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PubMed2006

Obesity prevention in pediatrics: A pilot pediatric resident curriculum intervention on nutrition and obesity education and counseling.

INTRODUCTION: Obesity is a highly burdensome public health issue associated with premature death, multiple comorbid disabilities and staggering healthcare costs. Between 1980-2000, the prevalence of obesity among children and adolescents nearly tripled. Obesity subjects youth to social stigmatization and discrimination. These economic and personal burdens mandate targeted prevention and detection educational programs for all individuals at risk. The most cost-effective method of approaching this obesity epidemic is through education of health professionals. METHODS: As part of an "Obesity Prevention in Pediatrics" curriculum, postgraduate-year (PGY)-2 residents first observed and then participated in the dietary evaluation and counseling of pediatric patients and their families. Attitudinal questionnaires, multiple-choice knowledge examinations and a pre-established checklist of desired skills and behaviors provided evaluation of the curriculum's effect on the participants' ability and willingness to manage actually obese or at-risk pediatric patients and their families. RESULTS: Attitudinal survey and knowledge test scores from control PGY-3 residents generally confirmed that their knowledge and counseling skills on obesity prevention and management were well below expectation. Following participation in the curriculum, study residents' knowledge tended to improve, as did their level of comfort in counseling obese and at-risk children, adolescents and their parents. CONCLUSION: Implementation of an "Obesity Prevention in Pediatrics" curriculum appears to improve participants' knowledge base as well as their skills and level of personal comfort in the recognition, evaluation and management, including counseling, of both obese and at-risk pediatric patients and their families.

Counseling↗
PubMed2006

The mentally ill: the way they perceive their own illness and their expectations from the society.

People diagnosed as mentally ill face the suffering of their own disease as well as the social stigmatization, which, in turn, can aggravate their psychopathological symptoms and exacerbate their social isolation. Mental diseases and their symptoms cause an ill person to seem recondite for the people around. She or he feels different from everybody else, thus requires special care, sensitivity, and respect from the others. A supportive and full of acceptation environment is indispensable to optimize socio-professional therapy and rehabilitation of the ill. The society should possess some knowledge of mental diseases and respect the dignity and human rights of the ill. The aim of our work was to show how the mentally ill perceive their illness as well as specify the patients' expectations concerning their relations with the healthy people from their environment. This work consists of a theoretical part, a research which contains the results of a questionnaire, and conclusions. There were 52 patients who took part in the research. They were all aware of their illness, although the research was held during the lighter phase of the disease or its remission. The analysis of the collected data indicates that the ill perceived their disease as a burden and obstacle to fulfilling their principal aims. The disease also engendered negative emotional reactions in them and significantly impaired the quality of their life.

Empathy↗
PubMed1989

[Biopsychosocial repercussions of AIDS and leads in intervention and research.].

The acquired immunodeficiency syndrome (AIDS) is a world wide health problem of exceptional magnitude with considerable effect in many areas : individual, social, economic, demographic and cultural. Current literature clearly indicates the emotional impact of the losses occasionnée by those suffering from this fatal disease. There include strong anxiety, fear, anger powerlessness and hopelessness. To this psychological distress is added isolation of AIDS victims. The negative reaction of society contributes to discrimination and stigmatization of these victims. AIDS may be seen as a personnal tragedy which often spells the collapse of family life. The psychosocial repercussions of this disease require intervention and further research with respect to the many unresolved problems generated by this syndrome.

English Abstract↗
PubMed2006

Preliminary evaluation of a web site for depressive symptoms management.

The purpose of this study was to (1) evaluate the characteristics of website users in relation to their depressive symptoms and (2) pilot test the effectiveness of the depressive symptoms management program. Computer-assisted intervention is as effective as face-to-face treatment for managing depressive symptoms, which are one of the most common and destructive mental problems. This kind of system can be particularly useful in Korea where stigmatism exists for those who seek mental health care. Investigators developed a web site for depressive symptoms management (URL: http://www.baejy.com/smile) in 2004. During the first year the number of users was 582. The findings from this study will provide an intervention strategy for the prevention and management of depression.

Adult↗
PubMed1991

Children with Apert syndrome: developmental and psychologic considerations.

Innovations in craniofacial surgery have enabled children with Apert syndrome to achieve their full potential by maximizing their opportunities for intellectual growth, physical competence, and social acceptance. However, at each developmental phase they are confronted with different challenges to their emotional and social adaptation that must be overcome. Children with Apert syndrome continue to face erroneous assumptions of mental retardation and social stigmatization because of their appearance. Families and medical care providers play a critical role in fostering their adjustment and supporting them during these emotionally stressful periods. Most importantly, by understanding the unique issues of each developmental period, parents and professionals also have the capacity to maximize their opportunity for psychologic well-being.

Acrocephalosyndactylia↗
PubMed1991

Racial variation in reaction to physical stigma: a study of degree of disturbance by vitiligo among black and white patients.

The effect of race on reaction to impaired appearance is explored in a sample of 158 patients with vitiligo, a disfiguring skin disease. Blacks and Whites do not differ in degree of disturbance by the disorder. Psychological coping resources and variables related to negative labeling of the stigma are associated with variation in degree of disturbance. Self-esteem and perceived stigmatization are associated significantly with degree of disturbance among both Blacks and Whites. Gender, age, and visibility of the condition are not related to difference in degree of disturbance within either race, although there is some evidence that they may have an indirect relationship to degree of disturbance. Importance of appearance is associated with degree of disturbance for Whites only, because of the threat of the depigmentation induced by vitiligo to the racial identity of Blacks. The implications of these findings for theory and practice are discussed.

Adaptation, Psychological↗
PubMed2006

["Zerquälte Ergebnisse einer Dichterseele"--literary critiques on psychiatry around 1900].

In the last decade of the 19th century dozens of "mad" people from the respectable bourgoisie went public with most stigmatizing details of their private lives. The authors told about healthy people branded as insane, and incarcerated in insane asylums. They took their cases to the "court of public opinion". These stories became the stuff of public scandals and also the basis of an organized "lunatics' rights" movement, which was a protest movement against the power and competency of psychiatric expertise. Inspired by this movement some authors and playwriters took up the criticism towards psychiatry and wrote novels and stage plays in which they told frightening and desparate stories of restrained people who had to suffer from arbitrary decisions of psychiatrists. The paper deals with three novels and stage plays written between 1908 and 1917 by Heinrich Mann, Frederik van Eeden, and Waldemar Müller-Eberhart. It analyses the gloomy picture of the asylum and the practice and attitudes of the asylum doctors painted by the three authors. I argue that the narratives had an impact on the public as well as the professional discourse on the problem of psychiatric arbitrariness, and that the authors not only conveyed citicism but also pointed out a concept of a humaine interaction between "normal" and "abnormal" people.

Germany↗
PubMed2006

Helping children cope with hair loss.

Alopecia totalis and alopecia universalis are emotionally devastating forms of hair loss, which are difficult to cure. When childhood hair loss is unresponsive to alopecia therapies, both traditional and nontraditional, children may be stigmatized and fall under extreme psychologic distress. The not-for-profit organization Locks of Love began providing custom hair prostheses to children in 1997 and has continued to serve the emotional and cosmetic needs of children with extensive hair loss.

Adolescent↗
PubMedDate not supplied

Switching strategies to improve lipid profile and morphologic changes.

Metabolic alterations and body fat changes are well-recognized limitations of protease inhibitor-based regimens. Strategies of replacing protease inhibitors with nonnucleoside reverse transcriptase inhibitors or abacavir have been shown to improve metabolic abnormalities, particularly by decreasing cholesterol and triglyceride levels, and reducing cardiovascular risk. The various therapeutic options show differences in efficacy, tolerability, and metabolic outcomes. Abacavir seems to be better tolerated, at least in the only randomized trial in which the three options were compared face-to-face, but it is associated with higher virologic failure in patients with prior suboptimal nucleoside therapy. Nonnucleoside reverse transcriptase inhibitors, particularly nevirapine, result in a better lipid profile with a greater increase in HDL cholesterol and in the HDUtotal cholesterol ratio, one of the most important parameters associated with a reduction in cardiovascular risk. Efavirenz has been associated with increased triglyceride levels in some studies. Although protease inhibitor compounds as a family have been linked to metabolic and body fat alterations, new drugs such as atazanavir seem to be associated with a more favorable lipid profile. Lipoatrophy is a stigmatizing complication in HIV-infected patients receiving HAART. There is strong evidence suggesting a prominent role of thymidine analogs, mainly stavudine, in its development. Substitution of stavudine or zidovudine for abacavir or tenofovir partially improves peripheral fat loss. In addition, the lipid profile significantly improves. Finally, although the extended use of non-thymidine nucleoside analogs and the development of new families of antiretroviral drugs will probably result in a lower impact in lipids and morphologic changes, many patients are currently under treatment with these compounds. In this setting, switching strategies may be useful to minimize clinical and psychological consequences, improving the quality of life of HIV-infected patients treated with HAART.

Anti-HIV Agents↗
PubMed1991

Mental and social problems of families with handicapped child.

Studies were carried out in a series of 100 mothers of children with facial clefts who were treated up to the age of 13 to 15 years at the Department for Plastic Surgery. Clefts were used as a model situation for studies into the response of parents--and especially of mothers--to the birth of a child with an inborn malformation. The main results showed: that three quarters of mothers designated the birth of a handicapped child as a mental shock followed by a variety of neurotic symptoms. A certain proportion of mothers suffered from reactive depression which was not diagnosed and therefore not treated. It was confirmed that the poor mental condition of the mother in the predominant part of the series examined persisted up to the adolescence of the affected child and exerted marked negative effects on the mental prosperity of the child. This resulted in a latent or manifest parental attitude of rejection and in the development of mental handicap in their children (impaired self-esteem, impaired sexual identification etc.). The stress situation was increased by factors including manifestation of stigmatization by the familial environment and by the collective of children which had an adverse effect approximately on about three quarters of mothers and children. The discussed forms of medical care and counselling could in the post partum period and later help to reduce the mental stress experienced by the parents, as well as promote the somatic and mental development of the child.

Adult↗
PubMed1991

Micrografts and minigrafts: a new approach for baldness surgery.

The main problem in conventional operations for baldness has certainly been the resultant scar. The scar stigmatizes the patient's forehead and frequently gives an unaesthetic and unnatural appearance. Any observer would say the patient is wearing a "hairpiece" or some other artificial element. To minimize this problem, we introduced and improved a new procedure for the treatment of pattern baldness by using microsurgical hair grafts taken from the occipital region. These are inserted, one by one, into the bald area through a small microsurgical knife and with the help of a jeweler's forceps. This technique is based on works of Marrit and Nordström, who made use of these micrografts for the first time to hide the anterior line of the forehead after surgery.

Adult↗
PubMed1991

[The Camurati-Engelmann syndrome (progressive diaphyseal dysplasia)].

The presented case-history demonstrates an infant with a rare bone disease with a very serious prognosis. Based on X-ray findings on the skeleton (sclerosis of the diaphyses of long bones, ribs, vertebrae and in particular the base and vault of the skull), the diagnosis of morbus Camurati-Engelmann--progressive diaphyseal dysplasia was established. With regard to the striking progression of the process in the cranial area and the progressing stigmatization of the patient's face, the authors consider also a more recent diagnostic unit--craniodiaphyseal dysplazia. With advancing sclerotization of the skull the most serious complications are compression of the cranial nerves which can be resolved in the final stage only by surgery. From a brief review of the literature: the aetiology of the disease is not known, the therapeutic effect of prednisone or calcitonin is small.

Camurati-Engelmann Syndrome↗
PubMed1991

Benefits of sport and physical activity for the disabled: implications for the individual and for society.

An increase of physical activity is commonly recommended to those with physical disability, but it is necessary to distinguish competitive sport from fitness programmes, remedial gymnastics and active recreation. Potential benefits of enhanced activity are reviewed. Likely psychological gains include an improvement of mood-state, with a reduction of anxiety and depression, an increase of self-esteem and feelings of greater self-efficacy. Sociological gains include new experiences, new friendships, and a countering of stigmatization. Perceived health is improved, and in a more long-term perspective there is a reduced risk of many chronic diseases. Finally, there is a greater likelihood of employment, with less absenteeism and enhanced productivity. Both the health and the industrial benefits have a potential to yield cost savings that could make an important contribution toward the expense of suitably adapted physical activity programmes. It is concluded that the physically disabled should be encouraged to engage in physical activity, although further large-scale longitudinal studies are needed to determine the optimal type of programme for such individuals.

Persons with Disabilities↗
PubMedDate not supplied

[Handicap and normality: needs and interventions].

The purpose of this paper is to restore the concept of "handicap" to its original etymologic meaning as a term that identifies a relationship rather than a property concerning only one subject. If the handicap is not considered only in terms of a single person but of the relationship between him and his environmental context, it is possible to avoid the dual ideological constraint whereby people are condemned to no-way-out disability or society is stigmatized as the receptacle for all ills. The wellbeing of the disabled and society alike can become feasible as a result of the flexible rediscovery of this relationship and the formulation of original new creative approaches to normality.

Persons with Disabilities↗
PubMed1991

Eating disorders. Highlights of nursing assessment and therapeutics.

Nurses providing care for individuals with eating disorders should identify and test the effectiveness of various milieu factors and nursing therapeutics employed in the treatment of these often-debilitating disorders. Nurses offer presence, role modeling, surveillance, and emotional and physiologic support while guiding reluctant patients to explore and experiment with new behaviors. Nurses provide flexibility, empathy, and rational limit setting in response to the unique and shifting needs of each patient. This interpersonal dynamic is often extremely different from that experienced in the patient's family of origin and, thus, contributes to the essential "interpersonal conditions" that are necessary for the patient to engage meaningfully in treatment. The prevalence of eating disorders suggests that nurses are likely to encounter people with eating disorders in many settings. Nurses should be skilled at spotting disordered eating among an array of clinical presentations (e.g., amenorrhea, disturbed family relationships, athletic injuries) because people engaged in disordered eating are hesitant to volunteer such information. In addition to the shame associated with disordered eating is the stigma associated with psychiatric treatment. Seeking help from a nurse may be perceived as less stigmatizing than seeking care from a psychiatrist. Thus, nurses may serve as important points of entry for the hesitant patient. The initial contact is so essential in setting the stage for the continuation and denouement of therapy. Finally, nurses and patients with disordered eating share at least one commonality. Both groups are predominantly women. The prevailing culture has been implicated repeatedly as a major factor in contributing to the prevalence of disordered eating. Nurses experience the influences of paternalism in their professional practice and confront daily the pressures of socially constructed feminine ideals. These gender-sensitive ways of knowing, which nurses bring to the treatment relationship, should be further analyzed as substantive dimensions with treatment and preventive potential.

Family↗
PubMed1991

Primary care physicians and AIDS. Attitudinal and structural barriers to care.

OBJECTIVE: To explore the extent to which primary care physicians are providing health care for people with human immunodeficiency virus (HIV) infection and to document barriers to HIV care giving. DESIGN: National random-sample mailed survey. PARTICIPANTS: Population-based random sample of 2004 US general internists, family physicians, and general practitioners in 1990. Response rate was 59%. MAIN OUTCOME MEASURES: HIV treatment experience, willingness to treat HIV-infected patients, negative attitudes toward homosexuals and intravenous drug users, fear of contagion of the acquired immunodeficiency syndrome (AIDS), perceived lack of information about AIDS, and time demands of HIV care. RESULTS: Most physicians (75%) had treated one or more patients with HIV infection. A majority (68%) believed that they had a responsibility to treat people with HIV infection, yet half (50%) indicated that they would not, if given a choice. Over 80% of respondents believed that they lacked information about AIDS and that caring for people with AIDS is time consuming. Further, 35% of respondents agreed that they "would feel nervous among a group of homosexuals" and 55% expressed discomfort about having intravenous drug users in their practice. Physicians who had treated 10 or more HIV-infected patients expressed less negativity toward members of these stigmatized groups who are likely to be HIV infected. CONCLUSIONS: These data suggest that many primary care physicians are responding professionally to the AIDS epidemic but that attitudinal barriers may be hindering some physicians from providing treatment to HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Stresses and interaction problems of physicians and nurses in the management of AIDS patients].

Caring for people with AIDS physicians and nurses are confronted with special problems. Compared to other severe illnesses there are specific problems in the relationship between doctors and nurses with their patients due to the similarity in age, the risk of infection and that most of the patients belong to stigmatized, marginal groups, that represent despised and threatening impulses (homosexu-ality, promiscuity, addiction). The results of our survey of 85 physicians and 111 nurses suggest, that physicians and nurses react with a typically professional attitude concerning the identification with AIDS-patients. The "concordant identification", that is induced by the same age of many AIDS-patients, is followed by a "complementary identification" with the professional role that serves as a defence and helps in coping with threatening internal conflicts. Wherein physicians have a mainly neutral attitude and delegate their feelings to the nurses, nurses show an unlimited commitment for AIDS-patients delegating their aggressive reactions to the physicians.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Living with HIV infection: adaptive tasks of seropositive gay men.

With improved understanding of the natural history of HIV/AIDS and the availability of effective early intervention, HIV infection recently has come to be conceptualized as a chronic illness. As we enter the next phase of the epidemic, insights into the challenges of daily living faced by seropositive persons will aid in designing appropriate interventions to educate for adaptive success and to ameliorate adaptive difficulties. In our analysis of focused interviews with 55 seropositive gay men, we identified three major adaptive challenges: dealing with the possibility of a curtailed life span, dealing with reactions to a stigmatizing illness, and developing strategies for maintaining physical and emotional health. The men's descriptions of these adaptive challenges are discussed in the context of adaptation to other chronic illnesses.

Adaptation, Psychological↗