Lise Rosendal Østergaard

Schizophrenics' offspring reared in adoptive homes

THIS is the first of a projected series of reports on what Dr. Kety, Dr. Wender and I call the Adoptees Study.l The one that Dr. Kety presented we call the Extended Family Study and the one that Dr. Wender presented we call the Adoptive Parents Study. The names may help to distinguish the studies in future discussions of them. This is a preliminary as well as a first report, since we are still very much in the midst of our extensive research activities. We will be finding and examining subjects for at least another year. In June 1967 we began the third year of this project. The reader will observe a strong resemblance, as well as important differences in conception and method, between the Adoptees Study and the study reported by Heston. We want to point out that our study was conceived and planned years before we learned of Heston’s remarkable feat, and it was well under way for some time before Heston’s report appeared. Although all our studies attempt to assess the relative contributions of heredity and environment to schizophrenia, the major focus of the Adoptees Study is somewhat different. Here we are trying to obtain evidence that a diathesis-stress theory of schizophrenia is correct. What we would like to do is to detect and describe some behavioral and psychological aspects of that inherited diathesis. Paul Meehl would call it the “schizotype”, which is a perfectly good name for it.

HIV/AIDS knowledge and condom use among Somali and Sudanese immigrants in Denmark.

Aims: This study explores the knowledge, attitudes and practices among Somali and Sudanese immigrants in Denmark with regard to HIV/AIDS and condom use. Material and methods: A 78-item questionnaire, divided into five thematic sections, was given to 192 purposively selected Sudanese and Somalis of both sexes, aged 18—49, who had lived in Denmark for one or more years. It was administered in Arabic and Somali in four locations and supplemented by 13 semi-structured interviews. Results: Education, sex, and nationality, but not length of residence in Denmark, were positively associated with knowledge about HIV/AIDS. Less than half of both men and women scored more than 70% on the knowledge portion of the questionnaire, while Sudanese knew more than Somalis. Men had a more negative attitude towards condoms than women, but greater knowledge about them. One-third of the women reported never having seen or heard of a condom, and almost half had never received information about condoms. Both sexes preferred receiving such information from the TV or friends instead of family doctors or HIV-positive individuals. Conclusions: This study suggests that knowledge about HIV/ AIDS is low in these two Danish immigrant groups, both of which are characterized by reported incidence rates that are higher than the national average. The groups receive little information, while condom knowledge is particularly low among poorly educated women, and men have a negative attitude to condom use. The findings indicate a need for targeted, culturally sensitive HIV/AIDS information and advice.

Trust matters: A narrative literature review of the role of trust in health care systems in sub-Saharan Africa

This article makes a contribution to the debate about health service utilisation and the role of trust in fostering demand for health services in sub-Saharan Africa. It is framed as a narrative literature review based on a thematic analysis of nine empirical, qualitative studies. For the purposes of this article trust is defined as a voluntary course of action, which involves the optimistic expectation that the trustee will do no harm to the trustor and is increasingly perceived as an important influence on health system functioning. The article looks at trust issues in interpersonal, intergroup and institutional situations. The findings of the review point to four elements that are important for trust to develop in health sector relationships: the sensitive use of discretionary power by health workers, perceived empathy by patients of the health workers, the quality of medical care and workplace collegiality. When trust works in health sector encounters, it reduces the social complexity and inherent uneven distribution of power between clients and providers. The article concludes that understanding and supporting trust processes between patients and providers, as well as between co-workers and managers, will improve health sector collaboration and stimulate demand for health care services.

Muted voices: HIV/AIDS and the young people of Burkina Faso and Senegal

This article explores the discrepancies between the vocal public discourse on HIV/AIDS and sexuality as generally encouraged by policy-makers and donor communities in Africa, and the often hushed voices of their target groups: young people in African communities. Based on fieldwork among urban youth in Senegal and Burkina Faso, we describe the silence of young people with regard to HIV/AIDS and sexuality as a social phenomenon, with focus given to family relations, peer relations and gender aspects in partnerships. Drawing on Foucault and Morrell, an inability and unwillingness to speak about HIV/AIDS and sexuality are analysed as a response to an everyday life characterised by uncertainty. This response represents a certain degree of resistance, while it constitutes a major barrier to any HIV/AIDS prevention effort. Finally, we stress that despite great constraints in their everyday lives, young people have some room to manoeuvre and are able to apply some negotiating strategies to reduce sexually-related health risks.

Role of women as a motivative and collective force in international development

Women in third‐world countries understand feminism in terms of the right to live in dignity, to organize against military repression and militarization, and to mobilize energies through an understanding and acknowledgment of womens own achievements and strengths. Women play, or have the potential to play, a key role in decision making and implementation within the areas of food and water security, environmental protection, energy saving, health, population, and the improvement of the level of education.

“Children get sick all the time”: A qualitative study of socio-cultural and health system factors contributing to recurrent child illnesses in rural Burkina Faso

BackgroundIn Burkina Faso, the government has implemented various health sector reforms in order to overcome financial and geographical barriers to citizens’ access to primary healthcare throughout the country. Despite these efforts, morbidity and mortality rates among children remain high and the utilization of public healthcare services low. This study explores the relationship between mothers’ intentions to use public health services in cases of child sickness, their social strategies and cultural practices to act on these intentions and the actual services provided at the primary health care facilities. Focusing on mothers as the primary caregivers, we follow their pathways from the onset of symptoms through their various attempts of providing treatment for their sick children. The overall objective is to discuss the interconnectedness of various factors, inside and outside of the primary health care services that contribute to the continuing high child morbidity and mortality rates.MethodsThe study is based on ethnographic fieldwork, including in-depth interviews and follow-up interviews with 27 mothers, informal observations of daily-life activities and structured observations of clinical encounters. Data analysis took the form of thematic analysis.Results and discussionFocusing on the mothers’ social strategies and cultural practices, three forms of responses/actions have been identified: home-treatment, consultation with a traditional specialist, and consultation at the primary health care services. Due to their accumulated vulnerabilities, mothers shift pragmatically from one treatment to another. However, the sporadic nature of their treatment-seeking hinders them in obtaining long-term solutions and the result is recurrent child illnesses and relapses over long periods of time. The routinization of the clinical encounter at rural dispensaries furthermore fails to address these complexities of children’s illnesses.ConclusionsThe analysis of case studies, interviews and observations shows how mothers in a rural area struggle and often fail to receive care at public healthcare facilities. Health service delivery could be organized in a manner that responds better to the needs of these mothers in terms of both access and retention.

Non-communicable diseases: Harnessing the current opportunities

Non-communicable diseases (NCDs) are receiving growing attention, which brings a unique opportunity to utilise solutions available to address them. These diseases are largely preventable; proven, cost-effective interventions are available; and when NCDs emerge, means exist to treat them, prevent complications, and to improve quality of life. Yet, there is a lack in progress in responding effectively to NCDs, and the current discussion and research focus predominantly on challenges rather than the opportunities, which this paper outlines.

Men in Uniforms: Masculinity, Sexuality and HIV/AIDS in Western Rwanda

The objective of this study was to provide an in-depth description and analysis of the lived experiences of men in uniforms in Western Rwanda with a view to the links between notions of masculinity, sexual practices and the spread of HIV. A total of 182 members of different uniformed cadres participated in focus group discussions, which were triangulated with findings from discussions held with 136 participants representing other local groups such as school girls and commercial sex workers. Using an ethnographic approach, the study paid attention to local concepts and practices and found that in Rwanda sexual gratification is understood to be equally important for women and men. Implications for the link between gender inequality and the spread of HIV are considered.