because of actual demented family members living at home or if the hypothetical situation arose in which they actually had demented family members living at home. The younger students were more likely to have this feeling (chi square for linear trend = 73.636, df = 1, p = 0.000). CONCLUSION: Younger children were more likely to feel stigmatized by dementia in a family member which suggests that they may need more psychological support in order to effectively deal with dementia related issues. These results have important implications for the development of suitable educational programs about dementia in the curricula of primary and junior high schools.

Adolescent↗
PubMed2005

[Efficacy of a combined Sabal-urtica preparation in the symptomatic treatment of benign prostatic hyperplasia. Results of a placebo-controlled double-blind study].

UNLABELLED: This re-evaluation of a double-blind placebo-controlled therapeutic study of the combined sabal-urtica preparation PRO 160/120 investigates the changes in the irritative symptoms of benign prostatic hyperplasia (BPH) under the test substance in comparison with placebo. It was found that, over the study period of 24 weeks, the micturition symptoms frequency and urgency were statistically significantly improved under the well-tolerated PRO 160/120 in comparison with placebo. The patient's quality of life was also significantly better under PRO 160/120 in comparison with placebo. CONCLUSION: The often distressing symptoms of BPH can be effectively ameliorated already after only a few weeks of treatment with the sabal-urtica preparation PRO 160/120. In particular those patients with the stigmatizing symptoms urinary urgency and frequency benefit from such treatment.

Aged↗
PubMed2005

Alcohol use and alcohol-related problems among lesbians and gay men.

While a substantial amount is known about some of the risk factors for alcohol-related problems among lesbians and gay men, major gaps in knowledge exist. Epidemiological studies focusing on alcohol use rarely ask about sexual orientation, and broad-based studies of sexual minority population groups have only occasionally assessed alcohol use. Although the AIDS crisis has stimulated substantial research on alcohol and other substance use among gay men, only a handful of studies have systematically explored lesbians' use of alcohol. Further, existing research on sexual orientation and alcohol use is characterized by a plethora of methodological problems. Nevertheless, when viewed as a whole, this research suggests that lesbians and gay men are more likely than their heterosexual counterparts to drink alcohol and to report alcohol-related problems; differences based on sexual orientation are more pronounced for women than for men. Risks related to alcohol use do not stem from sexual orientation per se, but are more likely a consequence of cultural and environmental factors associated with being part of a stigmatized and marginalized population. Much of the research on alcohol use among sexual minorities has focused on White, middle-class, and well-educated lesbians and gay men. There is a clear need for more research with bisexual women and men and with sexual minority members of color. Longitudinal studies, including those that focus on treatment effectiveness, are particularly lacking.

Adult↗