Mental Health Issue Accelerates Aging Faster Than Smoking - Study Rings Alarm For Pakistan Where It Still Remains A Taboo!

Madam, Mental health is defined as a state of mental well-being that enables people to cope with the stresses of life, realise their potential, learn and work well, and contribute to their community as a whole. (1) A recently published study in the journal Aging (2), revealed that mental health can be more deteriorating than smoking. The researchers used an ageing clock to measure how it impacted the pace of aging in 12,000 Chinese adults. Researchers found that smoking speeds up the rate of ageing by 1.25 years whereas mental health factors accelerated it by 1.65 years. The aging clock used blood, DNA and genetic test of individuals to measure their biological aging pace. The mental health variables tested included Depression, Sleep Issues, Hopelessness, Feeling unhappy, Loneliness, Married, Widowed, and Living in a Rural area. (2) Ageing directly predisposes individuals to diseases like Diabetes Type 2, Cancer, Cardiovascular and Neurological disorders which significantly affect the lifestyle and lifespan of individuals.(3) Talking about mental health is still seen as Taboo in Pakistan, and that’s why people don’t consider consulting about their mental health issues. Statistics have revealed that more than 14 million Pakistanis suffer from some sort of psychiatric illness and the majority of these believe that these are caused by supernatural forces such as spirit possession etc. This is mainly due to lack of awareness about mental disorders and shortage of mental health professionals. (4) The modern study showing mental health factors accelerated ageing faster than smoking (2), is an eye-opener and alarm for our society where we now do stress upon the hazardous effects of smoking, we also need to equally emphasize about working on Mental Health awareness on mass scales utilising media, health policies, and community health care programmes. Family is the primary source of your nurturing, and it is necessary to make Parents also realise that they should establish such a relation with their children that they can easily talk about any of their issues comfortably with them. An emphasis on considering mental health issues need serious professional consultation. Along with keeping a balanced life, spending quality time with family and friends, ease of interaction is needed to ensure that our population doesn’t fall prey to these issues and cost them their whole life.

A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication

Background

Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts’, or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal.

Methods

We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework.

Results

The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15–17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms.

Conclusion

Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

Neuromodulation of cursing in American English: A combined tDCS and pupillometry study

Many neurological disorders are associated with excessive and/or uncontrolled cursing. The right prefrontal cortex has long been implicated in a diverse range of cognitive processes that underlie the propensity for cursing, including non-propositional language representation, emotion regulation, theory of mind, and affective arousal. Neurogenic cursing often poses significant negative social consequences, and there is no known behavioral intervention for this communicative disorder. We examined whether right vs. left lateralized prefrontal neurostimultion via tDCS could modulate taboo word production in neurotypical adults. We employed a pre/post design with a bilateral frontal electrode montage. Half the participants received left anodal and right cathodal stimulation; the remainder received the opposite polarity stimulation at the same anatomical loci. We employed physiological (pupillometry) and behavioral (reaction time) dependent measures as participants read aloud taboo and non-taboo words. Pupillary responses demonstrated a crossover reaction, suggestive of modulation of phasic arousal during cursing. Participants in the right anodal condition showed elevated pupil responses for taboo words post stimulation. In contrast, participants in the right cathodal condition showed relative dampening of pupil responses for taboo words post stimulation. We observed no effects of stimulation on response times. We interpret these findings as supporting modulation of right hemisphere affective arousal that disproportionately impacts taboo word processing. We discuss alternate accounts of the data and future applications to neurological disorders.

When did "teaching" become a taboo word for clinician educators?

In our recent work with clinician educators leading UME small groups, we noticed a phenomenon - many clinician educators are saying they don't teach, they just facilitate. Medical schools have moved to a new model of curriculum that integrates basic, clinical, and social science concepts. As curriculum shifts, so too must the definition and role of a teacher in medical education. The purpose of this article is to explore the work of current clinician educators and to encourage clinician educators to embrace their teaching role and seek educator development opportunities. In this article, we explore the history of how and why the word "teaching" became taboo for clinician educators. Then we explain the current state of the complex work of teaching for today's clinician educators and its implications for educator development.

Are you really cursing? Neural processing of taboo words in native and foreign language

The use of socially opprobrious words (taboo words) is a cross-cultural phenomenon occurring between individuals from almost all social extractions. The neurocognitive correlates of using taboo words in the native language (L1) as compared to their use in a second (L2) language are largely unknown. We used fMRI to investigate the processing of taboo and non-taboo stimuli in monolinguals (Experiment 1) and highly proficient bilinguals (Experiment 2) engaged in lexical decision tasks. We report that for L1 socio-pragmatic knowledge is automatically conveyed and taboo words are processed with less effort than non-taboo words. For L2 the processing of taboo words is more effortful and engages additional structures (anterior cingulate cortex, insula) involved in social-norm representation and evaluation. Our results contribute to understand the interface between language and social-norm processing indicating that lexical processing is affected by socio-pragmatic knowledge, but only when the speaker has a contextual use of the language.

Food taboo among pregnant Ethiopian women: magnitude, drivers, and association with anemia

BACKGROUND

There are pervasive pregnancy-related food taboos and myths (PRFT) in Ethiopia. The evidence, however, is limited on whether PRFT contributes to the burden of maternal anemia. Thus, this study was aimed to determine the magnitude of PRFT, the reasons for adherence to PRFT, and the association of adherence to PRFT with anemia, among pregnant Ethiopian women.

METHODS

The study was case-control in design and recruited a sample of 592 pregnant women attending antenatal care in four health facilities in Addis Ababa, Ethiopia. Participants were classified into anemic cases (n = 187) and non-anemic controls (n = 405) based on their hemoglobin level. PRFT was assessed by the participants' subjective reporting of avoidance of certain food items during the current pregnancy due to taboo reasons. The specific types of food items avoided and the underlying reasons for the avoidance were also assessed. The relation of PRFT with anemia was evaluated by multiple logistic regression analysis, controlling for covariate factors.

RESULT

Almost a fifth of the study participants (18.2%) avoided one or more food items due to PRFT. Adherence to PRFT was 26.2 and 14.6% among the anemic and the non-anemic individuals, respectively. The food items most avoided due to adherence to PRFT were green chili pepper, organ meat, and dark green leafy vegetables like spinach, lettuce, kale, and broccoli. The underlying reasons for the adherence to PRFT were largely traditionally held beliefs and misconceptions. After controlling for covariates, PRFT was significantly and independently associated with a higher odds of anemia [adjusted odds ratio (AOR) = 2.12, 95% confidence interval (CI) = 1.32-3.42, P = 0.002].

CONCLUSION

PRFT might be contributing to the burden of maternal anemia in Ethiopia. It is time for public health authorities in Ethiopia to recognize PRFT as a public health risk, strengthen maternal nutrition counseling, and create public awareness of the consequences of PRFT.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03251664), 16 August 2017.

Exposure to violence in breast cancer patients: systematic review

RESULTS

The nine studies included were reviewed under two titles as descriptive and qualitative. Based on the results of six descriptive studies, it was determined that the majority of these studies focused on violence and abuse in childhood; depression is high among breast cancer patients exposed to violence; healing is unfavorably influenced among breast cancer patients exposed to spouse violence or abuse/violence in childhood; physical, emotional and functional welfare/comforts are restricted and quality of life is low during disease process; there is positive correlation between advanced-stage cancer and history of violence; they hesitate to ask the clinical staff for support. Although breast cancer women underreport the violence they have been exposed to, a study stated that 55% of women are exposed to violence after being diagnosed with breast cancer. Results of the three qualitative study revealed that violence is the field of "taboo" among breast cancer patients and they reconsider the "life", "relationship-origin stress", "social support" and "importance of breast for herself" over the disease process.

CONCLUSION

In conclusion, it is underlined that giving care becomes difficult, maintenance of treatment fails, and quality of life is decreased in breast cancer patients exposed to violence.

Between food delicacies and food taboos: A structural equation model to assess Western students' acceptance of Amazonian insect food

Interest in commercializing insect-based foods is growing steadily. Nevertheless, most Western consumers still consider insects a food taboo. In this study, we investigated how persuasion strategies based on technology and social communication can intervene to reduce aversion towards the practice of eating a tropical insect from the Ecuadorian Amazon. We used a research design based on ethnoentomological information to place the insect-based food in its cultural context. The study is based on an online survey of 125 students from an international university based in a cross-border region of the Italian Alps. We used a covariance-based structural equation model to test the influence of the 6-item version of the Food Neophobia Scale and of the aforementioned persuasion strategies on stated willingness to consume insects. Results show that food neophobia negatively affects persuasion strategies but that the latter do have a positive influence on stated consumption intention. Additionally, the model shows that the negative effect of Food Neophobia Scale on the willingness to consume insects is fully mediated by persuasion strategies. Our findings are in line with previous studies which indicate that peers' recommendations on the safety and palatability of edible insects, as well as the practice of disguising them in familiar food, increase the stated willingness to consume them. Moreover, the importance of the commercial context where the insects are sold is a driver of entomophagous practices. Finally, our study suggests that the introduction of contextual cultural information about insects as a food source may help to preclude a priori false assumptions regarding entomophagy. This is also one of the aims of Regulation (EU) 2015/2283 on insects as novel food which recently came into force. We discuss the implications of the findings for both scholars and practitioners.

[Assess spirituality with adolescent outpatients: taboo or necessity?]

Spirituality affects adolescents' as well as adults' daily life. It is usually considered to be a protective factor in physical and psychological health outcomes, but might also be a cause of suffering. In the perspective of an holistic approach, health professional should assess this subject with tact and sensitivity. Until there is a suitable instrument adapted to this age group and European culture, the exploration of spirituality and religious practices can be evaluated while taking the clinical history. Nevertheless, resistance which is common in health professionals, could be overcome by appropriate training.

The Taboo of Retirement for Diocesan Catholic Priests

This paper considers Catholic priests in the USA and their freedom to retire, the constraints that may restrain them from retirement, and the financial and psychological variables that impact them in ministry and in future retirement. Implications for pastoral care and counseling are considered.

Taboo and the different death? Perceptions of those bereaved by suicide or other traumatic death

Views differ on how far the subject of death has ever been taboo in Western Society. Walter (1991) criticised the way the 'taboo thesis' has been presented, arguing that it has often been 'grossly overdrawn and lacking in subtlety'. Research suggests that suicide and other traumatic death may be particularly difficult for people to talk about or even acknowledge. We interviewed 80 people bereaved due to suicide, or other traumatic death and used interpretative thematic analysis to consider whether the 'death taboo' is evident in these bereavement narratives. People referred to suicide as a different, even stigmatised, death but we also found that those bereaved through other traumatic death felt that their reactions had to be contained and relatively silent. The exception was those bereaved through terrorism or train crash, who were encouraged to grieve openly and angrily: reactions to deaths which are seen as 'private troubles' differ from reactions to deaths which are seen as 'public issues'. Using a symbolic interactionist approach we conclude that the shock and suddenness of the death is tied up both with the circumstances of the death (suicide, murder, accident, terrorism) and the attendant consequences for the social acceptance of public displays of mourning.

Practices and perceptions of adolescent girls regarding the impact of dysmenorrhea on their routine life: a comparative study in the urban, rural, and slum areas of Chandigarh

To estimate the prevalence, to compare the impact of dysmenorrhea on routine life among adolescent girls, to compare the practices and perceptions regarding Dysmenorrhea and to ascertain the reason for difference if any, a cross-sectional study was conducted in urban, rural and slum areas of Chandigarh, India. 300 girls in age group of 11-18 years, who had attained menarche were included in the study. A questionnaire including the Demographic and Family profile, menstrual history, Symptoms of Dysmenorrhea, Effect of pain on daily activities, Faces scale, Practices regarding Dysmenorrhea, Beliefs about menstruation was used. Analysis was done by percentage and chi square prevalance of dysmenorrhea was 61.33%. Sickness absenteeism due to dysmenorrhea was reported in 24.45% girls. Most common symptom experienced by the girls was stomach ache which was experienced by 139 girls; others symptoms experienced during menstruation were backache (107), and general body pain (80). Only 11.63% of the girls ever visited physician due to pain during menstruation. During menstruation only 10 girls use hot water bottle, 71 skip meal. Due to poor knowledge the practices were not optimal for pain management, which affected their school attendance. Formal as well as informal channels of communication, such as mothers and peers, need to be emphasized for the delivery of such information particularly linking instructions on menstrual hygiene to an expanded programme of health education in schools.

Evidence of a link between taboos and sacrifices and resource scarcity of ritual plants

BACKGROUND

One of the main obstacles for the mainstreaming of religious traditions as tools for the conservation of nature is the limited applicability of research results in this field. We documented two different restrictions implemented by local people (taboos and sacrifices) related to the use of ritual plants in Benin (West Africa) and Gabon (Central Africa).

METHODS

To see whether these restrictions reflected plant scarcity from an etic perspective (official threat status) and an emic viewpoint (perceived scarcity by local people), we conducted 102 interviews with traditional healers and adepts of traditional faiths.

RESULTS

We documented a total of 618 ritual plants, from which 52 species were used in both countries. In Benin, the use of 63 of the 414 ritual plant species was restricted; while in Gabon 23 of the 256 ritual plants were associated with taboos and sacrifices. In Benin, restricted plants were significantly more often officially threatened, perceived as scarce, and actively protected than non-restricted plants. In the more forested and less densely populated Gabon, plants that were perceived as scarce were more often associated to local restrictions than officially threatened species.

CONCLUSIONS

These results prove the presence of a form of adaptive management where restrictions are related to resource scarcity and protection of ritual plant species. By providing baseline data on possibly endangered species, we demonstrate how plant use in the context of religious traditions can yield important information for conservation planning.

Is the emotional memory effect sensitive to encoding instructions and the passage of time?

This study examined whether the emotional memory effect (i.e., superior recall for emotionally arousing events relative to neutral events) is sensitive to encoding instructions focusing participants' attention on denotation, connotation, or surface information and on the passage of time. Participants encoded taboo and neutral words under one type of instructions and then performed a free recall task after a variable delay. Attention to denotation negatively affected the emotional memory effect. Time elapsed from encoding weakened recall of neutral words but not of emotional words. These findings suggest that although attentional control can influence the emotional memory effect, distinctiveness can shield retrieval of taboo words from the passage of time.

The characteristics of unacceptable/taboo thoughts in obsessive-compulsive disorder

BACKGROUND

In the quest to unravel the heterogeneity of obsessive-compulsive disorder (OCD), an increasing number of factor analytic studies are recognising unacceptable/taboo thoughts as one of the symptom dimensions of OCD.

AIMS

This study aims to examine the characteristics associated with unacceptable/taboo thoughts.

METHODS

Using the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC) with 154 individuals with OCD, obsessive-compulsive symptoms were subjected to principal components analysis. The characteristics associated with the resulting symptom dimensions were then assessed using logistic and linear regression techniques.

RESULTS

Unacceptable/taboo thoughts comprised of sexual, religious and impulsive aggressive obsessions, and mental rituals. Higher scores on an unacceptable/taboo thoughts symptom dimension were predicted by higher Y-BOCS obsession subscores, Y-BOCS time preoccupied by obsessions scores, Y-BOCS distress due to obsessions scores, importance of control of thought ratings, male gender, and having had treatment prior to entering into the study. Unacceptable/taboo thoughts were also predicted by greater levels of hostility, and a past history of non-alcohol substance dependence.

CONCLUSIONS

An unacceptable/taboo thought symptom dimension of OCD is supported by a unique set of associated characteristics that should be considered in the assessment and treatment of individuals with these symptoms.

Gay theatre, AIDS, and taboo: reconsidering Robert Chesley

Theatre was among the first popular culture forms to address HIV/AIDS and did so memorably in such works as The Normal Heart, As Is, Love! Valor! Compassion!, and March of the Falsettos. As a response to criticisms of stage dramas focusing on HIV/AIDS in the main as undifferentiated and melodramatic, the author suggests critical consideration of two works by playwright Robert Chesley. In her analysis of Night Sweats and Jerker, the author argues Chesley offers an alternative perspective that is both liberatory and sex-positive.

TB questions, East Kwaio answers: community-based participatory research in a remote area of Solomon Islands

INTRODUCTION

East Kwaio is a remote region on the island of Malaita, Solomon Islands. Atoifi Adventist Hospital (the Hospital) is the only hospital and tuberculosis (TB) services provider in the region. If people come to the Hospital with TB, they are usually admitted for the two-month intensive phase of treatment as there are no community-based TB services. Most people walk or travel by canoe to the Hospital as there are no roads. East Kwaio is known to have high rates of TB; however, it has a low case detection rate and low treatment completion. The aims of this study were to explore why people with TB, especially from the mountain areas, present to the Hospital so late in their illness or do not present at all. The study was part of a larger project to strengthen the research capacity of local health workers and community leaders, supported by visiting researchers from Australia.

METHODS

Semi-structured interviews with TB patients, a focus group of key informants and direct interaction with a community with a history of TB were used to explore reasons why people present to the Hospital late in their TB illness.

RESULTS

Four interviews and a focus group of 12 key informants were conducted and a mountain hamlet with a history of TB was visited. The results represent the data from the interviews and the focus group. The time delay in presenting to the Hospital from when participants first became unwell ranged between two and three years. In the mountain hamlet, two additional people with probable TB were seen who had not presented to the Hospital during illnesses of five and nine months. Reasons for delays included: seeking care from traditional healers; the challenge of accessing health services due to distance, cost and cultural issues different from the Hospital's worldview; social isolation when in hospital; and being old so not having long to live. Delays in diagnosis of people with TB will increase the risk of transmission to family and through hamlets and villages. This study has led to plans being developed to build a more culturally appropriate TB ward and community treatment program.

CONCLUSIONS

The study has identified TB questions that need East Kwaio answers. It has shown that a small project can inform the development of important changes to TB services, such as the redevelopment and relocation of the TB ward. To enable TB control, the local health services need to develop an understanding of, and appropriately engage with, traditional beliefs that influence how people interact with Hospital TB treatment and management. This is the case even if the beliefs are based on a worldview different than that of the health service providers. Ongoing operational research is required into TB diagnosis and treatment services and the many factors that contribute to the high TB burden in this remote area.

A taboo within a stigma? a qualitative study of managing incontinence with people with dementia living at home

BACKGROUND

Incontinence in people with dementia is one of the factors associated with the decision to move to a care home. Managing incontinence adds to carer burden and has been reported by family carers as more difficult to manage than behavioural symptoms. Active management strategies have been reported to be associated with less carer depression. The purpose of this study was to investigate carers' perceptions of the range of incontinence problems they helped their relative with and the strategies they employed to manage these.

METHODS

Family carers of people with dementia living in their own homes were recruited through primary care, specialist community mental health services and voluntary organisations. Qualitative semi structured interviews were conducted either face to face or by telephone and thematically analysed.

RESULTS

Thirty two carers were interviewed. They described a range of problems from supporting the person to remain independent in toileting, through to dealing with inappropriate behaviours, to containing and managing incontinence. All carers actively used problem solving strategies but sometimes these were not acceptable or understood by the person with dementia, particularly as the dementia progressed. Most carers reported protecting the person's dignity by not seeking health professionals help often until the point of a crisis. Once the carer has decided to seek help the responses from health professionals can be less than helpful, and carers report local health service policies on access to continence products to be inconsistent and often inappropriate to their circumstances. A few carers reported strategies for managing toileting and incontinence that have the potential for distress and harm to the person with dementia.

CONCLUSIONS

Primary care professionals could be more proactive in enquiry, repeated over time, about toileting and incontinence problems and in giving advice and information to reduce crisis and problems.

Identity, morals, and taboos: beliefs as assets

We develop a theory of moral behavior, individual and collective, based on a general model of identity in which people care about “who they are” and infer their own values from past choices. The model sheds light on many empirical puzzles inconsistent with earlier approaches. Identity investments respond nonmonotonically to acts or threats, and taboos on mere thoughts arise to protect beliefs about the “priceless” value of certain social assets. High endowments trigger escalating commitment and a treadmill effect, while competing identities can cause dysfunctional capital destruction. Social interactions induce both social and antisocial norms of contribution, sustained by respectively shunning free riders or do-gooders.

[Coercion in Psychiatry - a taboo?]

History shows that the discussion concerning coercive measures against mentally ill is as old as psychiatry itself. The dilemma of psychiatry lies in its double role - having both a therapeutic and a regulatory function. Violence against sick and disabled people conflicts with the ethical principles of helping professions. This, however, is where the danger lies: that the violent parts of psychiatric work - which in the opinion of experts cannot be entirely avoided - are repressed or seen as taboo and are therefore more difficult to control. Comparisons between EU countries of the nature, frequency and duration of coercive measures are difficult because of the heterogeneity of regulation and differences in established practice. Scientific examination of this issue seems to be insufficient. There are only a few studies on important issues such as how patients rate these measures. An open and thorough debate about the meaning and meaninglessness of coercion and violence in psychiatric treatment would be necessary to prevent "routine violence" or the excessive use of force against the mentally ill.

Travelling the path from fantasy to history: the struggle for original history within Freud's early circle, 1908-1913

Between 1908 and 1913, Freud and his disciples debated different theories of the origins of mankind, which Freud analysed in the context of his theory of neuroses. Wittels was the first of this group to present, in 1908, what Freud labelled a "fantasy" on the subject. Wittels contemplated various prehistoric scenarios (such as a murder of the father by his children) which he postulated as potential explanations for the origin of man's conception of religion, law and state. Freud (1913) eventually conceived his own human prehistory which differed significantly from the ideas of Wittels and his other disciples (Jung, Tausk) and allowed him to claim he now held a "historical" point of view that his disciples were missing.

[The effect of taboo word on language processing]

Knowledge about how we process taboo words brings us closer to the and emotional processes, and broadens the interpretative framework in psychiatry and psychotherapy. In this study the lexical decision paradigm was used. Subjects were presented neutral words, taboo words and pseudowords in a random order, and they had to indicate whether the presented word was meaningful (neutral and taboo words) or meaningless (pseudowords). Each target word was preceded by a prime word (either taboo or neutral). SOA differed in the two experimental conditions (it was 250 msec in the experimental group, and 500 msec in the control group). In the experimental group, response latencies increased for target words that were preceded by taboo prime words, as compared to those that were preceded by neutral prime words. In the control group prime had no such differential effects on response latencies. Results indicate that emotional processing of taboo words occur very early and the negative effect of taboo words on the following lexical decision fades away in 500 msec. Our experiment and other empirical data are presented in this paper.

Sexuality and mental health nursing in Ireland: weaving the veil of socialised inhibition

The World Health Organisation first identified, in 1975, the need for health professionals to be educated in the area of sexuality. Since then, studies exploring aspects of educational preparation of general nurses in relation to sexuality, found that there was an 'absence' of education in this area of practice. This paper reports findings on the educational discourses that shape mental health nurses' understandings of sexuality. Unstructured interviews were conducted with 27 consenting mental health nurses working in the Republic of Ireland. Data were analysed using the principles of Grounded Theory. Findings suggest that participants were exposed to a subtle network of legitimised sexual discourses during primary, secondary, and professional socialisation. These discourses provided participants with a view of sexuality that emphasised taboo, privatisation, pathology, and control. Social, political, or rights-based discourses that could have provided participants with the knowledge and clinical competence necessary to include sexuality in an open and confident manner within the horizons of nursing practice were absent. These findings challenge educators involved in curriculum development to rethink the fundamental philosophy that is shaping mental health nursing curricula. They also challenge educators to rethink their ideas around the meaning of 'absence' in relation to education.

Transcultural nursing: its importance in nursing practice

Transcultural nursing is an essential aspect of healthcare today. The ever-increasing multicultural population in the United States poses a significant challenge to nurses providing individualized and holistic care to their patients. This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes. This article discusses changes that are important to transcultural nursing. It identifies factors that define transcultural nursing and analyzes methods to promote culturally competent nursing care. The need for transcultural nursing will continue to be an important aspect in healthcare. Additional nursing research is needed to promote transcultural nursing.

Dilemma with the local perception of causes of illnesses in central Africa: muted concept but prevalent in everyday life

The author of this study aims to explore people's perceptions of the cause of illnesses in the Democratic Republic of Congo using qualitative methods, namely case studies and focus group discussions, to gather data from participants. He identifies seven main categories of causes of illnesses and describes the relations between them. The local concept of the causes of illnesses does not absolutely respect the biomedical framework. As the popular saying puts it, Congolais hakufi na microbe, meaning "Congolese people do not die by microbes." The perception of witchcraft is strong as a cause of illness among the Bira of Mobala and the Nande of Mukulia. The author argues that health professionals should take this view into account instead of rejecting it.

Link between Epilepsy and Malnutrition in a Rural Area of Benin

PURPOSE

Epilepsy and malnutrition are both important public health problems in sub-Saharan Africa. A relationship between epilepsy and malnutrition has been suspected for many years. Our objective was to investigate the association between epilepsy and malnutrition in Djidja, Benin.

METHODS

A matched population-based cross-sectional case-control survey was performed: cases (patients with epilepsy) were matched to controls according to sex, age +/- 5 years, and village of residence. The World Health Organization's criteria for malnutrition was used. Anthropometric measurements (weight, height, mid arm upper circumference, triceps skinfold thickness) were taken. Bioelectrical impedance analysis, a standardized food and social questionnaire and a clinical examination were done. Statistical analysis (conditional logistic regression) was performed using SAS 8.0.

RESULTS

A total of 131 cases and 262 controls were included. The prevalence of malnutrition was higher in cases than in controls (22.1% vs. 9.2%, p = 0.0006). Social factors were significantly different between cases and controls. Feeding difficulties were more frequent and health status was worse in cases. Seven variables were associated with epilepsy: (i) nutritional factors: mid arm upper circumference (prevalence odds ratio (pOR) = 0.7, CI: 0.6-0.9), cereal consumption <3 times during the 3 days before the study (pOR = 4.2, CI: 1.8-10.0), <3 meals/day (pOR = 4.2, CI: 1.6-10.9), tooth decay (pOR = 2.9, CI: 1.1-7.4), food taboos (pOR = 25.0, CI: 8.3-100.0), (ii) social factors: surrogate respondent (pOR = 16.8, CI: 3.1-90.3) and no second job (pOR = 7.1, CI: 2.3-22.3).

CONCLUSION

Epilepsy and nutritional status are linked in sub-Saharan Africa. Programs to improve the nutritional status of people with epilepsy are needed.

Communication as a protective factor: evaluation of a life skills HIV/AIDS prevention program for Mexican elementary-school students

Literature suggests that communication is a protective factor against high-risk sexual behavior. This study assessed the impact of a fourth-grade communication-centered life skills program on attitudes, norms, self-efficacy, behaviors, and intentions toward communication about difficult subjects. Participants included 1,581 low-income Mexican elementary-school children, divided into experimental and control groups. Teachers were trained to replicate the program as part of the school curriculum over 15 to 20 weeks. Students completed self-report questionnaires before and after the program. Multilevel analyses demonstrated the program's statistically significant positive impact on communication about attitudes, self-efficacy, intentions, and behavior; perception of sociocultural norms regarding communication transformed as a result of the program. Gender significantly predicted differences in communication: with respect to attitudes, self-efficacy, and intentions. The results show that early intervention programs targeting communication about difficult subjects can prevent risky sexual behavior and its consequences (e.g., HIV/AIDS) and influence perception of norms and gender roles.

An intergenerational approach to understanding Taiwanese American adolescent girls' and their mothers' perceptions about sexual health

Taiwan-born mothers' perceptions of sexual health affect their Taiwanese American girls' sexual perceptions. Taiwanese American girls grow up balancing two different cultural influences (Taiwanese and American) while living in the majority society. The process of balancing two different cultures is called bi-cultural straddling. Four separate focus group interviews with two sets of mothers and daughters ( N = 20) were conducted to understand intergenerational transmission of thoughts, perceptions, values, and attitudes associated with sex-related taboos and their impact on sexual communication, safety, and sexual health of second-generation Taiwanese American girls. The findings suggest that mother-daughter relationships, particularly mothers' traditional cultural values, influence their daughters' decision-making process. A secondary finding suggests that these girls tend to experience mental strain if they decide to go against their mothers' advice. Implications are that maternal involvement should be increased and further studies conducted to understand mother-daughter relationships, their pattern of sexual-related communicating, and expectations.

Sacred bounds on rational resolution of violent political conflict

We report a series of experiments carried out with Palestinian and Israeli participants showing that violent opposition to compromise over issues considered sacred is (i) increased by offering material incentives to compromise but (ii) decreased when the adversary makes symbolic compromises over their own sacred values. These results demonstrate some of the unique properties of reasoning and decision-making over sacred values. We show that the use of material incentives to promote the peaceful resolution of political and cultural conflicts may backfire when adversaries treat contested issues as sacred values.

Antenatal taboos among Chinese women in Hong Kong

OBJECTIVE

to identify the antenatal taboos commonly practised by pregnant Hong Kong Chinese women; to explore the health beliefs behind these taboos; and to examine how pregnant women perceived and reacted to the cultural tradition.

DESIGN

general ethnography and in-depth interviews, followed by a quantitative self-reported survey.

SETTING

Antenatal clinic of a university-affiliated hospital in Hong Kong.

PARTICIPANTS

consecutive samples of 60 women for in-depth interviews, and 832 women for the survey.

MEASUREMENTS

an inventory on the adherence and attitude towards antenatal taboos, and the Beck Depression Inventory that measures severity of depression.

FINDINGS

antenatal taboos were still commonly observed by contemporary Chinese women. Miscarriage, fetus malformation and fetal ill-health were the key cultural fears that drove contemporary Chinese women to observe the traditional taboos. About one-quarter and one-tenth of the women, respectively, felt unhappy and disputed with their families about the taboos. These women had significantly higher levels of depression in late pregnancy and during childbirth.

IMPLICATIONS FOR PRACTICE

health-care practitioners should be aware of the benefits and risks of traditional antenatal taboos on maternal health. Although some taboos can be socio-morally protective, the tension created by the observation of cultural tradition in modernity may impair maternal psychological well-being. Health-care providers in Western countries should be vigilant of the complex cultural tension faced by migrant Chinese mothers.

Ecological influences of sexuality on early adolescent African American females

African Americans make up the greater proportion of AIDS cases in adolescent girls but little is understood about the development of sexual risk behaviors during the early adolescent years. This article will explore ecological factors influencing adolescent sexual risk behaviors. In the focus groups, which were conducted using 28 African American mothers and their early adolescent daughters, 2 major themes emerged: exposure and support systems. Mothers described the impact community had on their daughters and how monitoring and support systems worked together to control exposure. The girls detailed the different ways they were impacted by the community. Attitudes the girls adopted from their exposures resulted in risk-taking behaviors or a determination to positively impact the community. Community was shown to be the context of the acquisition of sexual knowledge and attitudes. These findings support the development of interventions to address the impact of community on the participation of sexual risk behaviors.

Knowledge, attitudes and beliefs about menarche of adolescent girls in Anand district, Gujarat

A questionnaire survey of knowledge, attitudes and beliefs towards menstruation was made in 22 schools in Anand district, Gujarat state. Of 900 schoolgirls aged 11-17 years, only 38.5% felt comfortable about menarche and only 31.0% believed that menstruation was a normal physiological process. Many (37.2%) had not been informed about menarche before its onset and 48.2% felt they were not mentally prepared. The major sources of information were the mother (60.7%) or an elder sister (15.8%); teachers and others relatives played a small role. In this area of India, many families continue the custom of celebrating the first menarche and observing social restrictions.

National inquiry into self-harm breaks down taboos

We usually say, ‘at least you still have your health’ when something emotionally trying happens to us. I don't think I've ever heard, ‘at least you still have your mental health’, although this may be a very appropriate comment. The results of the National Inquiry into Self-Harm Among Young People was released at the end of March. This 2-year inquiry discovered that about 1 in 15 young people (aged 11–25years) have engaged in self-harming behaviour. As Catherine McLoughlin, Chair of the National Inquiry Panel, states: ‘on average, in every secondary school classroom there will be two young people who have hurt themselves’ (Brophy, 2006). Each year, in England and Wales, about 19000 young people are admitted to hospital as a result of self-harm and there is evidence that rates of self-harm are higher in the UK than in the rest of Europe.

The anatomy of a forbidden desire: men, penetration and semen exchange

The rising popularity of unprotected anal sex (bareback sex) among men who have sex with men (MSM) is perplexing healthcare providers working in sexual health clinics. Epidemiological research on the topic overlooks several socio-cultural and psychological dimensions. Our research attempts to construct an appropriate theoretical edifice by which we can understand this sexual practice. In order to achieve this objective, a qualitative design was selected and 18 semiconductive in-depth interviews were carried out with barebackers from five European and North American cities. We then analyzed the data using two theoretical approaches that were sensitive to the issues of desire, transgression and pleasure. These theories are those of the late French psychoanalyst, Jacques Lacan, and those of poststructural thinkers, Gilles Deleuze and Felix Guattari. These theoretical frameworks helped shed light on the significance of bareback sex, and can potentially influence healthcare providers in gaining a better understanding not only of their clients, but also of their own role in the circuitry of desire at work within bareback. We found that while the exchange of semen constitutes a dangerous and irrational practice to healthcare professionals, it is nevertheless a significant variable in the sexual lives of barebackers that needs to be taken into consideration in the provision of healthcare services.

WOMEN’S SOMATIC STYLES: RETHINKING BREAST SELF-EXAMINATION EDUCATION

In this ethnographic study I explored women's somatic and sexual experiences, reception of breast self-examination (BSE) messages, and reactions to the practice of BSE. Mainstream BSE education uses messages that deemphasize the woman, her breasts, and her relationship to them as sexual. The turbid confluence of societally eroticized breasts and self-touch taboos makes it unlikely that women filter these messages in an asexual way. Using grounded theory, I examined women's expression of the self-body relationship and the sociocultural milieu within which women consider BSE education materials. Seven subjects varying in age, sexual orientation, parenting, and relationship status were interviewed about their physical experiences, self-touch, and body image. Subjects also participated in a BSE class and focus group, and composed a journal entry describing their reactions to practicing BSE. Discernible patterns in somatic memories, somatic styles, and reactions to BSE educational messages were found. This study suggests a need for a more consciously feminist approach to BSE education.

Food taboos among nursing mothers of Mexico

This cross-sectional study was carried out in Guadalajara, Mexico, during 1998-1999 to identify food taboos among nursing mothers who participated in a breast-feeding support programme. The study included 493 nursing mothers who were interviewed 10-45 days after delivery. A chi-square test was used for finding an association among food taboos, mother's characteristics, and demographic variables. 50.3% of the mothers avoided at least one food in their diet after childbirth due to beliefs that it was harmful during breast-feeding. Forty-seven percent avoided three or more foods. Fruits and vegetables (62%) and legumes (20%) were the most-avoided foods. These food taboos were associated with living more than 10 years in Guadalajara city (odds ratio [OR] 1.95 [1.25-3.09], p = 0.002), breast-feeding experience (OR 1.91 [1.18-3.12], p = 0.005), no-prenatal information about breast-feeding (OR 1.59 [1.08-2.34], (p = 0.01), and other people's suggestion to complement breast-feeding (OR 1.61 [1.09-2.38], p = 0.01). A supportive approach and efficient communication, taking into account mother's characteristics, might reduce the gap between scientific recommendations and nutritional practices of mothers willing to nurse their infants.