Social conditions in which medical students from the Faculty of Medicine of the National University of Mexico (UNAM) perform their Social Service in rural areas

The aim of this work is to describe the conditions in which medical students perform their Social Service, highlighting their experiences in areas such as: information before they move and the motivation to leave home; the perception of personal and environmental lack of safety; the institutional support that they receive during their work in the community and the financial support provided. The methodological design of the study included an exploratory phase, in which collective interviews were performed, using the focal group technique, with students who had been in rural areas. Three hundred sixty cases were considered, 72.8% corresponded to rural areas, and 27.7% to Mexico City. According to the findings, the following actions are proposed: give better information and improve the process of vacancy selection; increase the scholarship received by students in Social Service; establish legal, police, and community support mechanisms to guarantee the student's personal safety; pay attention to aspects such as the student's emotional and social situation, and design programs with gender perspective to enhance certainty and safety.     

Factors associated with posttraumatic stress disorder and depression in war-survivors displaced in Croatia

Aim

To examine the role of perceived stressfulness of trauma exposure and economic, social, occupational, educational, and familial adaptation after trauma in posttraumatic stress disorder (PTSD) and depression in displaced war survivors.

Methods

A cross-sectional survey was conducted between March 2000 and July 2002 with a sample of 173 internally displaced persons or refugees and 167 matched controls in Croatia. Clinical measures included Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale.

Results

Displaced war survivors reported the exposure to a mean ± standard deviation of 13.1 ± 8.3 war stressors, including combat, torture, serious injury, death of close persons, and loss of property. Compared to controls, they reported higher rates of marked to severe impact of war on family (16.2% vs 51.6%), social (7.2% vs 43.5%), economic (12.6% vs 55.4%), occupational (1.8% vs 15.9%), and educational (2.4% vs 8.8%) adaptation. In two logistic regression analyses, the strongest predictor of PTSD and depression was high level of perceived distress during trauma exposure. PTSD but not depression was associated with economic, social, occupational, educational, and familial adaptation after trauma.

Conclusion

Displaced survivors who experienced multiple war events perceived greater negative impact of war on their life domains compared to individuals who lived in a war setting but had no trauma exposure. The most important determinant of psychological outcomes was perceived stressfulness of war stressors. Although post-trauma adaptation in different life spheres had an impact, its effect was not robust and consistent across disorders. These findings suggest that it would be effective to use a trauma-focused approach in rehabilitation of war survivors.Armed conflicts, wars, and associated displacement affect large numbers of people in the world (1). According to the United Nations High Commissioner of Refugees (UNHCR) (2), at the end of 2010 the number of forcibly displaced people in the world was 43.7 million. Some war survivors are displaced within the borders of their countries as internally displaced persons, while others are displaced to other countries as refugees. In addition to war-related stressor events they have been through, such displaced war survivors are believed to experience enduring contextual stressors, including socioeconomic disadvantage and poverty, changes in family structure and functioning, loss of social support, lack of access to education, overcrowded housing, hostility and racism, acculturation difficulties, marginalization and isolation, and cultural bereavement (3-7). These stressors are claimed to cause general psychological distress (8), but there are few studies that examined their contribution to mental health while controlling for the impact of other potentially important variables.The most common mental health outcome of exposure to war-related traumatic stressors is posttraumatic stress disorder (PTSD) and depression (9). In a meta-analysis of 181 surveys comprising 81 866 refugees and other conflict-affected persons from 40 countries, the prevalence rate of PTSD across all surveys was 30.6% and that of depression was 30.8% (1). In this study, the factors that showed strong association with PTSD were cumulative exposure to traumatic events, time since conflict, and assessed level of political terror, while the factors associated with depression were cumulative exposure to traumatic events, time since trauma, torture, and residency status. An important factor that this meta-analysis did not control for (due to lack of data) was psychological processes during trauma exposure, including emotional reactions, perception of life threat, or dissociation during trauma, which have been determined to be the strongest predictors of PTSD (10-14). Indeed, in a series of studies involving war and torture survivors, distress and loss of control during exposure to traumatic stressors (9,15-19) emerged as the strongest predictors of PTSD when the effects of the number of trauma events (cumulative exposure) were statistically controlled for in a regression analysis.Some studies identified older age (20,21), female gender (3,21), and psychiatric history and current illness (22) as predictors of traumatic stress reactions but it is not possible to reach a conclusion about these associations because these studies rarely took into account the effects of trauma exposure characteristics.Political violence and terror during the 1991-1995 war in Croatia and the 1992-1995 war in Bosnia and Herzegovina were categorized as the highest level on the Political Terror Scale (23). Four years of conflict resulted in the displacement of almost 900 000 Croatian citizens of all ethnicities inside and outside the country. Serb secession in central and eastern parts of the country caused an internal displacement in Croatia of over 550 000 ethnic Croats. The war that erupted in Bosnia and Herzegovina in April 1992 resulted in a large population movement. Over the course of the conflict, Croatia accepted 403 000 refugees from the neighboring country (24). The total number of displaced war survivors in Croatia at the end of 1992 was more than 10% of the total Croatian population (25). In this study, we examined the factors associated with PTSD and depression in displaced war survivors in Croatia. Our aim was to determine the role of economic, social, occupational, educational, and familial adaptation after trauma on PTSD and depression while controlling for the effects of psychological processes during trauma exposure as well as demographic and personal history characteristics. Specifically, we hypothesized that 1) displaced war survivors who experienced multiple war-related potentially traumatic events would report greater negative impact on economic, social, occupational, educational, and familial adaptation compared to a control group of individuals who, despite living in a war setting, had no personal exposure to potentially traumatic events; 2) PTSD and depression would be most strongly associated with perceived stressfulness or uncontrollability of war-related traumatic stressors; and 3) economic, social, occupational, educational, and family adaptation in the aftermath of exposure to traumatic incidents would be an independent but weaker predictor of PTSD and depression.     

Intrapersonal and interactional empowerment: Implications for theory

This study builds on previous research linking empowerment theory with community participation. Empowerment theory has been criticized as overly individualistic and conflict‐oriented resulting in an emphasis on mastery and control rather than cooperation and community. The purpose was to develop a measure of interactional empowerment (assessing intellectual understandings of power and social change) and compare scores on this measure with scores on a measure of intrapersonal empowerment (assessing one's personal sense of control and efficacy). Results found that persons with greater levels of intrapersonal empowerment reported participating in community activities with greater frequency than persons with lower levels of intrapersonal empowerment. Persons with greater levels of interactional empowerment reported participating in organizational activities and having a stronger sense of community than persons with lower levels of interactional empowerment. © 2000 John Wiley & Sons, Inc.     

Country watch. Zimbabwe

One of the topics of the Second National Conference of People Affected/Infected with HIV/AIDS (Mutare, 1993) was support groups. These groups allow persons to share their experiences, which empowers the patient with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and informs the public about the needs of persons with HIV (PHIV). The most successful groups are those that promote activities (drama troupes which educate the public, income generating projects) that keep PHIV busy and positive, while promoting their acceptance in the community. Problems for support groups include funding, a lack of space, and the failure of income generating projects. Solutions will involve working with other organizations. It may be required to use open spaces under trees, shacks, community halls, or church buildings. Income generating projects will have to be better researched for feasibility. An HIV/AIDS Charter has been developed concerning the legal and human rights of PHIV. These include liberty and freedom of movement (no restriction on movement; no screening for travel; no segregation, isolation, or quarantine anywhere), employment (no discrimination), confidentiality, screening for HIV, education, employment, health and welfare support services, the media, spouses and sexual partners (their rights to be informed and protected), social and cultural rights, prisoners, and the responsibilities of persons with HIV. A national organization is being formed to facilitate the impact of support groups on policy and programs. 2 persons will represent each province.     

Después de la tormenta: Collective trauma following Hurricane Maria in a northeastern Puerto Rican community in the United States

Hurricane Maria was the largest disaster in Puerto Rico's history, affecting Puerto Rican communities throughout the United States. We conducted focus groups using a grounded theory approach with adults displaced from Puerto Rico to a northeastern community 12 (n = 5) and 17 months (n = 7) postdisaster. Key informant interviews were also conducted with nine community advocates working with displaced hurricane survivors. Emerging themes reflect narrative and social identity processes following collective trauma. Findings emphasize the need for timely and long‐term disaster responses that build on community strengths without leaving communities to cope on their own. We discuss how incorporating group storytelling in postdisaster research is a culturally sensitive practice that can promote resiliency among survivors.     

Personal support systems of former mental patients residing in board-and-care facilities

This is a study of the personal support networks of a selected group of formerly hospitalized psychiatric patients now residing in board-and-care facilities in Galt, California. Its purpose was to assess the particular forms of support available to such persons and to suggest ways in which short-comings in needed supportive interaction might be remedied. The article first reviews the circumstances of board-and-care placement. It then examines the concept of support systems and their relevance to the health and well-being of individuals. Following this, the findings of a study of 39 psychiatrically disabled persons residing in board-and-care homes in one rural California community are reported. Several recommendations are offered which illustrate two ways in which agency and community services might affect the support available to board-and-care residents.     

Reducing disparities in asthma care: priorities for research--National Heart, Lung, and Blood Institute workshop report

Minority groups with diverse racial and ethnic heritages and persons living in poverty are much more likely to die of asthma and to require emergency care for exacerbations of asthma than white persons not living in poverty. The National Heart, Lung, and Blood Institute convened a multidisciplinary group of expert scientists and clinicians to review current research aimed at understanding risk factors for these disparities in asthma health outcomes, to describe key barriers to improving asthma outcomes, and to establish priorities for future research. Education programs for asthma and other chronic diseases were reviewed. Successful elements of clinic and community-based programs were identified. Factors potentially involved in producing disparities include gene-environment interaction, psychologic and social factors, and socioeconomic status. Stress potentially contributes to asthma morbidity at both the individual and community level. Recommendations are made to stimulate research to understand risk factors for disparities and their mechanisms (e.g., gene-by-environment interactions and the role of stress), to define appropriate research designs and methods for evaluating behavioral and community interventions, and to examine how differential access to care contributes to morbidity. Research is encouraged to identify strategies that improve cultural adaptation and adoption of proven programs in a variety of populations.     

Medicine, morality and health care social media

ABSTRACT: Social media includes many different forms of technology including online forums, blogs, microblogs (i.e. Twitter), wikipedias, video blogs, social networks and podcasting. The use of social media has grown exponentially and time spent on social media sites now represents one in five minutes spent online. Concomitant with this online growth, there has been an inverse trajectory in direct face-to-face patient-provider moments, which continue to become scarcer across the spectrum of health care. In contrast to standard forms of engagement and education, social media has advantages to include profound reach, immediate availability, an archived presence and broad accessibility. Our opportunity as health care providers to partner with our patients has never been greater, yet all too often we allow risk averse fears to limit our ability to truly leverage our good content effectively to the online community. This risk averse behavior truly limits our capacity to effectively engage our patients where they are -- online.     

Network structural influences on the adoption of evidence‐based prevention in communities

This study examined the impact of key variables in coalition communication networks, centralization and density, on the adoption of evidence‐based substance abuse prevention. Data were drawn from a network survey and a corresponding community leader survey that measured leader attitudes and practices toward substance abuse prevention programs. Two types of coalition networks were measured: advice‐seeking and discussion relations. For each community, we computed network‐level measurements (n=20), and then used multiple linear regression. Results showed that adoption outcomes were associated with a decrease in centralization for the advice network and an increase in centralization for the discussion network, controlling for density. This suggests that community coalitions might consider decreasing their network density in such a manner that distributes power and influence among a broader base of coalition members to seek advice about programs while simultaneously discussing these programs in a more concentrated group to facilitate decisions about which programs to adopt. © 2009 Wiley Periodicals, Inc.     

The influence of a professional physician network on clinical decision making

ObjectiveThe aim of this study was to examine the role of physicians’ professional networks in decision-making processes.MethodsA professional network was examined in three stages: content analysis and categorization of discussions concerning decision-making processes, in-depth interviews, and a questionnaire.ResultsThe RAMBAM network has professional as well as social roles. On a professional level, physicians seek approval of their initial line of reasoning regarding their clinical cases, but will consider other approaches if such are suggested by persons of professional repute or if answers are based on evidence-based medicine and include referral to a relevant source. On a social level, physicians want to be part of their professional community and share information and experiences.ConclusionPhysicians’ professional networks have a social role that is expressed by a feeling of belonging to a community, as well as a professional role of capturing and disseminating medical knowledge during physicians’ decision-making processes. Professional networks constitute a unique source of tacit knowledge that extends existing formal knowledge resources.Practice implicationsThe study can increase physicians’ awareness of professional networks as a unique source of tacit knowledge and can assist in the future design of medical professional networks as knowledge resources for medical decision making.     

Transformed ground,transformed body: clinical implications for dance movement therapy with forced migrants

This paper considers the role of dance movement therapy (DMT) with forced migrants. The displacement of people refers to the forced movement of people from their locality or environment and occupational activities. It is a form of social change caused by several factors, the most common being armed conflict, although natural disasters, famine, development and economic changes may also be causes of displacement. In this study we consider the current situation experienced by people who have been forcibly displaced and the circumstances under which they left their country of origin, their journey and survival in the host country. A bibliographic review of DMT work with forced migrants and refugees highlights the importance of movement as a therapy with this population and stresses the urgency to find solutions for their integration in the host societies.     

Community attachment and satisfaction: the role of a community's social network structure

This paper links the micro and macro levels of analysis by examining how different aspects of community sentiment are affected by one's personal ties to the community compared with the organizational network structure of the community. Using data collected from residents of six communities in Washington State, network analysis combined with negative binomial regression is used to determine the effect of personal networks and community networks on community attachment and satisfaction. Findings suggest that while individual‐level variables, such as length of residence and individual ties, affect one's attachment to community, a community's network structure does not significantly affect community attachment. However, a community's network structure significantly affects one's evaluation of community. Regardless of one's ties to the community, residents of cohesive communities are more likely to evaluate the community's social and physical environments more positively. © 2010 Wiley Periodicals, Inc.     

SOCIAL ROLE VALORIZATION IN COMMUNITY MENTAL HEALTH HOUSING: DOES IT CONTRIBUTE TO THE COMMUNITY INTEGRATION AND LIFE SATISFACTION OF PEOPLE WITH PSYCHIATRIC DISABILITIES?

Despite its importance as a theory in the development of programs for populations with disabilities, social role valorization (SRV) has received relatively little attention in community mental health research. We present findings of a study that examined the relationship of housing‐related SRV to community integration and global life satisfaction of persons with psychiatric disabilities. The housing environments and associated supports of a group of 73 persons with psychiatric disabilities living in a mid‐sized city were assessed using the PASSING rating system on the extent that their housing environments facilitated SRV. In addition, in‐person interviews were conducted to determine the levels of physical integration, psychological integration, social integration, and life satisfaction of study participants. Results showed SRV contributing directly to all three types of community integration. Psychological integration was found to mediate the relationship between SRV and life satisfaction. Implications of the findings are discussed.     

A surgeon and a soldier--an interview with Booker King, MD, FACS. Interview by George Dawson

Periodically, for the past two years, the editorial staff of the Journal of the National Association has attempted to-for history's sake--highlight physicians of color. In this vein, and in light of the current hostile activities in the Persian Gulf, we felt it important we our bring readers, in this issue, the background and views of an African-American physician/soldier who served in the Iraqi theater of operations during the initial combat. Notwithstanding the current political machinations regarding the legitimacy of the conflict, his story is both insightful and inspiring because, in the end, it is soldiers and their families who bear the psychological and physical burden of armed conflicts. Finally, because of the history of privation that persons of African ancestry have had to endure in these lands, we feel it important that we, in these times, tell our story, on our terms. And Dr. Booker's story is one we feel truly proud to present. This interview was conducted by George Dawson, MD. He serves as editor of the Art in Medicine, History and Health Tidbit sections of the Journal of the National Medical Association.     

Personal, Cognitive, Behavioral, and Demographic Predictors of HIV Testing and STDs in Homeless Women

Using a multiracial sample of 621 homeless women, we tested a latent variable causal model of personal, cognitive, behavioral, and demographic predictors of two coping mediators and the outcome variables of HIV testing and return for test results and a recent STD infection. HIV testing and return were predicted by more social support, greater AIDS knowledge, greater perceived risk for AIDS, and more problem-focused coping strategies. Recent STDs were predicted by more AIDS knowledge, emotion-focused coping strategies, and risky sexual behavior and one measured variable, crack cocaine use. Emotion-focused coping strategies were predicted by drug use, less self-esteem, more social support, and greater perceived risk for AIDS. Hispanics reported less emotion-focused coping strategies than African-Americans. Predictors of problem-focused coping strategies included less drug use, more self-esteem, more social support, more AIDS knowledge, and less risky sexual behavior. African-Americans reported less problem-focused coping strategies than Latinas. Indirect effects on the outcomes mediated through coping styles are also reported. Theoretical and practical implications of results for community outreach are discussed.     

Social ecology and behavioral medicine: implications for training, practice, and policy

Social ecology offers a conceptual framework for understanding the etiology of multiple health problems and a basis for designing broad-gauge educational, therapeutic, and policy interventions to enhance personal and community well-being. Implications of social ecology for behavioral medicine are considered in relation to the development of diagnostic and therapeutic practices, professional training programs, and health policies implemented at municipal, state, and national levels. By influencing the training and practices of healthcare professionals and the decisions of corporate and community leaders, behavioral medicine can expand the scope and impact of future interventions beyond the health gains achievable through provision of direct services to patient populations. Potential barriers to establishing ecologically based health programs and policies and directions for research at the interface of behavioral medicine, social ecology, and public health are discussed.     

The relationship between parent-reported social support and adherence to medical treatment in families of adolescents with type 1 diabetes

OBJECTIVE: To investigate the relationships between both mother-reported spousal support and social network support, and mother-adolescent diabetes-related conflict, discrepancies in decision-making autonomy (DDMA), and adolescent adherence to diabetes treatment. METHOD: Fifty-one mothers of adolescents with IDDM completed self-report measures of social support, diabetes-related conflict, and adolescent autonomy for diabetes care. Analyses tested conflict and DDMA as mediators between mother-reported social support and adolescent adherence to treatment. RESULTS: Increased levels of mother-adolescent conflict were associated with poorer treatment adherence and both mother-reported diabetes-related conflict and DDMA predicted adolescents' glycemic control. Higher levels of mother-reported spousal support were associated with less conflict and greater adherence to treatment. Sobel's test indicated a statistical trend for conflict as a mediator between spousal support and adolescent treatment adherence (p < .07). DDMA did not predict mother-adolescent conflict and did not emerge as a mediator between mother-reported social support and adolescent adherence. CONCLUSIONS: This study highlights the role of spousal support for mothers of adolescents with IDDM and indicates that the level of spousal support mothers receive may play an important role in the health care behaviors of their adolescents.     

The influence of a professional physician network on clinical decision making

Objective

The aim of this study was to examine the role of physicians’ professional networks in decision-making processes.

Methods

A professional network was examined in three stages: content analysis and categorization of discussions concerning decision-making processes, in-depth interviews, and a questionnaire.

Results

The RAMBAM network has professional as well as social roles. On a professional level, physicians seek approval of their initial line of reasoning regarding their clinical cases, but will consider other approaches if such are suggested by persons of professional repute or if answers are based on evidence-based medicine and include referral to a relevant source. On a social level, physicians want to be part of their professional community and share information and experiences.

Conclusion

Physicians’ professional networks have a social role that is expressed by a feeling of belonging to a community, as well as a professional role of capturing and disseminating medical knowledge during physicians’ decision-making processes. Professional networks constitute a unique source of tacit knowledge that extends existing formal knowledge resources.

Practice implications

The study can increase physicians’ awareness of professional networks as a unique source of tacit knowledge and can assist in the future design of medical professional networks as knowledge resources for medical decision making.     

The supernatural, health and community action in Black Africa]

Based on the experience of community participation for tsetse control in the Congo, the author attempts to enlarge the reflexion on general health problems in Black Africa. He desires to draw the attention of the readers unfamiliar with anthropology, 1) to the current existence and social importance in the African communities of a particular approach, grounded on belief in the supernatural, radically different from Western thinking, 2) the intrinsic ambiguousness and richness of these ways of thinking, 3) to its great influence in community participation in sanitation programs. The ethical problems involved in the intervention of mediators using traditional or confessional ways of thinking are raised and included in a psychosocial problematic.     

HIV感染者/AIDS病人及其家属的焦虑、抑郁状况调查

目的:了解HIV感染者/AIDS病人及其家属的焦虑、抑郁状况及其相关因素,从而为建立HIV感染者/AIDS病人社区综合关怀支持模式、改善HIV感染者/AIDS病人及其家属的心理状况提供客观依据.方法:选择四川省HIV感染率和AIDS患病率较高的两个县(资中县和凉山州昭觉县)作为目标社区,在目标社区内共计调查了71名HIV感染者/AIDS病人及其162名家属和97名健康人群,选用抑郁自评量表(SDS)和焦虑自评量表(SAS)作为调查评定工具,选用生活质量量表(CQOL-74)、社会支持评定量表(SSS)收集相关资料,采用SPSS统计软件进行统计分析.结果:HIV感染者/AIDS病人的SAS和SDS评分高于正常对照(分别为t=5.343,t=5.272,P均＜0.001),已死亡的HIV感染者/AIDS病人家属的SAS和SDS评分高于正常对照(分别为t=4.873,t=5.133,P均＜0.001),HIV感染者/AIDS病人的SAS和SDS评分与疾病状况、物质滥用、社会支持及生活质量存在明显相关性.结论:焦虑和抑郁情绪在HIV感染者/AIDS病人及已死亡HIV感染者/AIDS病人家属中普遍存在,这些负性情绪主要与疾病状况、物质滥用、社会支持及生活质量等因素有关.