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1.
Medicine (Baltimore) ; 99(21): e18945, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481246

RESUMO

The article deals with the ways Russian authorities have constructed the social problem of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) in Russia. The statistical construction of HIV/AIDS includes data indicating the significant rise of HIV prevalence in Russia since 2000. The study focuses on what and how Russian authorities speak about HIV/AIDS, while there are official data on the rapid spread of the virus in the country. The work is based on a discourse analysis of the authorities' rhetoric about HIV/AIDS. During his first presidential terms, Vladimir Putin constructed HIV/AIDS not as an epidemic in the country, but as a "global problem," representing Russia as a participant in international efforts to combat AIDS. The president problematized the HIV spread through the rhetoric of endangerment but without its crucial term "epidemic," while at the same time de-problematized HIV in Russia by the strategy of naturalizing ("this is a problem that all countries face"). The Russian authorities appealed to traditional moral values and spoke about marginal or risk groups, rather than risk practices. After the deterioration of relations with Western countries since 2007, the Russian president excluded HIV/AIDS problem from his public agenda, despite the existence of the data on steep HIV growth in Russia. The Russian president's traditionalism, de-problematization, and silence concerning HIV/AIDS lead to the absence of the HIV/AIDS issues in media agenda, the agenda of local authorities, and consequently the personal agendas of Russian citizens. The consequences are ignorance, fears, stigmatization of people living with HIV, semi-legal status of needle, and syringe exchange programs for intravenous drug users, low antiretroviral therapy coverage, and the continuing HIV epidemic.


Assuntos
Governo , Infecções por HIV/epidemiologia , Problemas Sociais , Síndrome de Imunodeficiência Adquirida/epidemiologia , Humanos , Federação Russa/epidemiologia
4.
PLoS One ; 15(2): e0229385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32106225

RESUMO

Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness. This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomized trial site. Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales. Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories. The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression. Over two-years, three group trajectories of stigma and discrimination were identified. For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory. The Housing First treatment had no significant effect on discrimination or stigma trajectories groups. For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories. History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory. For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group. Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group. This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems. There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.


Assuntos
Pessoas em Situação de Rua/psicologia , Transtornos Mentais/psicologia , Serviços de Saúde Mental/normas , Saúde Mental , Discriminação Social/estatística & dados numéricos , Problemas Sociais/estatística & dados numéricos , Estigma Social , Adulto , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação , Humanos , Masculino , Transtornos Mentais/fisiopatologia
7.
Am J Psychiatry ; 177(1): 47-57, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31509004

RESUMO

OBJECTIVE: Adverse childhood experiences (ACEs) are associated with mental and physical health risks that, through biological and psychosocial pathways, likely span generations. Within an individual, telomere length (TL), an established marker of cellular stress and aging, is associated with both ACE exposure and psychopathology, providing the basis for an emerging literature suggesting that TL is a biomarker of the health risks linked to early-life adversity both within and across generations. The authors tested the effect of maternal ACEs on both the trajectory of infant TL and infant social-emotional problems at 18 months of age. METHODS: Pregnant women were recruited, and maternal scores on the Adverse Childhood Experience questionnaire were obtained, along with demographic and prenatal stress measures. Postnatal visits with 155 mother-infant dyads occurred when infants were 4, 12, and 18 months of age. At each visit, infant buccal swabs were collected for TL measurement, and mothers completed measures of maternal depression. Mothers also completed the Child Behavior Checklist at the 18-month visit. Mixed-effects modeling was used to test how maternal ACEs influenced infant TL trajectory. Linear regression was used to test the association between maternal ACEs and infant internalizing and externalizing behaviors. Finally, the interaction between telomere attrition from 4 to 18 months and maternal ACEs was examined as a predictor of infant scores on the Child Behavior Checklist. RESULTS: Higher maternal ACEs were associated with shorter infant TL across infancy and higher infant externalizing behavioral problems at 18 months. No associations were found with internalizing behavioral problems. Telomere attrition from 4 to 18 months interacted with maternal ACEs to predict externalizing behaviors. In infants whose mothers reported higher scores on the Adverse Childhood Experience questionnaire, greater telomere attrition predicted higher externalizing problems, even when accounting for maternal postnatal depression and prenatal stress. CONCLUSIONS: These data demonstrate an interactive pathway between maternal early-life adversity and infant TL that predicts emerging behavioral problems in the next generations.


Assuntos
Sintomas Afetivos/epidemiologia , Filho de Pais Incapacitados/psicologia , Problemas Sociais/estatística & dados numéricos , Encurtamento do Telômero , Adulto , Biomarcadores/metabolismo , Maus-Tratos Infantis , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos Prospectivos , Psicopatologia
8.
Tex Med ; 115(12): 26-28, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31800091

RESUMO

Data compiled by the Texas Medical Association and other organizations, as well as physicians' own anecdotal experiences, show how 5 million uninsured patients in Texas become 5 million dominoes. As they fall, so do countless others representing the health of Texas: The economy and well-being of entire communities. The classmates and friends of uninsured children. And yes, the physicians who deal with the burdens of treating uninsured patients in emergency rooms and providing uncompensated care.


Assuntos
Seguro Saúde , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Saúde Pública , Problemas Sociais , Absenteísmo , Adolescente , Adulto , Criança , Saúde da Criança , Comércio , Serviço Hospitalar de Emergência , Pesquisas sobre Serviços de Saúde , Hospitais , Humanos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Médicos , Saúde Pública/estatística & dados numéricos , Texas , Cuidados de Saúde não Remunerados , Estados Unidos , Adulto Jovem
9.
Adv Gerontol ; 32(4): 664-667, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800198

RESUMO

The article presents the results of the analysis of the needs of long-lived people with disabilities in medical and social care, reflects the problems that arise in this contingent of persons when it is necessary to address the issues of medical and social rehabilitation. A medical and social examination of 238 long-lived patients undergoing inpatient treatment in a geriatric medical organization was carried out. The most frequent deviations from the norm in laboratory and instrumental methods of research are revealed. Screening of «Age is no obstacle¼, which revealed the presence of cognitive disorders and depression in a significant number of investigated and their dependence on others. Emphasized the importance of participation of bodies of social protection of the population in solving the problems of the aged.


Assuntos
Pessoas com Deficiência , Problemas Sociais , Idoso , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/reabilitação , Depressão/epidemiologia , Depressão/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Humanos , Problemas Sociais/estatística & dados numéricos
10.
PLoS One ; 14(12): e0225883, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851689

RESUMO

This study estimates the effect of data sharing on the citations of academic articles, using journal policies as a natural experiment. We begin by examining 17 high-impact journals that have adopted the requirement that data from published articles be publicly posted. We match these 17 journals to 13 journals without policy changes and find that empirical articles published just before their change in editorial policy have citation rates with no statistically significant difference from those published shortly after the shift. We then ask whether this null result stems from poor compliance with data sharing policies, and use the data sharing policy changes as instrumental variables to examine more closely two leading journals in economics and political science with relatively strong enforcement of new data policies. We find that articles that make their data available receive 97 additional citations (estimate standard error of 34). We conclude that: a) authors who share data may be rewarded eventually with additional scholarly citations, and b) data-posting policies alone do not increase the impact of articles published in a journal unless those policies are enforced.


Assuntos
Políticas Editoriais , Disseminação de Informação , Política , Editoração , Problemas Sociais , Humanos
11.
PLoS One ; 14(12): e0226306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887152

RESUMO

BACKGROUND: Persons experiencing homelessness and vulnerable housing or those with lived experience of homelessness have worse health outcomes than individuals who are stably housed. Structural violence can dramatically affect their acceptance of interventions. We carried out a systematic review to understand the factors that influence the acceptability of social and health interventions among persons with lived experience of homelessness. METHODS: We searched through eight bibliographic databases and selected grey literature sources for articles that were published between 1994 and 2019. We selected primary studies that reported on the experiences of homeless populations interacting with practitioners and service providers working in permanent supportive housing, case management, interventions for substance use, income assistance, and women- and youth-specific interventions. Each study was independently assessed for its methodological quality. We used a framework analysis to identify key findings and used the GRADE-CERQual approach to assess confidence in the key findings. FINDINGS: Our search identified 11,017 citations of which 35 primary studies met our inclusion criteria. Our synthesis highlighted that individuals were marginalized, dehumanized and excluded by their lived homelessness experience. As a result, trust and personal safety were highly valued within human interactions. Lived experience of homelessness influenced attitudes toward health and social service professionals and sometimes led to reluctance to accept interventions. Physical and structural violence intersected with low self-esteem, depression and homeless-related stigma. Positive self-identity facilitated links to long-term and integrated services, peer support, and patient-centred engagement. CONCLUSIONS: Individuals with lived experience of homelessness face considerable marginalization, dehumanization and structural violence. Practitioners and social service providers should consider anti-oppressive approaches and provide, refer to, or advocate for health and structural interventions using the principles of trauma-informed care. Accepting and respecting others as they are, without judgment, may help practitioners navigate barriers to inclusiveness, equitability, and effectiveness for primary care that targets this marginalized population.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Confiança/psicologia , Administração de Caso , Técnica Delfos , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Problemas Sociais , Serviço Social
14.
BMC Med Educ ; 19(1): 387, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640744

RESUMO

BACKGROUND: Between the late 1960s and early 1980s, Frederick Wiseman filmed hundreds of hours in an emergency department, intensive care unit and asylum. These films recorded events as they happened without rehearsal and narration. MAIN BODY: Cinema and Medicine meet each other in feature fiction film and in documentary format. Showing films in hospitals is revealing for both the unexpected audience but also the medical establishment. This paper revisits Wiseman's edited but explicit films and their revelation of the complexity of care in this era in the United States. Although they offer a narrow view of medical institutions and the issue of informed consent later became problematic, the films provide an intriguing glimpse of US healthcare and decision making. These films are largely unknown but would be an invaluable resource in a masterclass on medical ethics in urgent care and end-of-life decisions. CONCLUSIONS: Despite their flaws, Wisemans' medical films have a significant educational value. Each documentary can be used in a masterclass on medical ethics. The films provide ample opportunities to discuss core issues in healthcare, professional interactions, and decision making in critically ill patients.


Assuntos
Medicina de Emergência/educação , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Filmes Cinematográficos , Serviço Hospitalar de Emergência/história , Ética Médica , História do Século XX , Humanos , Unidades de Terapia Intensiva/história , Filmes Cinematográficos/história , Opinião Pública , Controle Social Formal , Problemas Sociais
15.
PLoS One ; 14(10): e0223040, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618276

RESUMO

Advances in community detection reveal new insights into multiplex and multilayer networks. Less work, however, investigates the relationship between these communities and outcomes in social systems. We leverage these advances to shed light on the relationship between the cooperative mesostructure of the international system and the onset of interstate conflict. We detect communities based upon weaker signals of affinity expressed in United Nations votes and speeches, as well as stronger signals observed across multiple layers of bilateral cooperation. Communities of diplomatic affinity display an expected negative relationship with conflict onset. Ties in communities based upon observed cooperation, however, display no effect under a standard model specification and a positive relationship with conflict under an alternative specification. These results align with some extant hypotheses but also point to a paucity in our understanding of the relationship between community structure and behavioral outcomes in networks.


Assuntos
Comportamento Cooperativo , Diplomacia , Problemas Sociais , Nações Unidas , Modelos Lineares
16.
BMC Public Health ; 19(1): 1250, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31510963

RESUMO

BACKGROUND: One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. METHODS: A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. RESULTS: Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. CONCLUSIONS: To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.


Assuntos
Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Apoio Social , Suicídio/psicologia , Adulto , Características da Família , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Problemas Sociais , Fatores Socioeconômicos , Espanha , Suicídio/estatística & dados numéricos , Inquéritos e Questionários
17.
Arch Sex Behav ; 48(8): 2367-2379, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31502070

RESUMO

The purpose of this study was to identify specific social-cognitive factors that may influence the likelihood of engaging in sexting, and potential positive and negative outcomes of such behaviors, in adults. We asked 244 adult participants (64.5% women) to complete a set of online measures reflecting sexting engagement, social-cognitive factors (definitions, differential association, differential reinforcement, and imitation), and outcomes of sexting behavior (risky sexual behavior appraisal, sexual satisfaction, and relationship satisfaction). Results showed that 77.6% of our sample had sexted. Sexting in the context of a romantic relationship was predicted by differential reinforcement and friend imitation, while positive definitions of sexting alone predicted sexting someone outside the context of a romantic relationship. This indicates that motivations for sexting engagement may be context specific in adulthood. Those who had sexted demonstrated significantly higher sexual satisfaction than those who had never sexted. However, sexting outside of a romantic relationship predicted reduced perceived risk and heightened perceived benefit of engaging in real-life risky sexual behaviors. This suggests there may be both positive and negative implications of sexting engagement in adulthood.


Assuntos
Cognição/fisiologia , Comportamento Sexual/psicologia , Comportamento Social , Envio de Mensagens de Texto/normas , Adolescente , Adulto , Feminino , Humanos , Masculino , Problemas Sociais , Adulto Jovem
19.
PLoS One ; 14(8): e0220583, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31433821

RESUMO

BACKGROUND: Achieving Universal Health Coverage (UHC) by improving financial protection and effective service coverage is target 3.8 of the Sustainable Development Goals. Little is known, however, about the extent to which paying bribes within healthcare acts as a financial barrier to access and, thus, UHC. METHODS: Using survey data in adults from 32 sub-Saharan African countries in 2014-2015, we constructed a multilevel model to evaluate the relationship between paying bribes and reported difficulties of obtaining medical care. We controlled for individual-, region-, and country-level variables. RESULTS: Having paid bribes for medical care significantly increased the odds of reporting difficulties in obtaining care by 4.11 (CI: 3.70-4.57) compared to those who never paid bribes, and more than doubled for those who paid bribes often (OR = 9.52; 95% CI: 7.77-11.67). Respondents with higher levels of education and more lived poverty also had increased odds. Those who lived in rural areas or within walking distance to a health clinic had reduced odds of reporting difficulties. Sex, age, living in a capital region, healthcare expenditures per capita, and country Corruption Perception Index were not significant predictors. CONCLUSIONS: We found that bribery in healthcare is a significant barrier to healthcare access, negatively affecting the potential of African countries to make progress toward UHC. Future increases in health expenditures-which are needed in many countries to achieve UHC-should be accompanied by greater efforts to fight corruption in order to avoid wasting money. Measuring and tracking health sector-specific corruption is critical for progress toward UHC.


Assuntos
Acesso aos Serviços de Saúde , Pobreza , Problemas Sociais , Cobertura Universal do Seguro de Saúde , Adolescente , Adulto , África ao Sul do Saara , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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