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PubMed1996

Exile and professional identity: on going back to Cuba.

The author tells the story of her lifelong attempts to create a coherent, complex cultural identity from her family's multiple diaspora legacies, and the impact of these struggles on her personal and professional development. She emphasizes the intergenerational conflicts created by the sociopolitical circumstances of her generation's Cuban immigration experience, and progressive attempts to include her Cuban identity in her sense of self. An unexpected lesson in the politics and history of psychoanalysis, itself an immigrant movement that abandoned its social conscience to survive in exile, catalyzed a return to Cuba and a greater inclusion of its social values in her personal and professional lives.

Career Mobility↗
PubMed1996

Hypertension in the African American community: social, cultural, and psychological factors.

The potential influence of social and psychological factors on the risk of hypertension within the African American community must be examined in relation to cultural and historical influences on the community. Blood pressure elevation varies dramatically between and within black populations, with socioeconomically disadvantaged communities in North America showing the highest levels. It is this historical and continuing pattern of socioeconomic disadvantage that forms the context in which social and psychological factors must be examined. The research that is reviewed in this article explicitly takes into account such factors. It is consistent with a model in which African Americans are engaged in a chronic struggle to achieve and maintain valued social and personal goals in the context of few socioeconomic resources. This long struggle is itself associated with higher blood pressure, and may also lead to the greater experience of frustration and anger that compounds blood pressure elevation. Conversely, there are also supportive social institutions in the black community, including the church and the extended family, that appear to provide a protective effect with respect to problematic circumstances and lower the risk of hypertension. The twin goals of lowering blood pressure therapeutically and preventing the onset of hypertension must include the social and cultural context of African American patients, and the social and psychological processes associated with hypertension.

Black or African American↗
PubMed1975

Editorial: The right to know. On the freedom of medical information.

Information about health and disease has high social value and is, thus, subject to a variety of controls. These influence the freedom of investigators to generate it; of editors and publishers to transmit it; and of professionals and the public to have access to it. Unconstrained research may threaten the social order and evoke legal or political limit setting. Prominent in the present era are the possibilities of dangerous ethical and biological consequences of new knowledge or, perhaps more important, of procedures for obtaining it. Medical information is transmitted through both the mass media and professional journals. Access to both by potential authors is limited by institutionalized mechanisms of social control and the academic-research subculture. An emerging factor is the editor's possible ethical responsibility for material which he accepts for publication. Access to information is determined by what finally is published, as well as membership in informal communication networks. It is also influenced by dependence, due to cost, time limitation and information overload, on prepackaged material presented in texts, anthologies, busy clinician-oriented journals, or commercial, e.g., pharmaceutical firms. The possibility that governments will, in time, become the major distributors as well as generators of medical information raises new questions as to its eventual freedom and control.

Biomedical Research↗
PubMed1996

Social work in the academic medical center: advanced training--a necessity.

Although the total number of social workers within the academic medical center will probably decrease because of decreasing hospital bed usage, the role for those who remain will be that of a clinical specialist, a sophisticated and adaptable practitioner who can work flexibly under minimal supervision. The valued social work practitioner will be an independent player on the health care team who assumes a significant role which no other member of that team is equipped to take. Advanced training is more important today than ever before in the evolution of social work practice in academic health care. However, this training is not now available within the parameters of the two year master's program.

Academic Medical Centers↗
PubMedDate not supplied

Predicting vigorous physical activity using social cognitive theory.

OBJECTIVE: To test Social Cognitive Theory (SCT) in predicting future vigorous physical activity among college students. METHODS: College students (n=350) completed a set of instruments measuring SCT constructs. Their vigorous physical activity was tracked for 4 weeks. RESULTS: Exercise role identity, self-regulation, outcome expectancy value, social support, self-efficacy, and positive exercise experience accounted for 27% of the variance in days of vigorous physical activity. CONCLUSION: The results supported the use of SCT in understanding factors associated with vigorous physical activity rates among college students.

Adult↗
PubMed2004

Self-reported health and sleep complaints among nursing personnel working under 12 h night and day shifts.

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables--health conditions, sleep complaints, and insufficient time for nonprofessional activities--was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR=0.71; CI=0.55-0.92 and PR=0.71; CI=0.52-0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57-0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR=0.76; CI=0.59-0.98) and ex-night workers (PR=0.68; CI=0.50-0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07-6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR= 1.96; CI = 1.38-2.78) and rest/leisure (PR= 1.54; CI = 1.20-1.99). These results can be related to the "social value of time," as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment and larger sample size.

Circadian Rhythm↗
PubMed1992

Genetic disease patterns in Japan: a review.

Comprehensive genetic studies in which the genetic structure of a population is considered against the background of ecological factors, including environmental and social variables, often supply valuable information for the solution of a number of problems in human biology, including reproductive compensation and inbreeding depression. In the first section of this paper we consider the incidence of genetic diseases in Japan in reference to other populations. Some of the genetic disorders found elsewhere do not occur or are of lower frequencies in Japan. On the other hand, a number of genetic diseases occur at higher than usual frequencies, leading to an incidence of genetic disease of the order of about 1 per 100 in newborn Japanese. We next review the studies of consanguinity in Japan and report evidence of very high levels, ranging from 8.6% to 58.0%, for villages during the early part of the twentieth century. The rates are declining rapidly for the country but, because of traditional social values, inbreeding rates remain significant in many small villages. In the final section we consider the probable trends in the frequency of inbreeding on a worldwide basis and point out that frequencies of certain genetic diseases are likely to remain high and even increase in some societies because of various socially prescribed mating patterns.

Consanguinity↗
PubMed2005

Democracy justifies the means: political group structure moderates the perceived legitimacy of intergroup aggression.

The present research tested the hypothesis that the political structure of conflicting groups moderates perceived legitimacy of intergroup aggression. In two experiments, participants read scenarios of fictitious summer camps in which members of one group aggressed members of another group. The political structure of both the perpetrator and the victim groups was described as either egalitarian (defined with democratic decision-making procedures) or hierarchical (authoritarian decision-making procedures). Results of both experiments showed that aggressions perpetrated by members of egalitarian groups at the expense of members of hierarchical groups were evaluated as less illegitimate than aggressions committed in the three remaining conditions. This effect is discussed as a function of the higher social value attributed to democratic groups.

Adolescent↗
PubMed2005

Changing perspectives for practice in stuttering: echoes from a Celtic past, when wordlessness was entitled to time.

Changing perspectives for practice in stuttering therapy are informed by the changes in knowledge, social values, and belief systems of a society. The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) has a sociological emphasis with a focus on the ability and functioning of the person, and it is currently fostering changes in perspectives for working with those who stutter. These perspectives are reflected in Irish social mores in the 7th and 8th centuries, when social and legal codes enshrined the rights of people with speech disabilities in law and recognized the dignity and integrity of people with such disabilities. The society of the time showed awareness and acceptance of people with disabilities, and it provided the supports to enable their participation in society. To a large extent, these principles contrast with the predominantly impairment-based focus that has been the heritage of the speech-language pathology profession in the 20th century. In order to review changing emphases in stuttering therapy and to consider applications of a sociological approach to stuttering, an outline of historical perspectives of the profession of speech-language pathology is presented. The evolution of the ICF is also outlined, moving from an impairment-based focus to a more sociological perspective. Both perspectives provide a historical context for consideration of approaches to working with stuttering, reflecting the ICF and echoing principles that were practiced in an ancient Celtic society.

Disability Evaluation↗
PubMed1992

[Quality adjustment of life years--possibilities, limitations, alternatives].

QALYs express the sum of individual utility gains from medical interventions. As such they are potentially a useful measure in deciding how to allocate resources. They should not, however, be equated with the overall value that society places on different health care programmes. The latter is determined not only by the number of QALYs gained, but also by a series of distributional and ethical considerations. This should be made clear in the presentation of QALY-calculations, particularly in cost-per-QALY league tables. More comprehensive measures of social value that may be used in cost-utility studies need investigating.

Cost-Benefit Analysis↗
PubMed2006

Shifting discourses of professionalism: a case study of general practitioners in the United Kingdom.

This paper addresses shifting constructions of professional identity in the context of debates about reflexive modernisation and the changing role of professionals in the provision of primary healthcare. Data are drawn from interviews with 20 early-career general practitioners (GPs), who accounted for their orientations towards work in rather different ways from those typically reported in much primary care research. In particular, they reported high job satisfaction and success in achieving what they called 'nice work'. We argue that these GPs typify a shift in discourses of professionalism, characterised by respondents as the 'new general practice', which explicitly rejects many values attributed to 'traditional' general practice. Within the 'new general practice', professionalism has been de-coupled from some of the paradigmatic traits of traditional rhetorical accounts (such as vocation), and has significantly reframed others. Despite policy concerns that a retreat from 'vocational' professionalism will lead to reductions in service quality, we argue that this is not inevitable. The 'new general practice' resonates with the social values of reflexive modernisation, and has the potential to enable new, less paternalistic, forms of relationships with clients, although it remains to be seen whether this potential is realised in healthcare delivery.

Adult↗
PubMed1998

A holistic approach to the economic evaluation of health programs using institutionalist methodology.

The paper examines possibilities for employing more holistic approaches to the evaluation of health care programs. It is argued that the reductionism of conventional forms of economic evaluation, where value (or benefit) is seen in terms of either health consequences or individuals' utility, can cause a number of aspects of such programs to be overlooked. As such, this imposes fairly strict limits on the capacity of economic evaluation to inform public policy. In contrast, institutionalist economic theory in common with the community development approach to health promotion is an area of research which acknowledges that change to the broader socio-political environment can be a source of value. It is suggested that this idea has, for instance, significance for the evaluation of indigenous health programs where notions of "cultural appropriateness" have strong influence over the effectiveness and acceptability of such programs. It is concluded that no one evaluative approach is appropriate in all situations and that a greater receptiveness to broader sources of social value can help to improve the way evaluations are conducted.

Evaluation Studies as Topic↗