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 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Drawing on lessons learned from community experiences in concentrated epidemics, this paper explores three imperatives in the effort to reduce the sexual transmission of HIV: combat prevention fatigue, diversify HIV testing and combat stigma and discrimination. The paper argues for a non-judgmental harm reduction approach to the prevention of sexual transmission of HIV that takes into account the interpretation of risk by diverse individuals and communities in the era of antiretroviral therapy. This approach requires greater attention to increasing access to opportunities to know one's serostatus, especially among key populations at greater risk. Novel approaches to diversifying HIV testing approaches at community level are needed. Finally, the paper makes a plea for bold measures to combat stigma and discrimination, which continues to represent a formidable barrier for access to services for affected populations and may contribute to HIV-related risk behaviours. A "triple therapy" approach to address stigma and discrimination is discussed, which includes greater acceptance of people living with HIV and AIDS (PLWHA), improving relevant laws and policies, and involving prevention users- working with people rather than for people-.Note: this paper corresponds to the plenary talk of Bruno Spire at the XVIIth World AIDS Conference, August 8th, Mexico city: http://www.kaisernetwork.org/health_cast/player.cfm?id=4383.
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PMID:HIV prevention: What have we learned from community experiences in concentrated epidemics? 1901 56

Adults age 50 and older with HIV represent approximately 20% to 25% of the entire HIV population in the United States. This unique clinical population is expected to grow; therefore, understanding how to facilitate successful aging in this population is needed. Issues that can negatively affect successful aging with HIV have been identified, and include social isolation, suicidal ideation, HIV-related stigma, cognitive decline, sarcopenia, HIV-medication toxicity, osteoporosis, and fatigue. This brief overview provides nurses with specific insights for practice, intervention, and research.
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PMID:Successful aging with HIV: a brief overview for nursing. 1971 56

The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects many active women and girls, especially those in sports that emphasize appearance or leanness. Because of the athlete's psychological defense mechanisms and the stigma surrounding disordered eating, physicians may need to ask targeted questions about nutrition habits when assessing a patient who has a stress fracture or amenorrhea, or during preparticipation exams. Carefully worded questions can help. Physical signs and symptoms include unexplained recurrent or stress fracture, dry hair, low body temperature, lanugo, and fatigue. Targeted lab tests to assess nutritional and hormonal status are essential in making a diagnosis that will steer treatment, as are optimal radiologic tests like dual-energy x-ray absorptiometry for assessing bone density.
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PMID:Team management of the female athlete triad: part 1: what to look for, what to ask. 2008 95

Corn silk (Stigma maydis) is an important herb used traditionally by the Chinese, and Native Americans to treat many diseases. It is also used as traditional medicine in many parts of the world such as Turkey, United States and France. Its potential antioxidant and healthcare applications as diuretic agent, in hyperglycemia reduction, as anti-depressant and anti-fatigue use have been claimed in several reports. Other uses of corn silk include teas and supplements to treat urinary related problems. The potential use is very much related to its properties and mechanism of action of its plant's bioactive constituents such as flavonoids and terpenoids. As such, this review will cover the research findings on the potential applications of corn silk in healthcare which include its phytochemical and pharmacological activities. In addition, the botanical description and its toxicological studies are also included.
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PMID:Corn silk (Stigma maydis) in healthcare: a phytochemical and pharmacological review. 2289 Jan 73

The wounded healer is an archetype that suggests that a healer's own wounds can carry curative power for clients. This article reviews past research regarding the construct of the wounded healer. The unique benefits that a psychotherapist's personal struggles might have on work with clients are explored, as well as the potential vulnerability of some wounded healers with respect to stability of recovery, difficulty managing countertransference, compassion fatigue, and/or professional impairment. The review also explores psychologists' perceptions of and responses to wounded healers and examines factors relating to social stigma and self-stigma that may influence wounded healers' comfort in disclosing their wounds. We propose that the relative absence of dialogue in the field regarding wounded healers encourages secrecy and shame among the wounded, thereby preventing access to support and guidance and discouraging timely intervention when needed. We explore the complexities of navigating disclosure of wounds, given the atmosphere of silence and stigma. We suggest that the mental health field move toward an approach of greater openness and support regarding the wounded healer, and provide recommendations for cultivating the safety necessary to promote resilience and posttraumatic growth.
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PMID:The dilemma of the wounded healer. 2296 68

Epilepsy is a chronic neurological disorder that results in recurring seizures and can have a significant adverse effect on health-related quality of life (HRQL). The Neuro-QoL measurement initiative is an NINDS-funded system of patient-reported outcome measures for neurology clinical research, which was designed to provide a precise and standardized way to measure HRQL in epilepsy and other neurological disorders. Using mixed-method and item response theory-based approaches, we developed generic item banks and targeted scales for adults and children with major neurological disorders. This paper provides empirical results from a clinical validation study with a sample of adults diagnosed with epilepsy. One hundred twenty-one people diagnosed with epilepsy participated, the majority of which were male (62%) and Caucasian (95%), with a mean age of 47.3 (SD=16.9). Baseline assessments included Neuro-QoL short forms and general and external validity measures. The Neuro-QoL short forms that are not typically found in other epilepsy-specific HRQL instruments include Stigma, Sleep Disturbance, Emotional and Behavioral Dyscontrol, and Positive Affect and Well-Being. Neurology Quality-of-Life short forms demonstrated adequate reliability (internal consistency range=.86-.96; test-retest range=.57-.89). Pearson correlations (p<.01) between Neuro-QoL forms of emotional distress (anxiety, depression, stigma) and the QOLIE-31 Emotional Well-Being subscale were in the moderate-to-strong range (r's=.66, .71 and .53, respectively), as were relations with the PROMIS Global Mental Health subscale (r's=.59, .74 and .52, respectively). Moderate correlations were observed between Neuro-QoL Social Role Performance and Satisfaction and the QOLIE-31 Social Function (r's=.58 and .52, respectively). In measuring aspects of physical function, the Neuro-QoL Mobility and Upper Extremity forms demonstrated moderate associations with the PROMIS Global Physical Function subscale (r's=.60 and .61, respectively). Neuro-QoL measures of perceived cognitive function (executive function and general concerns) produced moderate-to-strong correlations with the QOLIE-31 Cognition subscale (r's=.65 and .75, respectively) and moderate relations with the Liverpool Adverse Events Profile (r's=.51 and .69, respectively). Finally, the Neuro-QoL Fatigue measure demonstrated moderate associations with the QOLIE-31 Energy/Fatigue subscale (r=-.65), Liverpool Adverse Events Profile (r=.69), and the Liverpool Seizure Severity Scale (r=.50). Five Neuro-QoL short forms demonstrated statistically significant responsiveness to change at 5-7months, including Fatigue, Sleep Disturbance, Depression, Positive Affect and Well-Being, and Emotional and Behavioral Dyscontrol. Overall, Neuro-QoL instruments showed good evidence for internal consistency, test-retest reliability, convergent validity, and responsiveness to change over several months. These results support the validity of Neuro-QoL to measure HRQL in adults with epilepsy.
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PMID:Validity of the Neurology Quality-of-Life (Neuro-QoL) measurement system in adult epilepsy. 2436 67

During the First World War combatants of all armies were prey to nervous disorders or psychological breakdown. These war neuroses were a response to the highly-industrialised nature of the warfare as well as to the fatigue engendered over four years of intense conflict. Yet while fear and mental breakdown were universal, national responses varied. A comparison of British and Belgian shell shock indicates that men suffered in very similar ways but that symptoms met with rather different responses: in Britain treatment and diagnostic regimes stressed the importance of class difference and shell shock was often linked to cowardice. These issues were not of overriding importance in the Belgian army. In the longer term shell shock became, and remained, a topic of political and social concern in Britain whereas in Belgium men suffering from kloppe (extreme fear) tended to be forgotten and the topic has not excited much popular interest or scholarly attention. Yet despite these differences one overarching theme remains clear, namely that despite the extensive experience of war neuroses during and after the First World War, there still remains a fierce stigma about the mental wounds of war.
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PMID:Shell Shock and the Kloppe: war neuroses amongst British and Belgian troops during and after the First World War. 2544 6

Drawing on a qualitative study that included 20 focus group discussions with male and female students at an urban-based university in South Africa, this article reports on perceptions, attitudes and reported behaviour with respect to HIV and AIDS and safer sex in the campus setting, with an aim to better understand how young people are responding to the challenges of HIV and AIDS in contemporary South Africa. The findings demonstrate the gap between reported HIV-prevention knowledge and safer-sex practices among a group of young and educated South Africans. Although the participants reported that students were knowledgeable about HIV and had easy access to condoms on campus, a range of factors mediated their capacity to apply this knowledge to safer-sex practices. Besides the usual set of complex social-cultural dynamics, including normative gender roles and power inequalities between men and women, socioeconomic challenges, and differences in age and status between sexual partners, the findings reveal substantial denial, stigma and HIV/AIDS 'fatigue.' The findings point to the importance of seeking creative ways to impart HIV-prevention and safer-sex messages that are not explicitly referent to HIV but link rather with broader issues concerning relationships, lifestyle and identity, and hence are responsive to the particular cultural context of university campuses.
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PMID:AIDS fatigue and university students' talk about HIV risk. 2585 14

The national antiretroviral (ARV) programme in South Africa commenced in 2004. ARV drugs became readily available to all South Africans due to the concerted efforts of 'access to all' campaigns. This study investigates medication adherence among a sample of South Africans after the ARV rollout in order to gain insight into the adherence challenges they face. A semi-structured questionnaire was completed by 439 participants from across the country. The results show that only 40% of the respondents were able to reach the optimum adherence level of 90% or above. The patients who displayed below-optimum adherence often had not been part of an ARV-preparation programme, did not have HIV-treatment supporters, lacked general knowledge about drug adherence, and felt unsupported by healthcare providers in their day-to-day effort to adhere to their medications. They often had no money for food or transportation, ran out of ARVs for various reasons, suffered from HIV-treatment fatigue, battled with depression, abused alcohol, could not disclose to sexual partners that they were on ARVs, and often had to hide or skip ARV dosages because they feared stigma and discrimination. Suggestions to assist patients to adhere to their ARV medications are made.
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PMID:Treatment adherence following national antiretroviral rollout in South Africa. 2586 Jun 28

Psychiatric education is confronted with three barriers to managing stigma associated with mental health treatment. First, there are limited evidence-based practices for stigma reduction, and interventions to deal with stigma against mental health care providers are especially lacking. Second, there is a scarcity of training models for mental health professionals on how to reduce stigma in clinical services. Third, there is a lack of conceptual models for neuroscience approaches to stigma reduction, which are a requirement for high-tier competency in the ACGME Milestones for Psychiatry. The George Washington University (GWU) psychiatry residency program has developed an eight-week course on managing stigma that is based on social psychology and social neuroscience research. The course draws upon social neuroscience research demonstrating that stigma is a normal function of normal brains resulting from evolutionary processes in human group behavior. Based on these processes, stigma can be categorized according to different threats that include peril stigma, disruption stigma, empathy fatigue, moral stigma, and courtesy stigma. Grounded in social neuroscience mechanisms, residents are taught to develop interventions to manage stigma. Case examples illustrate application to common clinical challenges: (1) helping patients anticipate and manage stigma encountered in the family, community, or workplace; (2) ameliorating internalized stigma among patients; (3) conducting effective treatment from a stigmatized position due to prejudice from medical colleagues or patients' family members; and (4) facilitating patient treatment plans when stigma precludes engagement with mental health professionals. This curriculum addresses the need for educating trainees to manage stigma in clinical settings. Future studies are needed to evaluate changes in clinical practices and patient outcomes as a result of social neuroscience-based training on managing stigma.
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PMID:Managing Stigma Effectively: What Social Psychology and Social Neuroscience Can Teach Us. 2616 63


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