Compliance and the patient's perspective: Controlling symptoms in everyday life

Non-compliance with medical advice is poorly understood. Most of the existing literature considers the problem only from the doctor's point of view. We undertook a diachronic, qualitative study of the illness experiences of 19 women to try to understand non-compliance from the patient's perspective. Three-fourths of our study group had ceased to follow their doctor's recommendations by four months postdiagnosis. Their non-compliance could not be explained by the fact that the women held understandings of their illnessses which were incongruent with their physicians'; nor were they unable to understand the diagnosis they received A consideration of the roles that their diagnosis and treatments played in their daily lives proved more useful in explaining their failure to follow physicians' recommendations. Patients' use of treatments reflected their desire to control symptoms within the constraints of their daily routines.     

Exemplars and the reproduction of everyday life: The Amherst affair

Frederick Errington is Aaaociate Professor of Anthropology, at Keene State College, New Hampshire. Deborah Gewertz is Professor of Anthropology, at Amherst College, Massachusetts.     

Materializing the nation in everyday life: on symbols and objects in the Palestinian refugee diaspora

This article considers the nationalizing practices of everyday life among Palestinian refugees in Jordan. Concerned with what some scholars call banal or everyday nationhood, it examines how particular objects within the ordinary lives of Palestinian refugees articulate conceptions of national belonging and difference. Attending to the discursive and the material, this article argues that understanding Palestinian national practice among refugees in Jordan requires specific attention to the material objects consumed and displayed within the homes and institutions of Palestinian life. As icons productive of a national sensorium, these objects are critical for understanding the constitution of nationhood and what I call a national visualscape. Embedded within the routine spaces of ordinary life, this paper argues that national practice is often visible yet unseen, articulated yet unheard. Palestinian nationhood in Jordan is thus an ordinary affair; it is the practical accomplishment of ordinary people engaged in the production of nationhood without a nationalist movement.     

Idioms of distress: Somatic responses to distress in everyday life

In-depth interviews were conducted among 50 subjects residing in the industrial town of Newcastle, Australia. Half of these subjects were from the general population and half were currently seeking counselling for personal/family problems. None of the subjects were receiving any medical care at the time of interview, though seven had done so during the episode of distress they were discussing. The study shows that while the subjects psychologized their problems, members of both groups tended to somatize at a rate proportional to the level of distress. Subjects were unaware of any relationship between the distress they were experiencing and their physical complaints. The results of this study support previous research which argues that those experiencing distress and those who tend to introspect are also those who are likely to amplify somatic symptoms. At the same time these results depart from findings in the United States which suggest that in the West, people learn to express social and personal distress in psychological terms,, thereby reducing the level of somatization. Though not representative of the population as a whole, the findings raised questions warranting further study.     

Photochemistry and photobiology of 5-azacytidine: effect of repair on photostabilization of Escherichia coli.

The photochemical stability of the anomalous nucleic acid base 5-azacytidine (z5Cyd) on irradiation at 254 nm is by about one order of magnitude less than that of cytidine (Cyd). Contrary to the photochemical behaviour, incorporation of z5Cyd into the nucleic acids of E. coli strains SR 20 (uvr+ rec+), SR 74 (uvr+ rec-) and SR 22 (uvr- rec+) produced a higher resistance to UV light. Only the SR 73 (uvr- rec-) strain was shown to have an increased UV sensitivity. This latter finding is in accord with the photochemical properties of z5Cyd. The results led to the conclusion that excision and recombination repair processes contribute to the observable protective effect. The fact that inhibition of excission repair by caffeine or proflavine of the mutant uvr+ rec- changes protection into sensitization supports this idea.     

Monitoring of blood glucose concentration in subjects with hypoglycaemic symptoms during everyday life.

OBJECTIVE--To study the persistence of hypoglycaemic symptoms, changes in blood glucose concentrations, and the relation between reported symptoms and measured blood glucose values in functional hypoglycaemia. DESIGN--Re-evaluation of symptoms in patients admitted consecutively with suspected hypoglycaemia followed by a case-control study. SETTING--The Steno Memorial Hospital in Gentofte, Denmark, which specialises in the diagnosis and treatment of and research on endocrine disorders, including hypoglycaemia. PATIENTS--21 Subjects admitted consecutively with hypoglycaemic symptoms that were relieved by eating in whom insulinoma and other organic disorders presenting with hypoglycaemia had been ruled out. Twelve of these subjects with persistent symptoms entered the case-control study, as did a matched control group. INTERVENTIONS--Four days of monitoring blood glucose concentrations at home, six daily samples being taken in fixed relation to meals by the finger prick method. Extra samples were taken when symptoms occurred. MAIN OUTCOME MEASURES--Blood glucose concentration, glycated haemoglobin concentration, and within subject variation in measured values. RESULTS--After one to three years of observation 19 of the 21 subjects still had symptoms. Six out of 12 subjects experienced hypoglycaemic symptoms during the controlled study. Blood glucose concentration ranged from 3.7 mmol/l to 7.5 mmol/l during these episodes. Changes in blood glucose concentration, mean blood glucose concentrations at each time point, within subject variation in the measured values, and glycated haemoglobin concentration were not significantly different in all patients compared with the control subjects and in patients with symptoms during the study compared with controls. CONCLUSION--Hypoglycaemic symptoms during everyday life in apparently healthy subjects are persistent but are not related to chemical hypoglycaemia.     

Short term effect of ultraviolet-B radiation on photosystem 2 photochemistry in the cyanobacteriumSynechococcus 6301

Exposure of intact cells of theSynechococcus 6301 to UV-B radiation induced a loss in photosystem 2 (PS 2) electron transport activity prior to the alteration in pigment complexes. Thus the degradation of PS 2 was not directly related to pigment alteration. Supported by Young Scientist grant No. SRJSYIB-05192 from the Department of Science and Technology, Goverment of India to SDSM.     

Stereochemical aspects of the hydration of trans-anethole epoxide in the rat

Racemic trans-anethole epoxide [1-(4′-methoxyphenyl)-propane-1,2-oxide] was incubated with water, buffers, and rat liver microsomes and cytosol and the stereochemistry of the diols produced was determined by HPLC as their dicamphanyl esters. The diol metabolites were isolated by HPLC from the urine of rats administered [1′-¹⁴C] trans-anethole and their stereochemistry determined after derivatization to their camphanyl esters. The stereochemical course of the metabolism of trans-anethole by rat liver microsomes and cytosol is discussed. © 1995 Wiley-Liss, Inc.     

The life and death of a street boy in East Africa: everyday violence in the time of AIDS

This article focuses on the life history of a single street boy in northwestern Tanzania, whom I name Juma. I suggest that Juma's experiences and the life trajectory of himself and of significant individuals around him (particularly his mother) were structured by everyday violence. I describe everyday violence in terms of a conjuncture between macrostructural forces in East Africa (including a history of failed development schemes and the contemporary political economy of neoliberalism) and the lived experience of individuals as they negotiate local, contextual factors (including land-tenure practices, the power dynamics between immediate and extended kin, life on the streets, and constructions of gender and sexuality). I suggest that AIDS and its many impacts on Juma's life course can only be understood in a broader context of everyday violence. From this basis, I draw several general conclusions regarding AIDS prevention and intervention strategies.     

Reproductive strategies and Islamic discourse: Malian migrants negotiate everyday life in Paris, France

Approximately 37 thousand Malians currently reside in France as part of the West African diaspora. Primarily Muslim, both women and men confront challenges to their understandings of Islamic prohibitions and expectations, especially those addressing conjugal relations and reproduction. Biomedical policies generate marital conflicts and pose health dilemmas for women who face family and community pressures to reproduce but biomedical encouragement to limit childbearing. For many women, contraception represents a reprieve from repeated pregnancies and fatigue in spite of resistance from those who contest women's reproductive decisions as antithetical to Islam. French social workers play a particularly controversial role by introducing women to a discourse of women's rights that questions the authority of husbands and of religious doctrine. Women and men frame decisions and debate in diverse interpretations of Islam as they seek to manage the contradictions of everyday life and assert individual agency in the context of immigration and health politics.     

Heart rate and plasma catecholamines during 24 h of everyday life in trained and untrained men.

Physical training decreases resting heart rate as well as heart rate and catecholamine responses to ordinary physical activity and mental stress. These effects have been speculated to diminish cardiac morbidity. However, the sparing of heartbeats and catecholamine production might be outweighed by exaggerated responses during training sessions. To elucidate this issue, heart rate was measured continuously and plasma catecholamine concentrations were measured frequently during 24 h of ordinary living conditions in seven endurance-trained athletes (T) and eight sedentary or untrained (UT) young males. T subjects had lower heart rates than UT subjects during sleep and during nontraining awake periods. However, because of the increase during training, the total 24-h heartbeat number did not differ between groups (107,737 +/- 3,819 for T vs. 113,249 +/- 6,879 for UT, P = 0.731). Neither during sleep nor during awake nontraining periods were catecholamine levels lower in T than in UT subjects. Peak catecholamine levels during exercise in T were much higher than peak levels in UT subjects, and 24-h average epinephrine and norepinephrine concentrations were twice as high. We concluded that in highly trained athletes the total number of heartbeats per day is not decreased and the catecholamine production is, in fact, increased.