Is there a duty to provide medical care to HIV-infectious patients? Facts, fallacies, fairness, and the future.
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The author examines and rejects two common types of argument in support of the duty to care for persons infected with HIV, namely, the view that exposure to this contagion has been accepted (individually or communally) by physicians, and the view that physicians can be held to a high standard of moral conduct that encompasses a substantial degree of self-sacrifice. He suggests rather that the duty to care for the HIV-infectious patient is grounded in the harm that would ensue were discrimination to be permitted, and in fairness to those members of the medical profession who refuse to discriminate. (+info)
Temporary stability of urban food and nutrition security: the East Jakarta study.
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The food and nutrition situation in households of East Jakarta was assessed in 1993/1994 and 1998/1999 with the aim of identifying the determinants of potential problems and the dynamics of change. In 1993/1994, the nutritional status of approximately 73% of children under 5 years of age and 60% of mothers was within the normal range, although underweight and overweight were prevalent in almost all households. Between 1998 and 1999, there was a sharp increase in fathers reporting unemployment. The consumption of animal food sources decreased, whereas the consumption of food derivatives such as oils and sugar remained high. Approximately 90% of the population obtained drinking water from wells. By 1998, the public garbage collection system had almost completely collapsed in East Jakarta. Between 1993 and 1998, the prevalence of diarrhoea and acute respiratory infections in children aged under 5 years increased dramatically, from 8 and 44% to 24 and 70%, respectively. The urban environment has undergone significant changes. In Indonesia, as a whole, many achievements in the improvement of household food security and care have been lost due to the economic and political crisis. The statistical association between mothers' and fathers' education and the nutritional status of their children that was observed in 1993/94 did not appear in the 1998 survey. It seems that the education-related coping mechanisms of the parents were inadequate to deal with the rapid deterioration in the economic and political situation. (+info)
Prehistoric human colonization of India.
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Human colonization in India encompasses a span of at least half-a-million years and is divided into two broad periods, namely the prehistoric (before the emergence of writing) and the historic (after writing). The prehistoric period is divided into stone, bronze and iron ages. The stone age is further divided into palaeolithic, mesolithic and neolithic periods. As the name suggests, the technology in these periods was primarily based on stone. Economically, the palaeolithic and mesolithic periods represented a nomadic, hunting-gathering way of life, while the neolithic period represented a settled, food-producing way of life. Subsequently copper was introduced as a new material and this period was designated as the chalcolithic period. The invention of agriculture, which took place about 8000 years ago, brought about dramatic changes in the economy, technology and demography of human societies. Human habitat in the hunting-gathering stage was essentially on hilly, rocky and forested regions, which had ample wild plant and animal food resources. The introduction of agriculture saw it shifting to the alluvial plains which had fertile soil and perennial availability of water. Hills and forests, which had so far been areas of attraction, now turned into areas of isolation. Agriculture led to the emergence of villages and towns and brought with it the division of society into occupational groups. The first urbanization took place during the bronze age in the arid and semi-arid region of northwest India in the valleys of the Indus and the Saraswati rivers, the latter represented by the now dry Ghaggar-Hakra bed. This urbanization is known as the Indus or Harappan civilization which flourished during 3500-1500 B.C. The rest of India during this period was inhabited by neolithic and chalcolithic farmers and mesolithic hunter-gatherers. With the introduction of iron technology about 3000 years ago, the focus of development shifted eastward into the Indo-Gangetic divide and the Ganga valley. The location of the Mahabharata epic, which is set in the beginning of the first millennium B.C., is the Indo-Gangetic divide and the upper Ganga-Yamuna doab (land between two rivers). Iron technology enabled pioneering farmers to clear the dense and tangled forests of the middle and lower Ganga plains. The focus of development now shifted further eastward to eastern Uttar Pradesh and western Bihar which witnessed the events of the Ramayana epic and rise of the first political entities known as Mahajanapadas as also of Buddhism and Jainism. The second phase of urbanization of India, marked by trade, coinage, script and birth of the first Indian empire, namely Magadha, with its capital at Pataliputra (modern Patna) also took place in this region in the sixth century B.C. The imposition by Brahmin priests of the concepts of racial and ritual purity, pollution, restrictions on sharing of food, endogamy, anuloma (male of upper caste eligible to marry a female of lower caste) and pratiloma (female of upper caste ineligible to marry a male of lower caste) forms of marriage, karma (reaping the fruits of the actions of previous life in the present life), rebirth, varnashrama dharma (four stages of the expected hundred-year life span) and the sixteen sanskaras (ceremonies) on traditional occupational groups led to the birth of the caste system - a unique Indian phenomenon. As a consequence of the expansion of agriculture and loss of forests and wildlife, stone age hunter-gatherers were forced to assimilate themselves into larger agriculture-based rural and urban societies. However, some of them resisted this new economic mode. To this day they have persisted with their atavistic lifestyle, but have had to supplement their resources by producing craft items or providing entertainment to the rural population. (+info)
Changes in contraceptive use in Bulgaria, 1995-2000.
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Comparison of results from national surveys conducted in Bulgaria in 1995 and 2000 reveal little overall change in use of modern contraceptives. Dramatic increases occurred, however, among women younger than 25 who entered their reproductive period after the end of the state socialist period. This finding suggests that contraceptive gains in the country will come largely as a cohort-replacement process. From these data, no separate program impact appears for special clinics established to provide direct, subsidized delivery of modern contraceptives to women in selected cities. The special clinics opened in cities where contraceptive use was already above the national average. During these five years, other cities lacking special clinics managed to gain in prevalence of modern contraceptive use, leaving a relatively homogenous urban-rural difference in levels of use throughout the country. (+info)
Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?
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OBJECTIVES: To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV. METHODS: In 1999, 379 women attending reproductive health care clinics were interviewed and underwent pelvic examination. Specimens for RTI/HIV diagnosis were taken. RESULTS: Seventeen per cent had undergone FGC, mostly clitoridectomy (97%). Female genital cutting prevalence was significantly lower among educated, Christian and Chagga women. Women aged >or=35 were twice as likely to be cut as those < 25 years. Seventy-six per cent of those who had undergone FGC intend not to perform the procedure on their daughters. Age < 25 years (P < 0.0001) and low parity (P < 0.01) were predictors of that intention. There was no association between RTIs, HIV or hepatitis B and FGC. CONCLUSION: FGC is still fairly common but there is evidence of a change of attitude towards the practice, especially among young women. The opportunity to educate women who attend reproductive health care facilities on FGC should be taken. (+info)
Changing status of doctors in Finland.
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This short sociological study discusses the changing status of doctors, in regard to both non-medical administrators and the public. Though based on observations in Finland I also see similar trends in other countries, trends which are associated with rapid social change in the West generally. These developments will lead to changes in the esteem in which a community holds its doctors. (+info)
Socio-demographic determinants of intrauterine device use and failure in China.
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BACKGROUND: This study examines social, demographic and family planning programme factors influencing intrauterine device (IUD) use, failure and subsequent resolution ('use dynamics') in the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence. METHOD: A time-to-failure model was used to identify independent determinants of IUD failure. Logistic regression was used to identify independent predictors of abortion in women after failure. RESULTS: Being younger at IUD fitting [<25 versus > or = 35 years, hazard ratio 5.9, 95% confidence interval (CI) 4.3, 7.7] and having a larger number of living children (> or = 3 versus <2 children, hazard ratio 1.2, 95% CI 1.1, 1.4) predict higher risk of IUD failure when controlled for each other; but in women with IUD failure, being older and having fewer children predict a much higher chance of resulting abortion. Contraceptive history and social/regional factors were also associated with higher IUD failure risk, in particular, use before 1984 (hazard ratio 1.3, 95% CI 1.2,1.4); and some of these factors were also predictive of abortion following failure. CONCLUSIONS: The determinants of IUD use dynamics suggest two main possible mechanisms. Some determinants may reflect effects of the Chinese family planning programme; some may indicate women's physiological and biological reactions to IUD. Health implications and relevant policy recommendations are discussed. (+info)