Regulating Pornography: A Public Dilemma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73656/1/j.1460-2466.1990.tb02271.x.pd

Depression and loneliness in Jamaicans with sickle cell disease

<p>Abstract</p> <p>Background</p> <p>Sickle cell disease (SCD) is the commonest genetic disorder in Jamaica, and has life-long implications for those afflicted with it. It is well known that depression and loneliness may exist in those with chronic diseases, but the coexistence of depression and loneliness in people with sickle cell disease is not clear. The aim of this study is to determine the prevalence of and factors associated with depression and loneliness in the Jamaica Sickle Cell Cohort Study and its age and sex matched controls.</p> <p>Methods</p> <p>277 patients with SCD and 65 controls were administered a questionnaire that studied demographics, disease severity, depression, and loneliness. Regression analyses were done to examine relationships between outcomes and associated variables.</p> <p>Results</p> <p>Depression was found in 21.6% of patients and 9.4% in controls. Loneliness scores were also significantly higher in patients (16.9 ± 5.1) than in controls (14.95 ± 4.69). Depression was significantly associated with unemployment [OR = 2.9, p-value: < 0.001], whereas unemployment (p-value: 0.002), and lower educational attainment were significantly associated with loneliness.</p> <p>In patients with SCD, depression was significantly associated with being unemployed (OR 2.4, 95% CI 1.2,4.6, p-value:0.01), presence of a leg ulcer (OR = 3.8, 95% CI: 1.7, 8.4, p-value: 0.001), frequent visits (OR = 3.3, 95% CI: 1.2, 8.9, p-value: 0.019), and frequent painful crises (OR = 2.5, 95% CI: 1.1, 5.8, p-value: 0.035). Not being employed (Coef.: 2.0; p-value: 0.004) and higher educational attainment (tertiary vs. primary education, Coef.: -5.5; p-value: < 0.001) were significant associations with loneliness after adjusting for genotype.</p> <p>Conclusions</p> <p>Health workers need to actively look for and manage these problems to optimize their patients' total biopsychosocial care.</p

Public opinion as a source of deinstitutionalization: A “spiral of silence” approach:A “spiral of silence” approach

This article develops a theoretical model to explain how public opinion can lead to the deinstitutionalization of a practice. Our model draws upon the ‘spiral of silence’ theory, that originated in the mass communication literature, and which suggests that social actors tend to support majority views. At the micro level, this behavior triggers a spiral of silence that leads to homogenous public opinion. We use analogical reasoning to posit the existence of a spiral of silence at the institutional field level. When public opinion becomes hostile to a particular practice, institutional fields tend to resist this external opposition. Insiders face the dilemma of whether to align with the majority view expressed by public opinion, or to comply with the one expressed at the field level. After discussing the mechanisms by which insider voices mediate and diffuse the hostility of public opinion at the field level, we discuss the boundary conditions applicable to our analogy. Our paper advances the understanding of nested and connected climates of opinion and bridges the gap between insider- and outsider- driven deinstitutionalization