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208 records · Page 12Linked to original sources
PubMed2006

Gender preferences and demand for preconception sex selection: a survey among pregnant women in Pakistan.

BACKGROUND: In its recent report 'Human Reproductive Technologies and the Law', the House of Commons' Select Committee on Science and Technology called for greater efforts to establish the potential demographic impact of sex selection across all sectors of UK society. Given the well-known preference for boys over girls among some communities, there is concern that a readily available service for social sex selection may upset the balance of the sexes. Of particular interest are the gender preferences and the demand for sex selection among Pakistanis. METHODS: We conducted a social survey on gender preferences and potential demand for preconception sex selection among 301 pregnant women in Karachi, Pakistan, using a self-report questionnaire consisting of 14 questions. RESULTS: About 41.5% wish to have a family with an equal number of boys and girls; 3.3% would like to have only boys, 1.0% only girls, 27.6% more boys than girls and 4.3% more girls than boys, and 22.3% stated that they do not care about the sex composition of their family. Whereas 6.3% could imagine employing cytometric sperm separation for social sex selection, 76.1% could not and 17.6% were undecided. About 27.2% felt that social sex selection ought to be legal, 48.8% thought it ought to be illegal and 23.9% were undecided. CONCLUSIONS: Although Pakistani women do show a statistically significant preference for boys over girls, the number of women willing to subject themselves to cytometric sperm separation appears to be too small to cause a severe imbalance of the sexes. However, further research among British citizens of Pakistani origin is needed to establish whether sex selection poses a serious threat to the sex ratio of UK communities.

Adolescent↗
PubMed1998

[Practice and research of forensic medicine learned from the dead].

Practice and Research of Forensic Medicine Learned from the Dead' is presented by looking back my 29 years' carrier as a forensic pathologist. After joining in Department of Forensic Medicine, Kumamoto University in 1969, I had spent several happy years with studying on postmortem corneal clouding. Soon I began to have doubts on a purpose of forensic autopsy in my department then, which seemed to be only to/under the police. I spent one year at Department of Forensic Medicine, Leeds University in England in 1979-1980 and experienced Forensic Medicine not only for the police but also for the society in general. Visiting several university departments in Europa at that time, I felt confident that Forensic Medicine is one special field of medical sciences and will be worth a subject to devote my life. Clinical Forensic Medicine is one field of forensic medicine. Its importance has been recognized in the society by increasing numbers of felonious crimes and campaigns of human rights throughout the world. In 1996, the 4th International Conference of World Police Medical Officers in Clinical Forensic Medicine was ended in a great success in Kumamoto, Japan. Now evaluation and development of Clinical Forensic Medicine are very essential for both forensic pathologists and clinicians to serve for the society. My own activities of teaching traffic safety and preventing child abuse and neglect were cited as examples of 'Practice of Forensic Medicine Learned from the Dead'. Studies on differentiation of postmortem discoloration and antemortem bleeding by glycophorin A or erythrocyte membranes and an international joint research project with Tanzania on neuropathology of AIDS were examples of 'Research of Forensic Medicine Learned from the Dead'. It is an important mission for a forensic pathologist to work for/with the police to solve crimes by hearing a voice of the dead on an autopsy table. Through friendship with foreign colleagues, however, I have learned much about what should be a forensic pathologist and have been inspired with a phrase, 'The information learned from studying the dead could be used to help the living.' by Dr. T.A. Gonzales of the Chief Medical Examiner's Office of New York. Because social activities of preventing crimes and accidents are very much important matters indeed, every forensic pathologist must devote his/her forensic practice and research to achieve a peaceful end of life for every citizen, I believe.

Accidents, Traffic↗
PubMed1977

Technology and the governance of the health care industry: the dilemma of reform.

With increasing public expenditures for health care services, the accountability of the health care industry has become a major political issue. Concomitant issues concern the structures and processes through which the public as patients, customers, and citizens can directly influence the delivery of health care services. These issues, which are currently part of the national health policy debate, are indicative of the larger question concerning the relationship of the individual to his increasingly complex society. This paper presents three arguments. (1) The medical profession, through its control of technology and its monopolistic hold on legitimate claims of expertise, is the primary determiners of the way health services are structured and resources are allocated. (2) Domination of doctor-patient relationships, medical care delivery organizations, and the national health care policy process, enables physicians to remain unaccountable to democratic institutions and insulated from public participation in decision-making. (3) Lack of accountability, disproportionate professional power and the failure of governmental regulation raise questions about the role and impact of the medical profession as a quasi-institutional political actor in terms of (a) the return on the investment of +135 billion spent annually for medical care, (b) claims of expertise and self-regulation, and (c) overarching democratic values.

Delivery of Health Care↗
PubMed2001

Alternative medicine and common errors of reasoning.

Why do so many otherwise intelligent patients and therapists pay considerable sums for products and therapies of alternative medicine, even though most of these either are known to be useless or dangerous or have not been subjected to rigorous scientific testing? The author proposes a number of reasons this occurs: (1) Social and cultural reasons (e.g., many citizens' inability to make an informed choice about a health care product; anti-scientific attitudes meshed with New Age mysticism; vigorous marketing and extravagant claims; dislike of the delivery of scientific biomedicine; belief in the superiority of "natural" products); (2) psychological reasons (e.g., the will to believe; logical errors of judgment; wishful thinking, and "demand characteristics"); (3) the illusion that an ineffective therapy works, when actually other factors were at work (e.g., the natural course or cyclic nature of the disease; the placebo effect; spontaneous remission; misdiagnosis). The author concludes by acknowledging that when people become sick, any promise of a cure is beguiling. But he cautions potential clients of alternative treatments to be suspicious if those treatments are not supported by reliable scientific research (criteria are listed), if the "evidence" for a treatment's worth consists of anecdotes, testimonials, or self-published literature, and if the practitioner has a pseudoscientific or conspiracy-laden approach, or promotes cures that sound "too good to be true."

Cognitive Dissonance↗
PubMed1986

The impact of public opinion on medical technology: the case of artificial heart implants.

A public opinion survey was conducted in the spring of 1985 in Kentucky to assess public attitudes toward artificial heart technology. The data, based on consumer and citizen perspectives, indicate that the public is interested in and aware of the technology and recent implant surgeries. More knowledgeable respondents are more likely to support Humana's involvement, but less likely to want an artificial heart and other organs to continue life, and less willing to support equitable access and increased taxes to achieve this equity. Technological optimists are more willing to have the heart and other organs as needed and more willing to have their taxes increased to pay for the technology for all in need. Optimists also see nothing wrong with Humana's involvement in this technology. People's judgments on artificial heart technology vary, depending on whether they see it as potentially desirable for themselves as opposed to possible implications for others and the broader society. Although both perspectives are crucial for understanding the role of public opinion on the further development of this technology, it must be recognized that the two perspectives might have different impacts, depending on societal judgment of whether the decision to proceed with further development of the technology is mostly a public or private choice.

Attitude to Health↗
PubMed1991

[Continuity--adjustment--autonomy--physician--patient--an overview of medical cultural philosophy in former East Germany].

The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war guilt of the National Socialist era. Guilt is a burden on the mind, but non-assessed guilt and lack of a possibility of redemption destroys humans. The article is a plea against an increasing tendency to criminalize the former GDR citizen and the doctors. "It will be necessary to honestly review the past history embodying my own errors, mistaken concepts and illusions." All this is only a first approximation to an important and complex subject. It is the author's aim to promote a better understanding between the former GDR citizens and those of West Germany.

Continuity of Patient Care↗
PubMed2004

To err is human--the fallible physician.

A 1999 report published by the Institute of Medicine shocked our nation's citizens and health care providers. This report, entitled To Err is Human: Building a Safer Health System, suggested that as many as 98,000 people die each year in the United States as a result of medical errors, making medical errors the 8th-leading cause of death. By comparison, Americans are much less likely to die from motor vehicle accidents, breast cancer, or AIDS. More Americans die annually from medication errors alone than from workplace injuries. Not all errors are fatal ones, of course. An error may cause only temporary problems or disability, or may have no consequence at all. Errors may be due to mistakes made by individual health care providers, or may be due to faulty or inefficient processes in organizations and other health care delivery systems. This editorial will focus on the inevitability of physician fallibility, two causes of individual provider errors, and suggestions for strategies that should be considered by health care providers in an attempt to reduce errors. Next month we will look at the efforts made by hospitals in order to improve patient safety, and how these efforts impact physician practice.

Clinical Competence↗
PubMed1992

Nutrition promotion for mature adults: a case study in peer education.

The peer education model, which enables trained learners to instruct their peers, was tested in a case study involving senior citizens in a nutrition education program. The case study approach, using action research, was chosen because the project involved the description and analysis of a unique group of 32 mature adults. Topics selected for presentation in the three two-hour sessions were selected by open consensus of the entire participating body. Six members of the group volunteered to engage in a preliminary training program. These individuals became known as volunteer peer educators (VPE), who subsequently took full responsibility for disseminating the nutrition information to their peers. Educational materials to meet the goals of the program were compiled by the researcher in a resource manual for each of the volunteer peer educators. Techniques of participant observation for data collection and qualitative analysis were used. The satisfactory implementation of the program was due in great part to group selection of the learning episode; to a relaxed atmosphere; to enthusiasm on the part of the VPE; to the availability of a good resource manual and a facilitator who provided a strong organizational framework. The peer education model was found to be a particularly useful tool in providing nutrition information to a much broader sector of the senior population than can be currently reached via public health programs.

Aged↗
PubMed1998

NIMH during the tenure of Director Herbert Pardes, M.D. (1978-1984): The President's Commission on Mental Health and the reemergence of NIMH's scientific mission.

To summarize these 5-1/2 years, I would offer the following. NIMH--which, like the mental health field in general, has focused principally on services and broad social issues in the 1960s and 1970s--was modified to be a more scientific institute focused on basic biology and behavioral science, major clinical disorders, diagnosis, treatment, and epidemiology. NIMH in its entirety regained a high level of respect in the general NIH community and won increasing support from Congress and the Administration. Increasingly positive perceptions of NIMH may have had a positive effect on the recruitment issue in psychiatry; the numbers of U.S. recruits started to turn back upward. After the early assault by the OMB and the Reagan Administration on the NIMH budget, the year 1982 and 1983 led to a more supportive attitude, and so the threat to the vitality of NIMH and to its overall fiscal support relented. Programs in research training and mental health clinical training and the intramural program were sustained along with the preeminent focus on building extramural support. We recognized that support of the intramural program accounted for an unduly high proportion of overall NIMH research expenditures. In response, we set firm policies designed to build the extramural program while maintaining the strength of the intramural program without expanding it. I might note parenthetically that I had the opportunity to chair an Intramural Research Program Planning Committee convened by NIMH. Without anticipating Dr. Hyman's comments regarding this effort, I will say that we found the intramural research program to be a national resource that, with continued emphasis on scientific quality, should contribute greatly to the nation's mental health and scientific goals in the years ahead. Perhaps in the most global terms the era can be remembered as one in which NIMH shifted toward becoming a predominantly research institute with related education programs. On the one hand, we drew some limits regarding what was considered the purview of NIMH, and we focused much more on illness. On the other hand, we retained much of the richness of NIMH and its focus on the relationships between various disciplines, while catalyzing the extraordinary explosion of the capacity to understand brain and behavior and thereby bring greater promise to the effort to control psychiatric disorders. The excitement of the research and the greater enthusiasm of the government, along with NIMH's encouragement of citizen group activity, contributed to destigmatization and set the groundwork for a much stronger overall advocacy effort on behalf of NIMH, which has continued over the last 10 to 15 years. Simultaneously, attempts were made to secure more data regarding the usefulness of psychiatric treatments and their effectiveness. This too would serve us well in terms of a more favorable attitude toward improving insurance through Medicare and through other areas of mental health care reimbursement. It is an honor to have worked at NIMH. The staff members there are superb, and I want to express my thanks to them. The dedication of outstanding federal leaders is one of the powerful assets of this nation and has been central to the many accomplishments of NIMH.

Administrative Personnel↗
PubMed2003

Issues of exploration: human health and wellbeing during a mission to Mars.

Today, the tools are in our hands to enable us to travel away from our home planet and become citizens of the solar system. Even now, we are seriously beginning to develop the robust infrastructure that will make the 21st century the Century of Space Travel. But this bold step must be taken with due concern for the health, safety and wellbeing of future space explorers. Our long experience with space biomedical research convinces us that, if we are to deal effectively with the medical and biomedical issues of exploration, then dramatic and bold steps are also necessary in this field. We can no longer treat the human body as if it were composed of muscles, bones, heart and brain acting independently. Instead, we must lead the effort to develop a fully integrated view of the body, with all parts connected and fully interacting in a realistic way. This paper will present the status of current (2000) plans by the National Space Biomedical Research Institute to initiate research in this area of integrative physiology and medicine. Specifically, three example projects are discussed as potential stepping stones towards the ultimate goal of producing a digital human. These projects relate to developing a functional model of the human musculoskeletal system and the heart.

Adaptation, Physiological↗