Alarming levels of stigma toward generalized dystonia: A cross-cultural comparison.

INTRODUCTION: Although stigma has been linked to poor quality of life, studies examining its prevalence in dystonia are lacking. Our objective was to determine prevalence and predictors of stigma against generalized dystonia in diverse cultural settings. METHOD: Participants were 273 (65.9% female) patients and visitors approached at primary care clinics from three populations: León, Nicaragua (92 participants); a mostly-Hispanic Clinic in Omaha, NE USA (85 participants); and a mostly-non-Hispanic population in Omaha, Nebraska (96 participants). Participants learned about generalized dystonia, epilepsy and schizophrenia through reading a small vignette and viewing videos, followed by a questionnaire designed to identify stigma. We compared levels of stigma between dystonia and other conditions at different sites and measured variables that could affect them. RESULTS: Prevalence of stigma was high toward dystonia (33.00%), similar to epilepsy and lower than schizophrenia. The results showed a complex relationship between the studied variables and level of stigma, especially with age. Female gender predicted more stigmatizing answers. Country of origin, level of education and self-identification of Hispanic ethnicity did not affect stigma. Learning more personal information about the dystonia patient decreased dystonia, a proof that unjustified preliminary negative judgment was present. CONCLUSIONS: Stigma against generalized dystonia was very prevalent across all the communities studied. Demographic and socio-cultural variables had different correlations to level of stigma, underlying the complexity of this problem. The alarming levels of stigma against dystonia justify further studies on how to minimize its impact on our patients.

The Intersection of National Immigration and Healthcare Policy.

Immigration policy and health care policy remain principal undertakings of the federal government. The two have recently been pursued independently in the judicial and legislative arenas. Unbeknownst to many policymakers, however, national immigration policy and health care policy are linked in ways that, if unattended, could undermine the well-being of a significant portion of the US population, specifically medically underserved rural and urban populations. Using current data from a workforce report of the Association of American Colleges and the published literature, we demonstrate the significant impact that contemporary immigration policy directives may have on the number and distribution of international medical graduates who currently provide-and by the year 2025 will provide-a significant portion of primary health care in the United States, especially in underserved small urban and rural communities.

Angioplastia transluminal coronária: indicações atuais, critérios de sucesso e segunda angioplastia / Coronary transluminal angioplasty: current indications, criteria of success and 2d angioplasty

De dezembro de 1979 a dezembro de 1984 foram realizadas 715 angioplastias coronárias (ATC) em 643 pacientes, cujas idades variaram de 25 a 80 anos (média 53,5 anos), sendo 501 do sexo masculino. Sessenta e oito casos (10,4%) apresentavam idade >= 65 anos. Em 604, a indicaçäo da ATC foi considerada eletiva. Os demais exibiam algumas das formas chamadas "síndromes coronárias agudas": 29,7%, síndrome intermediária; 18,0%, angina pós-infarto agudo do miocárdio (IAM); 17,1%, fase aguda do IM sem o uso prévio de estreptoquinase (ESQ) e 35,2%, na fase aguda do IM após o uso da ESQ. O sucesso primário foi de 81%. Imediatamente após o procedimento, ocorreram as seguintes complicaçöes: oclusäo total da artéria (3,7%), dissecçäo (1,2%), cirurgia de emergência (3,9%) e óbitos (0,27%). Houve diminuiçäo das operaçöes de emergência à medida que progrediu a experiência (8% em 1981 e 2,6% em 1984). Trezentos e cinqüenta e quatro casos, com mais de 6 meses de evoluçäo, foram avaliados tardiamente, do ponto de vista clínico e/ou laboratorial (288 por estudo angiográfico, 42 por teste ergométrico e/ou mapeamento cardíaco com tálio-201 e 5 apenas por dados clínicos). A reestenose foi documentada em 90 destes casos (25,4%), em um período que variou de 1 a 12 meses (média 3,6 meses) após a dilataçäo. Em 90% dos que reobstruíram o vaso tratado, houve retorno da angina e, nos restantes, a suspeita foi feita pela avaliaçäo näo invasiva. O sucesso da segunda ATC foi 84,6% (33 de 39 casos). Ocorreram, neste grupo, 7 reestenoses tardias (25%) e, nos demais, foi mantido o resultado do segundo procedimento. Em 2, obteve-se sucesso com a terceira angioplastia e, destes, 1 apresentou reestenose, sendo, entäo, operado. Os autores concluem que a ATC, em vista dos resultados imediatos e a longo prazo, firmou-se como método terapêutico da doença obstrutiva aterosclerótica coronária, com grande espectro de indicaçöes e complicaçöes cada vez menores. a reestenose deve ser tratada pela segunda angioplastia, que exibiu margem de sucesso, inicial e a longo prazo, igual à primeira ATC, conferindo um percentual acumulado de bons resultados de cerca de 85%