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 3,232 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A discussion of unconscious psychological resistance to contraception is illustrated by the case of a woman with a 10-year history of use of oral contraceptives and IUDs marked by repeated development of side effects and changes of formulation culminating in a serious depression after tubal ligation at age 35. The woman's postligation complaints of abdominal pain resistant to analgesic treatment were the expression of a serious depressive syndrome that responded poorly to antidepressants. The request for contraception normally contains 2 propositions: the individual desires to have sexual relations, and the individual does not wish to procreate. The logical connection between these 2 propositions at the conscious level is absent at the level of the unconscious, where there is no logic or possibility of reasoning. Forgetting a pill is a relatively minor form of resistance to contraception. Other symptoms, such as pain, vertigo, nausea, nervousness, insomnia, and anxiety with the pill or unexplained pain, repeated local infections, or anxiety and depression with the IUD may be manifestations of the psychological modifications inevitably caused by the psychic symbolism of the contraceptive. The difficulty experienced by certain women in accepting in their unconscious the 2 propositions about contraception causes the symptoms to be produced. Unconscious motives for resistance to contraception may include a woman's dependence on the potential for maternity for her sexual identity, or anxiety at the degree of sexual freedom offered by the contraceptive method. The unconscious elements related to resistance are sometimes open to modification. A study of women undergoing abortion at a center in Rennes indication that 91% failed to use an effective method of contraception at the time of the pregnancy, but that 1 year later 76% had accepted a method. Only 12% at risk of undesired pregnancy were not using a method. A large part of the increased usage was probably explained by contraceptive information provided at the time of the abortion, but the very fact of the abortion may have helped some of the women resolve their feelings of ambivalence about contraception. But 53% of the contraceptive acceptors complained of side effects, mainly anxiety, decreased sexual pleasure, weight gain and menstrual problems. It appears that an abortion may influence the decision to use a method without greatly changing the resistance to contraception. The practitioner wishing to assess the potential tolerance or resistance of a woman to contraception should take the time to discuss her feelings about contraception, menstruation (which signifies absence of pregnancy and thus maternity), and her sexual and emotional life. the dialogue can continue in subsequent visits if the women had complaints about side effects.
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PMID:[Resistance to contraception]. 219 28

Algodystrophy is a pathological syndrome of the limbs caused by a disturbance of the neurovegetative system of which the main consequence is a disorder of the regulation of the regional micro-circulation: pain, functional loss of use of a limb segment and the secondary appearance of trophic disorders with joint stiffening are the main symptoms of this disease. Among the etiologies, traumatic causes are first considered without forgetting nervous, visceral and drug induced causes. The treatment is based on pain killers, vascular medications, beta-blockers and Calcitonin. In addition to active physical therapy, recent experiments permit to confirm the advantages of scottish baths.
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PMID:[Algodystrophy of the upper extremity]. 288 99

Women who have chosen to undergo abortions often feel shame, guilt, or unease at knowledging their pain and grief. The grief of abortion is different from that following loss of a loved one because the abortion represents an act of will, a conscious choice. Instead of feeling sad, the woman is expected to make every effort to forget the experience, to speak of it no more. But in a chapter abortion in her latest book, "Feminine Sexuality", the psychoanalyst Francoise Dolto stresses that abortion is always an important event. The woman seeking an abortion should be allowed to speak of her anguish, her fear, her moral solitude, and perhaps of her hostility to her partner or to all men. After the operation, the woman should be seen again and provided with support as she tries to make sense of her experience. The greatest support one can offer a woman after an abortion is to restore her confidence in her desire to resume sexual relations. At the St.-Denis clinic in Montreal, a postabortion visit is always offered to young patients wishing to speak of their experience. The desire to forget is so strong that no adolescents consult the clinic for this postabortion dialogue. But among 15 patients aged 15-18 invited specifically to discuss the experience 2 weeks after their abortions, only 1 refused, saying it would prevent her from forgetting. The rest for the most part believed they had made the right decision, but some experienced regret or guilt, or said they had difficulties sleeping. Many felt lonely because they had obtained the abortion in secret and they had no one to talk to about it. The women grieved over not being able to share the intense sensations of early pregnancy, over not being able to realize their desire for a child, at the blow to their self-image represented by abortion, at the loss of childhood, and at the damage to their relationships caused by the abortion. To enable adolescents to express their grief, the practitioner should be able to listen in a nonjudgmental way. The interview should not aim to reassure at all costs, but to assist the patient in putting her feelings into words. The topic of sexual relations can be introduced through a discussion of contraception. The patient should know that it is common but not necessary to feel sadness and guilt, and that she can return to talk about her experience.
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PMID:[The right to live with pain]. 385 82

To approach the question of motivation toward contraception, the new French law on contraception passed in 1967, and the mode of action and risks of pills, IUDs, and diaphragms are reviewed. The new law governs import sale, prescription, placement of IUDs, consent for minors, and facilities of the clinics that issue contraceptives. Physicians dislike the prescription registration system, the written consent, lack of reimbursement by social security, and neglect of abortion. Oral contraceptives act on gonadotropin release, cervical mucus, and endometrial development. The can cause nausea, weight gain, bleeding, and thromboembolism. The relationship of medicine phobia, forgetting pills, and religion to success with pills remains to be studied. IUDs act on tubal and uterine motility and the endometrium. They frequently cause bleeding, pain, and expulsion, and rarely infection or perforation. Their failure rate is .5-2%. They are indicated when contraception must be separated from sexuality. Diaphragms and caps require technical fastidiousness and usually are preferred by older women. Their failure rate is 10-12% Now that contraceptive research can be done openly in France, more information about contraceptive motivation will become available.
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PMID:[Motivations, acceptance and refusal of contraceptive methods]. 575 71

Americans simultaneously worry about dying and about being tethered to machines that keep them alive beyond a point when life has any meaning. People living with terminal illness often feel isolated from life around them and a burden on those they love; they feel uncertain that their deaths will be relatively free of pain and suffering and that their dignity will be compromised as little as possible. These failings can be remedied. Traditional hospice care and integrating palliative care into the general medical setting are important, but they cannot alone occasion a better dying. The medical community must re-imagine dying and reflect about ways to transform image into reality in practice and in training colleagues and successors. Physicians and others know how to provide care and even improve living when cure is unlikely; the harder task is to respect such care as profoundly as curing. The exigencies of modern medicine, where time is a budgetable commodity, makes caring well for dying patients difficult. Medicine cannot have hegemony over dying and cannot singularly offer people a better death, but it cannot absent itself either. The almost single-minded focus on decision making that has infused conversations about dying and death may divert attention from the attentiveness and loving relationships that are as vital as life's end as at its beginning. Medicine has "colonized" death: It has transformed it into a place where progress in staving it off may appear to be unlimited, and thus it encourages forgetting that death is part of the human condition. The task before medicine, and academic medicine in particular, is to transform death back into a human scale. With all that is available to delay death--but not to make it optional--the most important task is to recover humbleness before an awesome moment and be with the patient, one human being to another, knowing that dying is not always open to solutions.
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PMID:Reflections on death and dying. 952 41

Aggressive symptom control is a vital component of palliative medicine. Frequently both physicians and patients focus on pain control, forgetting the broader issues of symptom control. Pain and other symptoms are inextricably linked. Common symptoms include constipation, nausea and vomiting, insomnia, anorexia, weight loss, and cough. All oncologists should be familiar with the indications, doses, and unwanted effects of drugs commonly indicated for symptom control. This article will discuss some drugs presently available to achieve good symptom control. At the correct dose and dosing schedule, these agents can have a significant impact on quality of life. As in all areas of medicine, it is best to know the benefits and unwanted effects of a few drugs, rather than randomly prescribing different agents for similar clinical situations. This is rational prescribing. While the list presented here is not exhaustive, it does reflect core drugs currently available in the United States.
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PMID:Symptom control in advanced cancer: important drugs and routes of administration. 1069 23

Qualitative methods were used to investigate decision-making among a group of older adults who declined the offer of flexible sigmoidoscopy screening for bowel cancer. Interviews were conducted with 60 people (30 men and 30 women) who either had not responded to the screening letter or who responded saying that they were not interested in participating. The findings suggest that low perceived susceptibility to bowel cancer, in terms of current health status, family history or absence of bowel symptoms. was an important factor in the decision to decline screening. Procedural barriers such as embarrassment, pain/discomfort and perceived unpleasantness of the test were reported as relatively minor, although the test was considered more physically intrusive than other screening tests. Avoidant attitudes emerged as an important theme and were reported by a third of respondents. Distinct patterns of decision-making were also observed and three groups emerged from accounts: (i) forgetting or avoiding making a decision about the test (ii) a confident rejection of the test based on a few salient factors, and (iii) a more careful consideration of the test focusing on issues of susceptibility. The findings are discussed in the context of models of health behaviour and bowel cancer screening participation research.
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PMID:Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process. 1147 46

This study tested questions of ecological validity by comparing the eyewitness testimonies of children directly experiencing a painful inoculation experience those of children in a yoked-control group who vicariously experienced the inoculation onwith videotape. The study involved 86 5-year-olds, divided between 2 groups: the experiential and yoked control. The experiential group was followed through a health department with a video camera as they received diphtheria, pertussis, tetanus (DPT), and oral polio inoculations. They were tested immediately, 20 min later, and 1 month later. Each child in the yoked-control group merely watched the videotape of his or her counterpart in the experiential group, made similar ratings of pain, and was given the same tests and suggestions. Stress and personal experience affected items congruent with the stressor to produce flashbulb-like memories, with slower rates of forgetting for some items, such as nurse identifications, and greater suggestibility for other items, such as estimates of needle size. These and the apparently conflicting results in the literature were said to make sense when personally experienced stress was viewed from S.-A. Christianson's (1992) interactive perspective rather than as a single ubiquitous variable.
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PMID:Similarities and differences in eyewitness testimonies of children who directly versus vicariously experience stress. 1167 66

The purpose of this study was to describe and classify the barriers to breast self-examinations (BSE) and mammography in African American women. A total of 125 African American women were recruited from historically black colleges, churches and community organizations in Nashville, Tennessee. Their responses to a comprehensive open- and closed-ended questionnaire about barriers to BSE and mammography were coded using a hierarchical coding system and analyzed according to participants' stage of behavior change assignment. On the average, each woman reported 3.1 barriers to BSE (2.5 psychological and 0.6 environmental) and 2.5 barriers to mammography (1.5 psychological and 1.0 environmental). Barriers cited included fear of finding cancer, forgetting, lack of time, lack of knowledge, competing demands, costs, pain, emotional consequences, cultural attitudes towards medicine, uncertainty about benefits and laziness. For BSE, the number of psychological barriers exceeded environmental barriers, while for mammography, the number of psychological and environmental barriers was similar. For BSE, but not mammography, psychological barriers appeared most important for women in the precontemplation, contemplation and preparation stages of behavior change. Overcoming barriers to BSE and mammography could increase early detection rates in African American women. Interventions based on stage of change theory may be especially applicable.
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PMID:A taxonomy of obstacles to breast examinations in African American women. 1498 90

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes.
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PMID:Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers. 1529 89


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