The large number of rural older adults suffering from untreated psychiatric illnesses suggests that stigma may be a significant barrier to the utilization of mental health services in this population. The current study examines self-stigma, public stigma, and attitudes toward specialty mental health care in a community sample of older adults living in a geographically isolated rural area, a rural area adjacent to a metropolitan area, and an urban area. One hundred and 29 older adults age 60 and above from the 3 geographic areas completed self-report measures of these constructs, and differences on the measures were assessed among the groups. Results indicated that older adults living in isolated rural counties demonstrated higher levels of public and self-stigma and lower levels of psychological openness than older adults in urban areas even after accounting for education, employment, and income. However, no differences emerged in reported willingness to use specialized mental health care in the event of significant distress. Results are discussed in the context of rural values, beliefs, and community structural factors. We further suggest that conventional binary rural/urban distinctions are not sufficient to understand the relationship between rurality and stigma.
In 1933 Schmidt and Livingstone attempted to determine the cause of the marked fall of blood pressure which results when morphine sulphate is injected intravenously into the cat or the dog. They showed that. the phenomenon exhibited tachyphylaxis and that it was unaffected by ether, urethane, barbitone, or phenobarbitone. They were unable to arrive at any definite conclusions and could only suggest that " depression of the vasomotor centre plays some part in this effect, but most of it is due to dilatation of cutaneous and muscular blood vessels by direct action upon their walls." Sollmann and Pilcher (1917) reported that morphine evoked the triple response in the human skin, an observation which was confirmed by Lewis (1927). Since that time Nasmyth and Stewart (1950) have shown that the weals caused by morphine in human skin are reduced by antihistamine drugs. Feldberg and Paton (1950) reported that the intra-arterial injection of morphine into the isolated perfused gastrocnemius muscle of the cat caused the appearance of histamine in the effluent, and later (Feldberg and Paton, 1951) showed that the drug also released histamine from the cat's skin and that after its intravenous injection into the intact animal the plasma histamine was raised. They considered that the fall of blood pressure caused by the intravenous injection of morphine could not be wholly accounted for by the release of histamine.In this work we have shown that the effect is complex and that at least three factors which would affect the blood pressure are involved when morphine is injected intravenously.
METHODSAnaesthesia.-All the rats from which records of blood pressure were taken were anaesthetized with urethane (7 ml./kg. of a 25 per cent (w/v) solution injected subcutaneously). Rats which received injections of morphine sulphate into the jugular vein 24 hours before records of blood pressure were taken from them were anaesthetized with ether while the vein was exposed.Cats were anaesthetized with ether followed by 80 mg./kg. of chloralose intravenously.Records of blood pressure.-All animals except decerebrate and spinal cats, from which records of blood pressure were taken, were heparinized. The apparatus described by Condon (1951) was used to record the blood pressure of the rats.
This review found no evidence of effect resulting from enhanced peri-abortion contraceptive counselling on subsequent unplanned pregnancy rate or the uptake of LARC. However, these findings are limited by the small number of relevant studies available and the marked heterogeneity between published studies. Further, larger-scale RCTs should be undertaken to ensure that there is sufficient power to detect an effect.
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