Étude des perceptions du trouble de stress post-traumatique parmi des militaires canadiens et leur conjointe

Cette recherche vise à explorer la satisfaction à l’égard des services reçus par les militaires diagnostiqués d’un trouble de stress post-traumatique (TSPT) et leur conjointe, ainsi qu’à comprendre leurs besoins et le sens donné au TSPT. Nous utilisons l’analyse qualitative exploratoire comme méthode d’analyse de données. Nous découvrons d’une part que les militaires et les conjointes rencontrées souhaitent recevoir des services adaptés à leur situation particulière (cas par cas) et d’autre part, que tous les répondants ont le besoin commun que l’on reconnaisse leurs sacrifices. Pour les militaires, une manière de reconnaitre ces sacrifices serait de respecter leurs souhaits et leurs demandes en ce qui concerne les soins. Une prise en charge complète de l’aspect administratif du rétablissement et de la libération serait également souhaitable lorsqu’indiquée. Nous trouvons également des différences entre les militaires ayant reçu un diagnostic de TSPT il y a plus de 5 ans et ceux qui l’ont reçu récemment. Nous proposons des hypothèses liées à ces différences. Finalement, les lacunes importantes en ce qui concerne les services offerts aux conjointes sont le manque de connaissance de ces dits services par les conjointes, la stigmatisation et la perception négative qu’ont les conjointes à l’égard du principal prestataire de service, les centres de ressources pour les familles des militaires. Cette étude nous permet de faire des recommandations en lien avec les résultats trouvés.

Non-Invasive Prenatal Testing: Review of Ethical, Legal and Social Implications

Article

Láser Excimer en Vitiligo. ¿Tratamiento efectivo y seguro para esta enfermedad? Revisión sistemática de la literatura

Introducción: El vitíligo es una enfermedad prevalente en nuestro medio con una prevalencia del 2% de la población mundial. Los síntomas de esta enfermedad son principalmente estéticos al manifestarse como máculas acrómicas, simétricas en las extremidades y en rostro donde genera la mayor estigmatización de los pacientes. Actualmente ningún tratamiento provee mejoría pronta y permanente de los síntomas. Objetivo: Determinar la efectividad del Láser Excimer 308 nm en el tratamiento del vitíligo por medio de una revisión sistemática de la literatura. Métodos: Búsqueda sistemática de ensayos clínicos y estudios cuasiexperimentales en las bases de datos más importantes acerca de la efectividad del Láser Excimer 308 nm en la repigmentación de los pacientes adultos con vitíligo. Se evaluó su calidad metodológica. Resultados: De 862 artículos encontrados se escogieron 40 artículos potenciales de los cuales dos fueron incluidos en esta revisión. El láser Excimer 308 nm como monoterapia presenta una pigmentación efectiva (≥50%) en 28.03% de las áreas tratadas, de los cuales 72.9% se localizaron en áreas sensibles a radiación ultravioleta y 27.02% en zonas no sensibles. Inicio de pigmentación a la sesión número 13 (un mes post inicio del tratamiento). El láser fue seguro y bien tolerado. Conclusión: La evidencia sugiere que el tratamiento con Láser Excimer 308 nm, como monoterapia, es una alternativa terapéutica para lograr repigmentación pronta de las máculas acrómicas del vitíligo en áreas sensibles a radiación ultravioleta. Deben considerarse estudios que evalúen combinaciones de fármacos y Láser en el tratamiento de vitíligo.

Transformación de la ocupación del suelo en el marco de relaciones de clientelismo político. Estudio de caso: barrio Pablo Escobar, 1982-1995

El interés de este estudio de caso es evidenciar la relación que existe entre el clientelismo y las transformaciones de uso del suelo en el barrio Pablo Escobar en Medellín, entre 1982 y 1995. Se analiza como la marginación de la población del barrio Moravia conduce a la creación de capital social y el fortalecimiento de las redes sociales existentes dentro del mismo. Se muestra además cómo estas redes son aprovechadas por Pablo Escobar en su carrera política para aumentar su capital político. Por último, se muestra cómo su programa de Medellín sin Tugurios cambia el comportamiento y el uso de suelo de la población de los tugurios de Moravia, ahora reubicada en el barrio Pablo Escobar.

Imaginarios, biomedicina y normatividad: una respuesta a los procesos de estigmatización y discriminación por VIH

El tratamiento del VIH/sida, como problemática que ocupa a la salud colectiva, requiere nuevas perspectivas teóricas para su análisis. Objetivo: reconstruir algunas matrices imaginarias, configu- radoras de la infección de VIH, vinculadas con prácticas normativas y con la formación del saber clínico, visibilizar consecuencias de estos procesos y articular estas matrices con las problemáticas de discriminación y estigmatización que pesan sobre el diagnóstico. Materiales y métodos: se efectuaron entrevistas en profundidad a jóvenes entre 18 y 35 años y a profesionales de la salud dedicados al tratamiento del VIH/sida de hospitales públicos de las ciudades de Santa Fe y Paraná (Argentina). Resultados: el discurso biomédico –nodal en tanto exigencia de la norma y garante del ejercicio de normalización de los individuos y de las poblaciones a partir del binomio normal/ patológico– incide en la apropiación de la diagnosis y la convivencia con la infección. Conclusión: a partir de los resultados, es posible comprender los procesos de estigmatización y discrimina- ción como mecanismos privilegiados de estas instancias normativas que median la configuración discursiva del VIH. A su vez, se advierte que el rechazo prevalente en jóvenes a realizarse las pruebas diagnósticas, como las dificultades de acceso a los servicios de salud, es consecuencia de los procesos indicados.

Barnfri : en stigmatiserad position

Childfree: a stigmatized position International research has addressed the subject but in Sweden voluntary childlessness has until now been overlooked. This article draws on qualitative, semi-structured interviews with 21 Swedish childfree women. The interviews focused their decision not to have children and attitudes they faced due to their rejection of motherhood. They all had encountered pressure to conform to a pronatalistic norm, proclaiming parenthood to be self-evident in an adult normal life. The results highlight different strategies used by the women to avoid instigating the dislike of those around them. The article argues that understanding childfree as a stigmatized position helps providing new insights to what conditions the social relations between the childfree and ‘the normals’, i.e. persons who advocate having children. Further, viewing the childfree as a stigmatized group has theoretical implications that contribute to developing Goffman’s classical theory of social stigma.

Konsten att välja rätt spårvagn : en studie av segregation, skolval och unga människors studieplaner

The art of choosing the right tram – A study of urban segregation, choice of school and young people’s life plans When discussing barriers to integration and young people’s choice of school, research often focuses on language skills, cultural capital, supportive environments and other more obvious, distinct and material aspects that have an impact on educational achievement. In the present study, we have instead chosen to look at how young immigrants construct their inner career landscapes and life-plans, and how this relates to their perception of ethnicity, neighbourhood and identity. The sample used here consists of altogether twenty individuals. The interviews were used to explore certain designated dimensions and processes. All interviews were conducted in the school environment, in classrooms and other locations. The students attended two different inner-city schools. A narrative-sociological approach is used in the analysis. The young people’s perceptions and narratives are analysed in relation to concepts such as: territorial stigmatization, identity, self-perception and modifications of life plans. The findings show that the feelings of otherness which originates in housing conditions, experiences of exclusion and the everyday life of many immigrants, are transposed into the school area and transformed into strategies and life plans.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

Shaming, shame and recidivism : a test of reintegrative shaming theory in the white-collar crime context

Despite the popularity of reintegrative shaming theory in the field of criminology, only a small number of studies purporting to test it have been published to date. The aim of the present study, therefore, is to provide an empirical test of Braithwaite's (1989; Braithwaite and Braithwaite 2001) theory of reintegrative shaming in the white-collar crime context. The data on which the study is based came from survey data collected from a group of 652 tax offenders. Consistent with predictions, it was found that feelings of reintegration/stigmatization experienced during an enforcement event were related to reoffending behaviour. Those taxpayers who felt that their enforcement experience had been reintegrative in nature were less likely to report having evaded their taxes two years later. Consistent with Braithwaite and Braithwaite's (2001) hypotheses, shame-related emotions were also found to partially mediate the effect of reintegration on subsequent offending behaviour. Implications for the effective regulation of white-collar offenders are discussed.

Sexually transmitted infections

This research found that for people with a medically incurable STI, gender, relationship status, level of guilt, and disclosure factors were associated with respondents' sexual self-concept, and their feelings of stigmatization. This research has significant implications for health practitioners involved in the management and care of individuals with an STI.

How will information about the genetic risk of mental disorders reduce stigma?

Objectives: To suggest ways of testing hypotheses about the impact that information on genetic risk may have on the social stigma of mental disorders and to analyse the implications of these hypotheses for genetic screening for mental disorders.

Method: Literature review and critical analysis and synthesis.

Results: An optimistic view is that information on the genetic risk for mental disorders will reduce blame and social stigma experienced by individuals living with mental disorder. A more pessimists view is that genetic risk information and the use of predictive genetic testing will lead to earlier stigmatization of those at risk of mental disorders. Research is identified that is needed to provide a better understanding of the implications of predictive genetic testing for the stigmatization of different mental health disorders.

Conclusions: It is essential that research on the genetics of mental disorders is accompanied by social science research on the ways in which genetic findings influence the lives of those who are tested.

The role of labeling processes in elderly consumers' responses to age segmentation cues

This investigation explores labeling processes underlying age segmentation cue effects on discount usage intentions. Depth interviews regarding participants' experiences using senior-citizen-type discounts reveal three levels of responsiveness to consumer offerings promoted with age segmentation cues: rejecting senior citizen discounts to avoid self-devaluation, rejecting senior citizen discounts to avoid stigmatization, and assigning positive meanings to the status that promotes senior citizen discount usage. An experimental investigation, undertaken to assess the sequential ordering of these levels of responsiveness, reveals that self-devaluation and perceived stigma mediate age segmentation cue effects on discount usage intention only for younger-aged elderly. Results lend support for a stage model of consumers' progression through phases of responsiveness to "senior citizen" labeling.

How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study

Obesity stigma exists within many institutions and cultural settings. Most studies suggest that stigmatising experiences have a negative impact on individuals' health and social behaviours and outcomes. However, some studies indicate that obesity stigma can motivate individuals to lose weight. Limited research has examined weight-based stigma from the perspective of obese individuals, including their perceptions of, and responses to, the different types of weight-based stigma they face in their daily lives. This study advances knowledge about weight-based stigma by documenting how obese adults (mostly female) described the different types of obesity stigma that they faced, how they responded to this stigma, and how different types of stigma impact on health and social wellbeing. Semi-structured, qualitative interviews were conducted between April 2008 and March 2009 with a diverse sample of 141 obese Australian adults. Guided by Link and Phelan's (2006) categorisation of different types of discrimination, participants' experiences could be grouped into three distinct types of stigma: 1) Direct (e.g. being abused when using public transport); 2) Environmental (e.g. not being able to fit into seats on planes); and 3) Indirect (e.g. people staring at the contents of their supermarket trolley). Participants described that more subtle forms of stigma had the most impact on their health and social wellbeing. However, it was the interaction between direct, environmental and indirect stigma that created a barrier to participation in health-promoting activities. Participants rarely challenged stigma and often blamed themselves for stigmatising experiences. They also avoided situations where they perceived they would be stigmatised and constantly thought about how they could find a solution to their obesity.

Essays in heterogeneous agent macroeconomics

This thesis is comprised of three chapters. The first article studies the determinants of the labor force participation of elderly American males and investigates the factors that may account for the changes in retirement between 1950 and 2000. We develop a life-cycle general equilibrium model with endogenous retirement that embeds Social Security legislation and Medicare. Individuals are ex ante heterogeneous with respect to their preferences for leisure and face uncertainty about labor productivity, health status and out-of-pocket medical expenses. The model is calibrated to the U.S. economy in 2000 and is able to reproduce very closely the retirement behavior of the American population. It reproduces the peaks in the distribution of Social Security applications at ages 62 and 65 and the observed facts that low earners and unhealthy individuals retire earlier. It also matches very closely the increase in retirement from 1950 to 2000. Changes in Social Security policy - which became much more generous - and the introduction of Medicare account for most of the expansion of retirement. In contrast, the isolated impact of the increase in longevity was a delaying of retirement. In the second article, I develop an overlapping generations model of criminal behavior, which extends prior research on crime by taking into account individuals' labor supply decisions and the stigma effect that affects convicted offenders, lowering their likelihood of employment. I use the model to guide a quantitative assessment of the determinants of crime and of a counterfactual experiment in which an income redistribution policy is thought as an alternative to greater law enforcement. The model economy considered in this paper is populated by heterogeneous agents who live for a realistic number of periods, have preferences over consumption and leisure, and differ in terms of their age, their skills as well as their employment shocks. In addition, savings may be precautionary and allow partial insurance against the labor income shocks. Because of the lack of full insurance, this model generates an endogenous distribution of wealth across consumers, enabling us to assess the welfare implications of the redistribution policy experiment. I calibrated the model using the US data for 1980 and then use the model to investigate the changes in criminality between 1980 and 1996. The main results that come out of this study are: 1) Law enforcement policy was the most important factor behind the fall in criminality in the period, while the increase in inequality was the most important single factor promoting crime; 2) Stigmatization is not a free-cost crime control policy; 3) Income redistribution can be a powerful alternative policy to fight crime. Finally, the third article studies the impact of HIV/AIDS on per capita income and education. It explores two channels from HIV/AIDS to income that have not been sufficiently stressed by the literature: the reduction of the incentives to study due to shorter expected longevity and the reduction of productivity of experienced workers. In the model individuals live for three periods, may get infected in the second period and with some probability die of Aids before reaching the third period of their life. Parents care for the welfare of the future generations so that they will maximize lifetime utility of their dynasty. The simulations predict that the most affected countries in Sub-Saharan Africa will be in the future, on average, thirty percent poorer than they would be without AIDS. Schooling will decline in some cases by forty percent. These figures are dramatically reduced with widespread medical treatment, as it increases the survival probability and productivity of infected individuals.