795 research outputs found
Structure, (governance) and health: An unsolicited response
Background: In a recently published article, it was suggested that governance was the significant
structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the
observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the
paper raised but left unexamined the potentially more important questions about the relationship
between the broader health of populations and structural factors such as the national economy and
physical infrastructure.
Methods: Utilizing substantially the same data sources as the original article, the relationship
between population health (healthy life expectancy) and three structural factors (access to
improved water, GDP per capita, and governance) were examined in each of 176 countries.
Results: Governance was found to be significantly correlated with population health, as were GDP
per capita, and access to improved water. They were also found to be significantly correlated with
each other.
Conclusion: The findings are discussed with reference to the growing interest in structural factors
as an explanation for population health outcomes, and the relatively weak relationship between
governance and HIV prevalence
HIV, Stigma, and Rates of Infection: A Rumour without Evidence
The modern concept of a social stigma comes from the work of American sociologist Erving Goffman, who described it as a response to a deeply discrediting attribute that devalues the person [1]. In the medical literature, stigma is almost inevitably written about in terms of adverse social sequelae of a disease—such as leprosy, tuberculosis, epilepsy, schizophrenia, or filariasis [2–6]—or a physical characteristic or functional loss, such as obesity, deafness, or paraplegia [7–9]. The consequences of stigma range from moderate opprobrium at one end of the spectrum to death [10]
Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses' attitudes
Background: Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS
(PLWHA). In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially
marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes
towards injecting drug users on perceptions of PLWHA within the health care contexts has not
been thoroughly explored, and typically neglected in terms of stigma intervention.
Methods: Semi-structured interviews were conducted with a group of twenty Thai trainee and
qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the
constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were
explored with a focus on how participants' views concerning the high-risk behaviour of injecting
drug use might influence their attitudes towards PLWHA.
Results: The analysis shows that active efforts were made by participants to separate their views
of patients living with HIV/AIDS from injecting drug users. While the former were depicted as
patients worthy of social support and inclusion, the latter were excluded on the basis that they
were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the
community. Absent in the narratives were references to wider socio-political and epidemiological
factors related to drug use and needle sharing that expose injecting drug users to risk; these
behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed
for their seropositive status. These attitudes could potentially have indirect negative implications
on the nurses' opinions of patients living with HIV/AIDS more generally.
Conclusion: Decreasing the stigma associated with illicit drugs might play crucial role in improving
attitudes towards patients living with HIV/AIDS. Providing health workers with a broader
understanding of risk behaviours and redirecting government injecting drug policy to harm
reduction are discussed as some of the ways for stigma intervention to move forward
Socioeconomic inequalities in access to health care: Examining the case of Burkina Faso
Copyright @ 2011 Johns Hopkins University PressThe past decade has recorded remarkable interest in socioeconomic inequalities in health care. A multivariate analysis of the World Health Survey data for Burkina Faso was conducted using STATA. This included questions on household economic factors, perceived need, and access to health care. Poverty was defined using Principal Components Analysis. There was no significant difference in perceived need on the basis of poverty or gender. The less poor accessed health care more than the poor, but this difference was significant only among males. Respondents who lived in urban areas accessed health care more than those in rural areas, but this difference was significant only among females. We argue that health care financing arrangements affect self-reported need and access to health care. Even when they perceive need, the poor do not access care, probably because of cost, exacerbated by non-availability of readily accessible health care facilities
"Social Medication" and the control of children: A qualitative study of over-the-counter medication among Australian children
Objective. The aim of the study was to
identify the patterns of use of over-the-counter (OTC)
medications among children.
Methods. The study used a qualitative design, with
in-depth interviews of 40 parents with children <5 years
of age.
Results. There were 3 striking and readily apparent
themes in the use of OTC medications among children.
One was the administration of OTC medications as a
form of “social medication,” to give parents control over
children’s behavior that they perceived as fractious and
irritating. A related theme was the use of OTC medications
to reduce the inconvenience to the parents of having
a sick child, again giving parents greater control and
better time-management abilities. Finally, acetaminophen
was considered by many parents to have almost
miraculous properties in calming, sedating, and lifting
the mood of children.
Conclusions. The use of OTC medications for the
treatment of minor ailments among children is widespread,
despite the lack of evidence of efficacy of the
most commonly used medications and the potential for
toxicity. With the increasing propensity to look to medication
as a means of supporting changing lifestyles,
there is an urgent need to review the prevalence and
effects of social medication. Pediatrics 2004;
114:e378 –e383. URL: http://www.pediatrics.org/cgi/
content/full/114/3/e378; parental stress, parental perception,
child behavior, drug safety, over-the-counter
Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation – A factorial survey of medical students in China
Background: HIV/AIDS related stigma interferes with the provision of appropriate care and
support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as
if it occurs in isolation, separate from the co-stigmas related to the various modes of disease
transmission including injection drug use (IDU) and commercial sex (CS). In order to develop
better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between
HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an
experimental study for disentangling the layering of HIV/AIDS related stigmas.
Methods: The study used a factorial survey design. 352 medical students from Guangzhou were
presented with four random vignettes each describing a hypothetical male. The vignettes were
identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a cocharacteristic
(IDU, CS, commercial blood donation (CBD), blood transfusion or no cocharacteristic).
After reading each vignette, participants completed a measure of social distance that
assessed the level of stigmatising attitudes.
Results: Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently
developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics
were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of
AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of
IDU alone or CS alone.
Conclusion: The findings pose several surprising challenges to conventional beliefs about HIV/
AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma.
Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to
people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating
effect on the stigma of certain co-characteristics like IDU. The strong interdependence between
the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas
should be an integral part of HIV/AIDS stigma intervention within this context
Health systems performance in sub-Saharan Africa: Governance, outcome and equity
Copyright @ 2011 Olafsdottir et al.BACKGROUND: The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance.
METHODS: Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. RESULTS: Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. CONCLUSION: This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results
Behaviour Change in Public Health: Evidence and Implications
Article ID 598672The evidence on the role of particular lifestyles, smoking, binge drinking, lack of physical activity, and poor health care seeking, in increased risks for mortality and morbidity is compelling [1]. Understanding the pathways through which these various “unhealthy” behaviours affect health is complicated by the broader ecological context in which they occur. The complexity is further enhanced because behaviours do not occur in isolation and there is often a convergence of associations. Interventions to achieve changes in either single or multiple behaviours have therefore often been limited in their effectiveness and longer term sustainability. In order to develop and implement a meaningful behaviour change agenda we need to establish innovative ways of operationalizing and understanding the complexity of behavioural factors and their dynamic interrelationships and how these collectively affect health. The Behaviour Change Research Cycle (BCRC) (Figure 1) provides a simple illustration of the life cycle of evidence required
Psychology ethics down under: A survey of student subject pools in Australia
A survey of the 37 psychology departments offering courses accredited by the Australian Psychological Society yielded a 92% response rate. Sixty-eight percent of departments employed students as research subjects, with larger departments being more likely to do so. Most of these departments drew their student subject pools from introductory courses. Student research participation was strictly voluntary in 57% of these departments, whereas 43% of the departments have failed to comply with normally accepted ethical standards. It is of great concern that institutional ethics committees apparently continue to condone, or fail to act against, unethical research practices. Although these committees have a duty of care to all subjects, the final responsibility for conducting research in an ethical manner lies with the individual researcher
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