The cross-cultural evidence on "extreme behaviors": what can it tell us?

Many kinds of body/mind practices are capable of producing remarkable behaviors and altered body states. A typology of such behaviors and states, defined as observable and intentional "extreme" alterations to the body, is presented. Epistemological and methodological issues are discussed: limitations of observational data, and role of meaning, intentionality, and consciousness. Rapprochement between Western medicine and Indo-Tibetan medicine requires rethinking biomedicine's radical grounding in physicality and reliance on "evidence-based medicine," and guarding against an ethnocentric Western intellectual hegemony motivating medical science and clinical practice to colonize and subvert non-Western traditions like Indo-Tibetan Buddhist medicine.

Rituximab therapy for multisystem autoimmune diseases in pediatric patients.

OBJECTIVE: To evaluate the effects of rituximab (anti-CD20 monoclonal antibody) on the disease course in pediatric patients with multisystem autoimmune diseases. METHODS: Four patients with multisystem autoimmune diseases refractory to conventional immunosuppressive medications, each with central nervous system (CNS) involvement, were treated with four weekly infusions of rituximab. Their clinical and laboratory responses were evaluated. RESULTS: Each of the patients had improvement in clinical symptoms and laboratory parameters. One patient with autoimmune cytopenias and autoimmune CNS and peripheral nervous system disease had resolution of the cytopenias and marked improvement in neurologic symptoms; he currently receives no immunosuppressive medications. Two half-siblings with lymphoplasmacytic colitis, pulmonary nodules, and CNS disease had improvement of their symptoms. A fourth patient with chorea and seizures secondary to primary antiphospholipid antibody syndrome had improvement in fine and gross motor function and reduced seizure frequency. There were no serious adverse events. CONCLUSIONS: The biologic response modifier rituximab, designed to eliminate B lymphocytes, was safe and effective in four pediatric patients with multisystem autoimmune disorders. It appears to be beneficial in autoimmune conditions presumably mediated by a variety of B-cell-related mechanisms, and may decrease or eliminate the need for other immunosuppressive medications.

Consistency of self-reports of sexual activity among young adolescents in Jamaica

Examines consistency of self-reports of sexual activity among young adolescents in Jamaica. Reporting of sexual activity, especially among boys; Highlight of limitations of relying on self-reported data to identify sexually active adolescents.(AU)

Evaluation of a sexuality program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviours. Using a quasi-experimental design, the studies measured the effect of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on the use of contraception at first intercourse (P = .08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive effect on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact. (AU)

Evaluation of a sexuality education program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuallity education and pregnancy preventative programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and the use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact (AU)

Evaluation of a sexuality education program for young adolescents in Jamaica / Evaluación de un programa de educación sexual para adolescentes jóvenes en Jamaica

Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that ingluence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact

Pese a su número creciente, son pocos los programas de educación sexual y prevención del embarazo que han sido evaluados en los países en desarrollo. Este estudio, realizado entre 1995 y 1997, evalúa en 945 escolares jamaiquinos de 7o grado (11 a 14 años de edad) el impacto de un programa escolar de educación sexual, el denominado "Proyecto de 7o grado", sobre la iniciación de su actividad sexual, el empleo de anticonceptivos durante el primer coito y los conocimientos y actitudes que influyen en sus comportamientos. Utilizando un diseño casi experimental, el estudio midió los efectos del proyecto al final de los nueve meses de intervención (corto plazo) y un año más tarde (largo plazo). El análisis de regresión logística multivariado reveló que el proyecto no tuvo efectos sobre la edad de inicio de la actividad sexual, aunque sí tuvo un impacto positivo a corto plazo sobre el empleo de anticonceptivos en el primer coito (P = 0,08); la probabilidad de utilizar anticonceptivos fue dos veces mayor en los adolescentes del grupo sometido a la intervención educativa. El proyecto también tuvo una influencia positiva a corto plazo sobre varios aspectos de los conocimientos y actitudes de los adolescentes hacia la sexualidad y el embarazo. El moderado impacto del proyecto es alentador, dado que los programas escolares de educación sexual de duración limitada raramente tienen impacto a largo plazo y que, además, en Jamaica existen fuerzas socioeconómicas y culturales antagónicas que alientan la sexualidad temprana y la paternidad entre los adolescentes. El empleo de métodos educativos más participatorios y la reducción del número de alumnos por clase podría fortalecer el "Proyecto de 7o grado" y aumentar su impacto

Sexual Attitudes and Behaviour among young adolescents in Jamaica

Describes the attitudes and behaviour among low-income adolescents in Jamaica. Contributing factors to early sexual activity and pregnancy; Social pressure and encouragement among boys to be sexually active; Branding of young girls who become pregnant as having loose morals; Motivations for engaging in sex among girls and boys.(AU)

Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)

The effect of user fees on the utilization of family planning services: a clinical study

A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinic records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods. (AU)

Mapping study and private physicians' survey opportunities for expanded family planning services in Jamaica: final report

Reports of a project aimed at importing the effectiveness and sustainability of Jamaica's National Family Planning Programme in light of the planned phasedown of international donor support particularly the reduction of USAID-donated contraceptive supplies. A "Mapping Study and Private Physicians Survey" was designed to collect background information on the existing infrastructure of service delivery points (SDPs)and a better undrestanding of physicians' skill and interest levels pertaining to long-term and permanent methods. This information would enable interventions to be designed that would target less-well-served areas offer appropriate incentives for private-practice physicians to become more involved in family planning, and meet specific needs among the private physician community as they try to become more involved. Among the noteworthy findings of this study are, given that a key goal of the project is to increase use of longer-acting methods, these methods are not readily available at affordable prices to rural consumers/patients ie. half the Jamaican population. long-term and permanent methods are concentrated in urban areas and offered primarily by private physicians. Short-term or supply methods were widely available to both urban and rural users and were quite affordable. Another significant finding is that private physicians have an interest in increasing their understanding of and involvement in family planning, widespread interest was expressed in the Private Physicians' Pilot Project. The private sector it was found offers the most SDPs, the widest range of methods and the greatest number of hours of operation, however, it is the public sector that provides the most services ie. about 60 percent of family planning services. These was a tendency for private sector providers to be concentrated in urban areas due to available supporting medical services; a further intra-urban clustering of private sector sites was also found; ther was a tendency among newer doctors to establish practices in urban areas outside of Kingston; a more evenly distributed pattern for public sector SDP was found, along with a clear emphasis on serving rural communities; an expansionary trend in terms of number of SDPs in urban areas is noticeable whereas a slight reduction in overall number of SDPs serving rural areas was noted. The recommendations are, to use the findings from this mapping study to plan future activities; to improve availability on long-term and permanent methods for rural groups; to encourage the private sector to increase its participation in family planning; to engage pharmacies and private physicians in expanded social marketingprogrammes; and that the social marketing programme be encouraged to expand its marketing support to include longer-acting methods. (AU)

Mapping study and private physicians' survey opportunities for expanded family planning services in Jamaica: final report

Reports on a project aimed at importing the effectiveness and sustainability of Jamaica's National Family Planning Programme in light of the planned phasedown of international donor support particularly the reduction of USAID-donated contraceptive supplies. A "Mapping Study and Private Physicians Survey" was designed to collect background information on the existing infrastructure of service delivery points (SDPs)and a better undrestanding of physicians' skill and interest levels pertaining to long-term and permanent methods. This information would enable interventions to be designed that would target less-well-served areas offer appropriate incentives for private-practice physicians to become more involved in family planning, and meet specific needs among the private physician community as they try to become more involved. Among the noteworthy findings of this study are, given that a key goal of the project is to increase use of longer-acting methods, these methods are not readily available at affordable prices to rural consumers/patients ie. half the Jamaican population. long-term and permanent methods are concentrated in urban areas and offered primarily by private physicians. Short-term or supply methods were widely available to both urban and rural users and were quite affordable. Another significant finding is that private physicians have an interest in increasing their understanding of and involvement in family planning, widespread interest was expressed in the Private Physicians' Pilot Project. The private sector it was found offers the most SDPs, the widest range of methods and the greatest number of hours of operation, however, it is the public sector that provides the most services ie. about 60 percent of family planning services. These was a tendency for private sector providers to be concentrated in urban areas due to available supporting medical services; a further intra-urban clustering of private sector sites was also found; ther was a tendency among newer doctors to establish practices in urban areas outside of Kingston; a more evenly distributed pattern for public sector SDP was found, along with a clear emphasis on serving rural communities; an expansionary trend in terms of number of SDPs in urban areas is noticeable whereas a slight reduction in overall number of SDPs serving rural areas was noted. The recommendations are, to use the findings from this mapping study to plan future activities; to improve availability on long-term and permanent methods for rural groups; to encourage the private sector to increase its participation in family planning; to engage pharmacies and private physicians in expanded social marketingprogrammes; and that the social marketing programme be encouraged to expand its marketing support to include longer-acting methods.

Young adult reproductive health survey, Jamaica 1987: final report

Survey attempts to explore the attitudes of young adults towards to sex education and sexual activity, the history of their sexual experience and the use of contraceptives and to arrest fertility trends among Jamaican youths. Project aimed to: to obtain the necessary data on sexual behaviour and contraceptive use of young adults and to provide information for the development of new programme strategy of existing national family planning programmes and strategies, provide information to develop new educational material in the national programme and to make available data for regional comparisons (AU)

The Women's Centre in Jamaica: an innovative project for adolescent mothers

In 1978 the Jamaican Women's Bureau established the Women's Centre, the 1st project in the developing world to help pregnant teenagers avoid the usual hardships of poverty and dependence. The women take courses in academic subjects and prenatal and postnatal health, and receive good medical care. Fathers and parents are involved in counselling sessions where practical life skills, including family planning, are emphasized. The young mothers improve dramatically in self confidence, self esteem, and in their ability to take care of their babies. The Centre's success has helped to loosen the policies of the Jamaican government on the education of pregnant school age women (AU)