Gender disparities in utilization, unmet need and expenditure for mental health care

Objectives: To compare mental health care utilization regarding the source, types, and intensity of mental health services received, unmet need for services, and out of pocket cost among non-institutionalized psychologically distressed women and men. ^ Method: Cross-sectional data for 19,325 non-institutionalized mentally distressed adult respondents to the “The National Survey on Drug Use and Health” (NSDUH), for the years 2006 -2008, representing over twenty-nine millions U.S. adults was analyzed. To assess the relative odds for women compared to men, logistic regression analysis was used for source of service, for types of barriers, for unmet need and cost; zero inflated negative binomial regression for intensity of utilization; and ordinal logistic regression analysis for quantifying out-of-pocket expenditure. ^ Results: Overall, 43% of mentally distressed adults utilized a form of mental health treatment; representing 12.6 million U.S psychologically distressed adults. Females utilized more mental health care compared to males in the previous 12 months (OR: 1. 70; 95% CI: 1.54, 1.83). Similarly, females were 54% more likely to get help for psychological distress in an outpatient setting and females were associated with an increased probability of using medication for mental distress (OR: 1.72; 95% CI: 1.63, 1.98). Women were 1.25 times likelier to visit a mental health center (specialty care) than men. ^ Females were positively associated with unmet needs (OR: 1.50; 95% CI: 1.29, 1.75) after taking into account predisposing, enabling, and need (PEN) characteristics. Women with perceived unmet needs were 23% (OR: 0.77; 95% CI: 0.59, 0.99) less likely than men to report societal accommodation (stigma) as a barrier to mental health care. At any given cutoff point, women were 1.74 times likelier to be in the higher payment categories for inpatient out of pocket cost when other variables in the model are held constant. Conclusions: Women utilize more specialty mental healthcare, report more unmet need, and pay more inpatient out of pocket costs than men. These gender disparities exist even after controlling for predisposing, enabling, and need variables. Creating policies that not only provide mental health care access but also de-stigmatize mental illness will bring us one step closer to eliminating gender disparities in mental health care.^

Internet sex among non-gay identifying men who have sex with men

The aim of this study was to examine the role of the Internet in Internal Homonegativity (IH) among Non gay identifying men who have sex with men (NGI-MSM). This study at University of Texas School of Public Health (UTSPH) had a mixed method research design and consisted of men 18 years of age and older who were residents of the US and Canada. The data were collected using an online survey called 'Men's Sexual Health Survey' which was developed in collaboration with Boston University School of Public Health and Denver Public Health. These surveys were administered in English, which took 30-minutes to complete, and were placed on gay oriented websites and chat rooms. 141 participants were presented with the module relating to IH. A Principal Component Analysis with varimax rotation on the nine questions that asked the participants about their feelings about gay men produced three factors of IH identified as (1) public identification as gay; (2) perception of stigma associated with being gay; and (3) social comfort with gay men. The factors significantly correlated with age, grade completed in school, income, openness about being gay and socializing with gay people, meeting partners online, dating on the Internet, attitude toward condom usage, alcohol and drug use before sex and having unprotected sex with Internet partners. These findings point toward the role of the Internet in determining IH and sexual behavior. Despite the risks, the Internet's popularity and outreach in NGI-MSM makes it an effective medium to spread public health programs.^

Cellular Trafficking of Single and Multistage Vectors

Nanomedicine is an innovative field of science which has recently generated many drug delivery platforms with exciting results. The great potential of these strategies rely on the unique characteristics of the devices at the nano-scale in terms of long time circulation in the blood stream, selective accumulation at the lesions sites, increased solubility in aqueous solutions, etc. Herein we report on a new drug delivery system known as a multistage system which is comprised of non-spherical, mesoporous silicon particles loaded with second stage nanoparticles. The rationally designed particle shape, the possibility to modulate the surface properties and the degree of porosity allow these carriers to be optimized for vascular targeting and to overcome the numerous biological barriers found in drug delivery. In this study we investigated the intra and inter cellular trafficking of the multistage system in endothelial cells bringing evidence of its bio-compatibility as well as its ability to perform multiple intra and inter cellular tasks. Once internalized in cells, the multi-particle construct is able to dissociate, localizing in different subcellular compartments which can be targeted for exocytosis. In particular the second stage nanoparticles were found to be secreted in microvesicles which can act as mediators of transfer of particles across the endothelium and between different endothelial and cancer cells.

Factors associated with the retention of HIV-infected children in care in Botswana

Lost to follow up (LTFU) in the care and treatment of HIV/AIDS represents a particularly problematic aspect when evaluating the success of treatment programs. Identifying modifiable factors that lead to LTFU would be important if we are to design effective retention interventions. The purpose of this study was to identify the challenges faced by children seeking care and treatment at a large HIV Clinic in Botswana. In order to identify those factors, we used mixed methods from different sources of information available at the Baylor Clinic. The first method involved a case-control study through which we interviewed a select representation of children 1-18 years who, at some point in time, have attended clinic at Baylor Clinic in Gaborone, Botswana. We document this in detail using the first journal article. We defined LTFU as patients who had not attended clinic for more than 6 months at the onset of the study; the comparison group was recruited from among those who have attended clinic at any point in the 6 months leading to the start of study. Factors were compared between the cases and controls. The second methodology involved conducting in-depth interviews with health providers to elicit their opinions and experiences dealing with patients at the at the Baylor clinic in general and the LTFU patients in particular. We document this methodology and its findings in the second journal article. ^ We found that most patients that are LTFU failed to engage with the clinic. Most of the LTFU made only one visit to the clinic (47.66%) as compared to less than 1% in the control group (P<0.01, 2-tailed Fisher's exact test). Among the interviewed patients, psychosocial factors such as stigma, religious beliefs, child rebellion and disclosure of HIV status concerns were characteristic of the LTFU population, but psychosocial issues were not cited among the comparison group. We also found that these psychosocial aspects of the patients point towards a bigger problem of mental health that needs to be addressed. Socioeconomic factors such as lack of transport, school-related activities and forgetting check-up dates were cited predominantly by the controls than cases. ^ From these findings, there is need to target interventions towards engaging pediatric patients at their initial clinic visit. Such interventions would focus on psychosocial support, as well as involving faith-based organizations in planning joint responses.^

Attitudes of health-care workers toward pregnant, HIV -positive women

The management of HIV infection with antiretroviral drugs has succeeded in increasing survival rates, but the subject of pregnancy in HIV-positive women continues to garner debate. Discrimination and stigma have been identified as barriers to health care, suggesting that women with HIV may be disinclined to seek prenatal care if health-care workers exhibit negative attitudes toward the women's pregnancies. To optimize prenatal and medical care for women with HIV infection, it is important to understand the general social conditions and cultural context in which these women have children. Goffman's treatise on stigma, Foucault's discussion of the knowledge/power matrix, and Bandura's Social Cognitive Theory offer theoretical perspectives by which we can evaluate the gender, race, and class issues that are inherent in pregnancy decision-making for women with HIV infection. It is also necessary to evaluate prevailing attitudes on childbearing toward HIV-positive women and to review the historical background of prejudice in which HIV-positive women make decisions regarding childbearing. ^ This qualitative study used a survey instrument and one-on-one interviews with HIV-infected women to elicit their perceptions of how they were treated by care providers when they became pregnant. It also included interviews with health-care workers to determine what their feelings are about pregnancy within the context of HIV infection. Results of the ethnographic inquiry reveal that most of the women had negative experiences at some point during a pregnancy, but that the situation improved when they sought care from a provider who was familiar with HIV infection. The health-care providers interviewed were firm in their belief that HIV-positive women deserved optimal care and treated the women with respect, but these are individuals who are also experts in providing care to HIV-positive patients. The question remains as to what kind of care HIV-positive women are receiving generally and what types of attitudes they are being subjected to if they see less experienced providers. Further research is also needed to determine whether HIV-positive women from a broader ethnic representation and higher socioeconomic status experience similar negative attitudes. ^

Morfología y anatomía floral de Schinopsis balansae (Anacardiaceae)

Se realizó el análisis morfo-anatómico de Schinopsis balansae Engl. con microscopía óptica y electrónica de barrido a fin de obtener datos de las flores de esta especie, definida como polígamo-dioica. Los resultados muestran que las flores estructuralmente perfectas son funcionalmente pistiladas, si bien presentan cinco estaminodios, los mismos carecen de tejido esporógeno; mientras que en las flores estaminadas la estructura denominada pistilo vestigial no es más que la excrecencia del ápice del receptáculo, cubierta por tejido nectarífero. De este modo, lo correcto es describir S. balansae como especie dioica. El estudio de la vascularización de las flores estaminadas muestra que el proceso de reducción es completo, ya que ni siquiera persisten los haces vasculares del pistilo. El gineceo de las flores pistiladas es pseudomonómero, con un carpelo funcional, un estilo/estigma dorsal y un óvulo; además posee dos carpelos vestigiales representados por sendos estilo/estigma laterales. Ambos tipos de flores presentan un disco nectarífero intraestaminal, con nectarostomatas para la salida del néctar. El análisis de la estructura anatómica de S. balansae brinda datos que concuerdan con los encontrados en otros géneros estudiados de la subfamila Anacardioideae de la familia Anacardiaceae.

Saving Young Lives: Pathfinder International’s Youth-Friendly Postabortion Care Project

As many as 2.5 million adolescent women seek abortion each year, and nearly 70,000 women die from complications related to unsafe abortion, of which almost half are women under the age of 25. A further 5 million women suffer disability due to unsafe abortion yearly. In most developing countries, abortion is legally restricted or highly inaccessible, which leads young women to seek services from unskilled practitioners often leading to incomplete, septic abortions and massive bleeding, which can result in permanent injury, infertility, and death. Based on our deeply held belief that all people, including adolescents, have a right to sexual and reproductive health services and the importance of addressing adolescent needs within Postabortion Care (PAC) services, Pathfinder used private funds to initiate a Youth-Friendly Postabortion Care (YFPAC) program in eight sub-Saharan African countries. Implemented between June 2007 and May 2008, the YFPAC program offered an opportunity to apply the PAC Consortium’s Technical Guidance on Youth-Friendly PAC, generating promising approaches and lessons learned. The goal of the YFPAC initiative was to increase access to PAC services that are responsive to adolescent needs in sub-Saharan Africa. While outcomes varied according to the country, the overall outcomes included: Increased community support for services and activities that prevent unwanted pregnancy, decreased stigma around abortion, and awareness of the issue of unsafe abortion among adolescent women: 311 peer educators reached almost 17,487 youth and other community members; 171 stakeholders (e.g., religious and traditional leaders, health officials, and local government officials) were sensitized on YFPAC, resulting in a positive shift in communities’ attitudes toward youth in need of PAC services. 125 service providers were trained to deliver YFPAC services and three doctors in Ghana were provided with a technical update on YFPAC. YFPAC services are available in Angola, Ghana, Nigeria, Mozambique, Tanzania, Uganda, Ethiopia, and Kenya. Pathfinder introduced YFPAC services into 25 facilities (in 27 service delivery points), and provided more than 3,800 clients with YFPAC services throughout the eight countries. The number of adolescent PAC clients seen at the project facilities increased— 710 clients were seen in the first quarter, 1,144 were seen in the fourth. The number of adolescent PAC clients who adopt a contraceptive method to prevent future unintended pregnancies has increased. Statistics show an average postabortion contraceptive acceptance of 69%, with the highest acceptance being 83% and the lowest being 44%. Evidence-based approaches, tools, and lessons learned are being disseminated and used for scale-up or replication of YFPAC interventions.

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Impacts of an HIV counseling and testing initiative -- results from an experimental intervention in a large firm in South Africa

We have run experimental interventions to promote HIV tests in a large firm in South Africa. We combined HIV tests with existing medical check programs to increase the uptake. In the foregoing survey we undertook previously, it was suggested that fears and stigma of HIV/AIDS were the primary reasons given by the employees for not taking the test. To counter these, we implemented randomized interventions. We find substantial heterogeneity in responses by ethnicity. Africans and Colored rejected the tests most often. Supportive information increased the uptake by 6 to 16% points. A tradeoff in targeting resulting in stigmatizing the targeted and a reduction of exclusion error is discussed.

Arquitectura cognitiva basada en el gradiente sensorial y su aplicación a la robótica móvil

El objetivo de esta tesis es el desarrollo de un sistema completo de navegación, aprendizaje y planificación para un robot móvil. Dentro de los innumerables problemas que este gran objetivo plantea, hemos dedicado especial atención al problema del conocimiento autónomo del mundo. Nuestra mayor preocupación ha sido la de establecer mecanismos que permitan, a partir de información sensorial cruda, el desarrollo incremental de un modelo topológico del entorno en el que se mueve el robot. Estos mecanismos se apoyan invariablemente en un nuevo concepto propuesto en esta tesis: el gradiente sensorial. El gradiente sensorial es un dispositivo matemático que funciona como un detector de sucesos interesantes para el sistema. Una vez detectado uno de estos sucesos, el robot puede identificar su situación en un mapa topológico y actuar en consecuencia. Hemos denominado a estas situaciones especiales lugares sensorialmente relevantes, ya que (a) captan la atención del sistema y (b) pueden ser identificadas utilizando la información sensorial. Para explotar convenientemente los modelos construidos, hemos desarrollado un algoritmo capaz de elaborar planes internalizados, estableciendo una red de sugerencias en los lugares sensorialmente relevantes, de modo que el robot encuentra en estos puntos una dirección recomendada de navegación. Finalmente, hemos implementado un sistema de navegación robusto con habilidades para interpretar y adecuar los planes internalizados a las circunstancias concretas del momento. Nuestro sistema de navegación está basado en la teoría de campos de potencial artificial, a la que hemos incorporado la posibilidad de añadir cargas ficticias como ayuda a la evitación de mínimos locales. Como aportación adicional de esta tesis al campo genérico de la ciencia cognitiva, todos estos elementos se integran en una arquitectura centrada en la memoria, lo que pretende resaltar la importancia de ésta en los procesos cognitivos de los seres vivos y aporta un giro conceptual al punto de vista tradicional, centrado en los procesos. The general objective of this thesis is the development of a global navigation system endowed with planning and learning features for a mobile robot. Within this general objective we have devoted a special effort to the autonomous learning problem. Our main concern has been to establish the necessary mechanisms for the incremental development of a topological model of the robot’s environment using the sensory information. These mechanisms are based on a new concept proposed in the thesis: the sensory gradient. The sensory gradient is a mathematical device which works like a detector of “interesting” environment’s events. Once a particular event has been detected the robot can identify its situation in the topological map and to react accordingly. We have called these special situations relevant sensory places because (a) they capture the system’s attention and (b) they can be identified using the sensory information. To conveniently exploit the built-in models we have developed an algorithm able to make internalized plans, establishing a suggestion network in the sensory relevant places in such way that the robot can find at those places a recommended navigation direction. It has been also developed a robust navigation system able to navigate by means of interpreting and adapting the internalized plans to the concrete circumstances at each instant, i.e. a reactive navigation system. This reactive system is based on the artificial potential field approach with the additional feature introduced in the thesis of what we call fictitious charges as an aid to avoid local minima. As a general contribution of the thesis to the cognitive science field all the above described elements are integrated in a memory-based architecture, emphasizing the important role played by the memory in the cognitive processes of living beings and giving a conceptual turn in the usual process-based approach.

A diversidade cultural e as suas implicações no processo de ensino e aprendizagem : como integrar a diversidade na educação de infância

Relatório de estágio apresentado para obtenção do grau de mestre na especialidade profissional de Educação pré-escolar

RELIGIÃO E MST: ESTUDO DOS BATISTAS DA CONGREGAÇÃO MONTE SIÃO NO ASSENTAMENTO ANTONIO CONSELHEIRO II NA REGIÃO DO PONTAL DO PARANAPANEMA

A inserção de uma igreja evangélica em um assentamento rural do Movimento dos Trabalhadores Rurais Sem-terra (MST), é objeto de nosso estudo de caso neste presente trabalho. A dissertação pesquisa e analisa a inserção dos evangélicos batistas no assentamento Antonio Conselheiro II na região do Pontal do Paranapanema, no estado de São Paulo, assim como a conseqüente implantação neste da Congregação Batista Monte Sião . Partindo de uma perspectiva teórica e empírica, o objetivo concentra-se em analisar a experiência de vida dos assentados batistas no interior do assentamento, buscando retratar as formas, tanto conceptuais como práticas, que estes vivenciam sua fé, costumes e crenças, sonhos e ideais, sempre procurando tecer relações que nos permitam melhor avaliar a forma como os mesmos compreendiam e comunicavam sua fé enquanto assentados do MST. Da apreciação crítica dos relatos obtidos nas entrevistas e dos dados do questionário, ambos aplicados aos agentes de nossa pesquisa, surge uma história que nos desvela faces de uma relação identitária que mescla ideologia e fé, ser evangélico batista e assentado no MST, bem como uma proposição internalizada de uma metodologia da não-violência nas manifestações do movimento Sem-terra.(AU)