PubMed · 10184064
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1994. Configuring services for community needs.. https://pubmed.ncbi.nlm.nih.gov/10184064/
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The population in Jordan mounted from half a million in 1952 to 5.3 millions in 2004 and is composed of a variety of ethnic groups, the majority being Arabs. Couples nowadays tend to have fewer children, with the total fertility rate falling from 7.4 in 1976 to 3.7 in 2004. Consanguineous marriages are traditionally favored, with the preferred marriage partner being the offspring of the father's brother. First-cousin marriages declined from 28.5% for marriages contracted between 1950 and 1979 to 19.5% for marriages contracted after 1980. In the overall population, carrier rates for beta-thalassemia, alpha-thalassemia and sickle cell anemia are in the range of 2-4%, 3.2-12% of males have glucose-6-phosphate dehydrogenase deficiency, and the prevalences for familial Mediterranean fever and cystic fibrosis were estimated at around 0.04% each. A mandatory premarital screening program for beta-thalassemia carriers commenced in June 2004. The high consanguinity rate and the large family size in Jordan have contributed to the description of a number of rare and new autosomal recessive conditions. Genetic services in Jordan are still scarce and do not cover all the country due to the major impediments of a paucity of resources and trained health professionals in the area of medical genetics. The demographic data suggest that the health system in Jordan is capable of introducing some basic community genetic services into the primary health care program through comprehensive and cost-effective programs.
Higher-than-average cervical cancer incidence and mortality rates occur in Ohio Appalachia. Little is known, however, about societal norms and social determinants that affect these rates. To examine county-level sociocultural environments to plan a cervical cancer prevention program, the authors interviewed key informants from 17 of 29 Ohio Appalachia counties. Findings include the perceived offensiveness of the term Appalachia, the importance of long-standing family ties, urban and rural areas within counties, use and acceptability of tobacco, the view that cancer is a death sentence, and the stigmatization of people with cancer. Barriers to screening included cost, lack of insurance, transportation problems, fear, embarrassment, and privacy issues. These findings highlight the important role of geography, social environment, and culture on health behaviors and health outcomes. The interviews provided information about the unique characteristics of this population that are important when developing effective strategies to address cancer-related health behaviors in this medically underserved population.
This paper, based on original oral history research in a single locality, re-examines the impact of the structural division of British medicine, especially between community and hospital-based medicine, on rank-and-file general practice. Interviews were carried out with 29 retired and practising National Health Service (NHS) general practitioners (GPs) in Paisley, Scotland. In contrast to the historiography and literature of academic general practice, most retired and working family doctors who were interviewed rejected the significance of the division, and instead placed emphasis on the positive relationships between primary and secondary care in their locality. Particular stress was placed by these interviewees on the significance of local medical relationships in crossing the divide between primary and secondary medical practice. An analysis of the oral testimonies, informed by the work of Bakhtin [(1984). Problems of Dostoevsky's poetics. Minnesota: University of Minnesota Press] and Schrager [(1983). What is social in oral history? International Journal of Oral History, 4(2), 76-98] identified multiple discourses within single accounts. These discourses contained 'dialects' that suggested a commonality of beliefs, especially when social and clinical networks were detailed, but they also contained 'traces' of oppositional narratives. These 'traces' of alternative perspectives suggest both the power of imagined solidarity and the exclusion of a minority of practitioners. Thus imagined solidarities, based on the making of local identities, combined with imagined oppositional positions, in which those who were constructed as not belonging were given voice. We argue that, to understand alliances between community and hospital medicine it is necessary to appreciate the position of the excluded. Those family doctors who were identified in the oral histories as outsiders tended to serve the more deprived populations. The role of private medicine was especially significant in the process of exclusion, especially the pattern of general practice referrals of patients from the NHS to secondary private care.