Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study

Using ethnographic data from Nigeria, Tanzania, and Uganda, Norma Ware and colleagues examine why levels of adherence to HIV/AIDS drugs are so much higher in sub-Saharan Africa than in North America

Social Relationships and Mortality Risk: A Meta-analytic Review

In a meta-analysis, Julianne Holt-Lunstad and colleagues find that individuals' social relationships have as much influence on mortality risk as other well-established risk factors for mortality, such as smoking

Plural medicine in Sri Lanka: Do ayurvedic and western medical practices differ?

In Sri Lanka, as in India, two formally structured systems of medicine exist side by side. While Western-style biomedicine is believed to be useful, Ayurvedic medicine is well established and commonly used. Underlying one explanation for the persistence of such plural medical systems is a functional theory, suggesting that each system is used for different treatments, diseases, or for the ideological, linguistic or social characteristics of the physician. In part, Ayurvedic and Western medicine may persist because their practitioners provide distinctly different services. We tested part of this functional explanation by sending trained 'pseudo-patients' to 764 Ayurvedic and allopathic physicians across Sri Lanka. 'Patients' reported symptoms of common cold, diarrhea or back pain, and recorded after leaving the clinic many aspects of history-taking, diagnostic procedures and physician-patient interaction. Medicines prescribed were later analyzed by a laboratory. We found, basically, no significant differences between the medical practices of sampled Ayurvedic and Western-style physicians, with one exception. While both types spend 3-4 min asking four questions and doing two or three physical examination procedures, and while both prescribe, overwhelmingly, only Western medicines, the allopathic physicians give drugs, that, from the point of view of Western medicine, either 'help' or 'harm' and Ayurvedic physicians prescribe 'neutral' medicines. While we have not directly tested the entire functional explanation we suggest that a structural explanation of the persistence of two systems of medicine may be more valid. Ayurvedic and Western medicine continue in Sri Lanka because they, as institutions, are linked to the social, economic and political structure of the society. Thus, survival is based, not on what a physician does in his practice but upon the power of his medical profession to control medical territory.plural medicine Sri Lanka Ayurveda Western biomedicine

Effects of social relationships on survival for women with breast cancer: A prospective study

In this study we examine the relationship between a woman's social contexts at the time of diagnosis and her chances of having survived breast cancer four years later. A cohort of 133 women were followed prospectively after initial diagnosis and treatment and data were obtained from a questionnaire mailed soon after diagnosis and from hospital charts. Using multivariate methods to examine predictors of survival, two clinical factors, pathologic nodal status and clinical stage of disease, were significantly associated with survival. In addition we found significant and indepedent effects on survival of: number of supportive friends, number of supportive persons, whether the woman worked, whether she was unmarried, the extent of contact with friends and the size of her social network. Thus, the woman's social context, particularly contexts of friendship and work outside the home, are statistically important for survival. Using existing literature, further data analyses and interviews with some survivors, we speculate on the ways in which social contexts may influence survival and suggest research methods suitable to this question.breast cancer social networks social support survival

Infant mortality in Sri Lankan households: A causal model

The infant mortality rate in Sri Lanka has fallen precipitiously since World War II, to 44 per 1000 births, a rate that is similar to a number of Western Countries. Yet the aggregated country rate masks wide variations across districts, from a low 21 per 1000 in Jaffina District to a high of 100 per 1000 in Nuwara Eliya District. Such regional variations in infant mortality rates have been shown to be related to a number of social, demographic and intitutional characteristics of each area. To specify such linkages we move, in this paper, from the aggregate level of analysis to the level of individual households in order to look for social, economic and other characteristics associated with infant deaths. Data are derived from a systematic interview of 480 household heads in 12 villages of Sri Lanka, collected in 1980. The most proximate factors, public health or medical variables, that predict infant death in particular households include quality of family nutrition, supervised childbirth, immunization of children and, most significant, whether the family has a sanitary latrine. Yet these medical variables are strongly associated with educational and economic characteristics of the family which, in turn, are predictive of infant mortality. Poor families and poorly educated mothers are less likely to go to hospital for childbirth, have a latrine, etc., and more likely to have had an infant die. Underlying the variations in education and economic status are variations in ethnic group; families with poor sanitation, least education and few economic resources are most likely to be members of the minority communities, Ceylon or Indian Tamils and Muslims. Minority group membership is significantly associated with infant mortality as well. When a set of medical, educational, economic and cultural variables are examined simultaneously within a path model we show that the best causal explanation of infant death in Sri Lankan households says, "Minority group status results in poverty which prevents families from having safe sanitary facilities which causes infant death". Infant mortality in Sri Lanka is thus not simply a medical problem to be dealt with by public health programs, nor is it solely an economic problem that can be solved with creation of jobs, but it is better seen as a problem of the structure of the whole society.

A measure of the 'sick' label in psychiatric disorder and physical illness

Persons with psychotic disorders recieve devalued labels. Despite considerable theorizing, the proposition that these labels affect the course of psychotic illness has rarely been subjected to investigation. The lack of an adequate operational measure for the labeling construct has hampered research. The present report describes the development of the Social Response Questionnaire (SRQ), a measure of the 'sick' label which incorporates moralistic attitudes, fear of dangerousness and negative expectations attached to the role of the severely psychiatrically ill. This 32-item scale, a multidimensional measure of informal labeling, which may be administered in a self-report format or to significant others, permits the study of dose-response relationships. The SRQ is internally stable. It also exhibits construct validity. Schizophrenics and persons with affective psychosis label themselves and are labeled by others more harshly than persons with Crohn's disease or normals. While self-percepts and the perceptions of significant others are fairly congruent for normals and persons with a significant physical illness, there is no agreement between the self-ratings of psychotics and their significant others. Psychotic persons view themselves more negatively than Crohn's disease sufferers or normals, but not as negatively as their therapists, families and friends. Potential uses for the SRQ in longitudinal research are addressed.labeling stigmatization schizophrenia perception of mentally ill