301 research outputs found
Economy, ecology, and globalization
No full text4 p.Paper written by Jabez Meulemans in the spring semester 2012 at the University of Wisconsin-River Falls for Dr. Greta Gaard's English 228 class. In this paper, the author examines the idea that economic globalization leads to the destruction of locally unique cultures and lifestyles and degrades the self-sufficiency of those communities
HIV testing in Europe : mapping policies and exploring practices in the era of increased treatment availability
No full textSummary
When the HIV antibody test became available in 1985, it was mired in controversy: who should be tested, for what purpose, and under what conditions? In the absence of treatment and in the context of discrimination, HIV testing was embedded within exceptional procedures.
With increasing treatment effectiveness, early HIV diagnosis became important, calling for normalisation of testing. With the objective to contribute to the understanding of how national HIV testing policies and practices are evolving in the context of a changing HIV testing paradigm, a health policy analysis has been undertaken. The core of the analysis concerned a multi-country study aimed at mapping national HIV testing policies in EU/EEA countries. The mapping study was complemented with an implementation study to investigate practices and barriers with regard to HIV testing.
Current HIV testing policies exhibited a high level of exceptionalism, with informed consent and counselling constituting the normative base. Meanwhile, HIV testing practices are moving ahead faster than policies to accommodate changing contexts and practical needs. The study results showed that HIV testing is done in a wide variety of settings and that HIV testing is being normalised. In practice, there is less focus on pre-test counselling, yet more emphasis on post-test follow-up. However, there are barriers to testing which could cause a deficit in the normalisation since they are based on denial of risk and fear on the patients’ side and a certain embarrassment or awkwardness to address sexual health and HIV more actively on the providers’ side.
The challenge lies now in the further accomplishment of the normalisation of HIV testing, with a clear focus on an efficient testing service delivery as being the starting-point of the HIV treatment cascade. For this, an improved understanding of the epidemic will provide a foundation for the development of an HIV testing model, considering the best mix of HIV testing approaches to achieve full coverage. However, for all HIV testing, the chief reason for testing must always be to benefit the individuals tested. Sufficient information should be provided to make an informed and voluntary decision to get tested whilst ensuring confidentiality and referral to appropriate follow-up services. To assure access to high-quality testing services which adhere to the guiding principles of HIV testing, the different testing approaches should be integrated within a national HIV testing policy framework. Finally, political commitment will be needed to reduce barriers to HIV testing, to support stakeholders at all levels in consolidating best practices and to expand targeted efforts within an enabling and supportive environment
Diving into the contexts of in-between worlds: worldmaking in medical tourism
No full textIn this review article, the authors contextualize the contemporary practice of medical tourism in terms of the concept of worldmaking, which was introduced (in this journal) with two articles a year or two ago by Hollinshead. Here, the authors first contextualize medical tourism in terms of "worldmaking" per medium of the observations of the corporeal realms identified by Alexis de Tocqueville almost 200 years ago. In 1835, de Tocqueville wrote with enthusiasm tinged with nostalgic regret about the new world of American democracy that he then saw as the world of the future. A serious rupture in history took place of which he became a most relevant critic. But there have been (according to Mainil, Platenkamp, and Meulemans) many ruptures since then: that is, there have been short periods of "in-between worlds" that became ever more anchored in the timeline of Western history. Today, they argue that tourism as a field of expertise, practice, and knowledge is intertwined with several other networks of expertise. It is responsible (itself) for many small "ruptures" in these modern times. Mass tourism can be seen as such a shift. Sustainable tourism and the attention paid to climate change would be another such shift. And the authors of this review argue that an interesting and deep-seated case in this regard is medical tourism. They argue here that medical tourism has a great deal of worldmaking capacity, especially by means of the Internet and international marketing tools. It arises in the interstices of the interacting networks of a global world. It crosses borders in line with emerging power structures in a global network, but it also meets local resistance or regional obstacles that are related to other networks. In between these worlds of human experience, various interactions of perspectives on the concept of health itself come to the surface. Within the field of medical tourism different stakeholders play a role in a worldmaking process. Our reviewers from the Low Countries thereby argue that medical tourism itself is responsible for a Tocquevillean rupture within and across our global network society. In their view, medical tourism also constitutes a new hybrid-that is, as a hybrid medical paradigm that seems to be appearing within the performative and productive world of tourism
Living with TB: the ‘career’ of the tuberculosis patient in the Free State, South Africa
No full textThis thesis has three main aims. The first aim is to profile the ‘career’ of tuberculosis patients. In this regard, the focus is broadly on the socio-economic and socio-cultural variables impinging on the health-seeking behaviour and adherence to treatment of pulmonary TB patients. Secondary to this aim, the intention is to provide all stakeholders with insight into the living circumstances and experiences of pulmonary TB patients. The third main aim is to propose criteria for innovative behavioural prevention strategies and health-seeking behaviour for TB patients.
The study was conducted at nine primary health care clinics in three geographic areas or health districts in the Free State province (South Africa). The areas were purposively selected to represent different regions in the Free State, including rural and urban areas. Together, the selected areas represent the broad spectrum of socio-economic and socio-cultural variables impinging on the illness ‘career’ of TB patients. The study was conducted using a combination of quantitative and qualitative research methods. Face-to-face interviews was conducted with 220 randomly selected pulmonary TB patients. In addition, nine focus group discussions (FGDs) were conducted with 85 PTB patients.
Fifty-five percent of interviewed patients were male and 45% female. The majority of patients were new patients (68%), while almost a third was re-treatment patients (32%). Of the re-treatment patients, just more than half were on re-treatment following previous cure (53%), while just more than a fifth (21%) was on re-treatment following treatment completion. A third (35%) of the patients was married. On average, the patients lived in families of 4.4 persons per household with an average of 2.1 persons per room.The majority of the patients indicated that they had access to electricity (80%), piped water (85%) and to refuse removal services at least once a week (77%). However, a third (35%) reported having no proper sanitation. While the average monthly per capita income of patients increased from R985.36 immediately prior to illness with TB to R1 113.16 afterwards, the mean cumulative monthly household income decreased from R1 214.50 before being diagnosed with TB to R946.85 afterwards.
It was shown that the illness ‘career’ of individuals with TB is characterised as a long-term experience in which the individuals had to rely families and friends to overcome daily challenges. In an attempt to provide a meaningful separation of events constituting the illness experience, the illness ‘career’ of the TB patient was divided into five different phases from experiencing symptoms, to assuming the sick role, to contacting a health care provider, to being a patient and, finally, relinquishing the sick role. The findings indicate that the patients in this study not only had to cope with physical disabilities and the side effects of treatment, but also with the psychological traumas of fear of recurrence of the disease and social stigma, and the disappointment of a
considerably reduced range of future possibilities for career and marriage. It was also indicated
that few of the patients in this study were treated negatively by their spouses/partners, family
members or their communities. Living with TB in “modern” society where stress, AIDS and an
array other social and psychological factors are seen to threaten the individuals, is an enormous
burden
In respect of determinants of treatment adherence, the quantitative evidence shows that
stigma, the socio-economic circumstances of the patient, and migrancy play an important role in
explaining non-adherence. In addition, patients whose tablet taking was supervised were more
likely to adhere to treatment. Based on the qualitative evidence, some of the perceived factors
affecting adherence included lack of knowledge about TB, non-sustainability of educational
campaigns, side effects of drugs, hunger and lack of family support, stigma attached to TB, and
the attitude of health care workers and the long delay in obtaining a diagnosis. Based on this
evidence, recommendations are made regarding a number of provider-, patient- and communitycentred
interventions that can improve adherence.National Research Foundation (NRF)Andrew Mellon FoundationMedical Research FoundationAnglo-American Chairman’s Fun
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