Social science & medicine
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Social science & medicine · Nov 2003
Pain management and symptoms of substance dependence among patients with sickle cell disease.
Concerns about dependence on prescribed analgesia may compromise pain management, but there was previously little reliable evidence about substance dependence among patients with sickle cell disease (SCD). We conducted in-depth, semi-structured interviews with SCD patients in London, UK, to assess DSM-IV symptoms of substance dependence and abuse. Criteria were applied to differentiate between pain-related symptoms, which corresponded to the DSM-IV symptoms but involved analgesics used to control pain, and non-pain-related symptoms, which involved analgesic use beyond pain management. ⋯ Psychological disturbance was a theme associated with non-pain-related symptoms. The implications are for more responsive treatment of pain in SCD and greater awareness of how patients' pain coping may be perceived as analgesic dependence. Further research could examine ways that pain-related and non-pain-related symptoms of dependence may be associated with other pain coping strategies and with the outcomes of treatment for painful episodes in hospital.
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Social science & medicine · Nov 2003
Comparative StudySomatization and mental health: a comparative study of the idiom of distress hypothesis.
Somatization is the expression of physical symptoms in the absence of medically explained physical illness. As a disproportionate response to psychosocial distress, somatization is usually correlated with depression. According to the idiom of distress hypothesis, the association of somatization and mental health is mitigated when somatizing indirectly expresses, and is understood by others as, emotional distress. ⋯ Bivariate and multivariate analyses revealed that the relationship of somatization with mental health depends on culture. Also, the disparity in mental health was greatest and favored the U. S. adults at low levels of somatization, but the disparity in mental health between countries disappeared as somatization increased.
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Social science & medicine · Nov 2003
Physicians' experiences of caring for late-stage HIV patients in the post-HAART era: challenges and adaptations.
As medical treatment for AIDS has become more complex, the need for good palliative and end-of-life care has also increased for patients with advanced disease. Such care is often inadequate, especially among low-income, ethnic minority patients. The current study investigated physicians' experiences with caring for dying HIV patients in an underserved, inner city community in the Bronx, NY. ⋯ Working with dying HIV patients in the post-HAART era of efficacious treatment challenges physician's cherished roles and values. Physicians adapt to the challenge through a variety of cognitive and behavioral strategies. The failure to adapt successfully has psychological consequences for providers that may impact patient care.
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Social science & medicine · Nov 2003
The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India.
Few studies have investigated the impact of immunization campaigns conducted under the global polio eradication program on sustainability of polio vaccination coverage, on coverage of non-polio vaccines (administered under Expanded Program on Immunization (EPI)), and on changes in social inequities in immunization coverage. This study proposes to fill the gaps in the evidence by investigating the impact of a polio immunization campaign launched in India in 1995. The study uses a before-and-after study design using representative samples from rural areas of four North Indian states. ⋯ Significant dropouts between first and third dose of polio raise concerns of sustainability of immunization coverage under a campaign approach. Similarly, little evidence to support synergy between polio campaign and non-polio EPI vaccinations raises questions about the effects of polio campaign on routine health system's functions. However, moderate success of the polio campaign in reducing social inequities in polio coverage may offer valuable insights into the routine health systems for addressing persistent social inequities in access to health care.