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PubMed2004

New pathways for reactive oxygen species generation in inflammation and potential novel pharmacological targets.

Oxidative agents are generated in large amounts during inflammation. These highly reactive intermediates interact with several extracellular and intracellular molecules and with each other, thus generating a complex network of responses culminating in an outcome that may be detrimental or beneficial for the host. Alongside with the well known systems involved in production of reactive oxygen species or reactive nitrogen species, such as the NADPH oxidase or the nitric oxide synthase, novel enzymatic pathways have been discovered. This has unveiled new targets and functions for oxidant species, and has prompted the development of innovative anti-inflammatory drugs. In the new integrate scenario stemming from these studies oxidant species are increasingly recognized as true messengers, and even their toxic effects are viewed as the result of the perversion of an otherwise physiological extra/intra cellular signaling.

Animals↗

PubMed1986

Competition and primary care in the United States: separating fact from fancy.

Competitive strategies have been advocated as the solution for the economic ills of the U.S. economy. During the 1980s many economists and health care practitioners are arguing that a competitive strategy will bring down health care costs; these plans emphasize the existence of perverse incentives which reward cost reducing behavior with less revenue. Competitive strategies assume the existence of a "health care marketplace." Historically, the United States health care sector has not conformed to the ideal of the competitive market because of the special characteristics involved in the production and consumption of health care. Consumers have the least power in the health care sector and yet most competitive proposals are explicitly directed at changing consumer behavior, especially in the area of primary care. Much evidence indicates that competitive plans inhibit consumers from using primary care services, increase long-term health care costs, and ultimately require more government regulatory action.

Cost-Benefit Analysis↗

PubMed1995

Playing chicken with people: the occupational safety and health consequences of throughput über alles.

The political-economic and legal analysis of regulation in this article argues that the speed of work on disassembly lines in poultry processing plants, the fastest growing factory employment in the United States, is de facto regulated not by the Occupational Safety and Health Administration, the agency charged with protecting workers, but, perversely, by the U.S. Department of Agriculture. In arrogating to itself the power to set line speeds in connection with its inspection of processed carcasses, the Department of Agriculture has one-sidedly promoted chicken oligopolies' interests by accommodating their drive to produce as much product as quickly and cheaply as possible (throughput über alles) and especially without regard to the incidence of repetitive stress disorders associated with high-speed machine-paced manual production. In contrast, the Occupational Safety and Health Administration has failed either to assert its statutory authority over this vital determinant of workers' well-being or to persuade any administrative or judicial tribunal that it possesses such authority. Consequently, the article concludes, the health and safety of 200,000 low-paid and largely unorganized, female, and non-white workers continue to be held hostage to the self-valorization needs of capital and the state's cheap food policy.

Animals↗

PubMed1980

Clinicians' reasons for overuse of skull radiographs.

Observations based on a high yield indication list (HYL) revealed that 80% of posttraumatic skull radiographs requested by physicians were not indicated. To investigate this possible overuse of radiography, 15 resident physicians who had used the HYL in a university emergency room were interviewed. The interviews included a questionnaire, case simulations, and discussion of actual head trauma patients. Several general reasons for the overuse were detected: (1) overriding indications to the HYL; (2) basic problem-solving strategies of the physicians (pattern recognition, method of exhaustion, and hyopthesis generation and evaluation); (3) the context of the decision-making (patient and family expectations, mentor and peer pressure, malpractice threat, time management concerns); (4) fear of uncertainty; and (5) routines. It was found that overuse of diagnostic radiography was not perverse or irrational, but was produced by a complex mixture of actual expectation of yield from the procedure, personal approaches of the individual physicians, and pressures in the decision-making environment.

Craniocerebral Trauma↗

PubMed1996

On-line sexual addiction: a contemporary enigma.

On-line computer bulletin boards, although screened for offensive content, have become a breeding ground for sexually related material and erotic-chat networks. Participants can interact individually or in groups (chat rooms) on a host of sexually perverse subjects. Persons afflicted with various erotic predilections via 'cybersex' have recently gained the attention of mental health professionals. The authors report on a 'cybersex' group in treatment for sexual addiction.

Computers↗

PubMed2001

Representation of the serial killer on the Italian Internet.

The representation of serial killers was examined from the analysis of 317 Web pages in the Italian language to study how the psychological profiles of serial killers are described on the Italian Internet. The correspondence analysis of the content of these Web pages shows that in Italy the serial killer is associated with words such as "monster" and "horror," which suggest and imply psychological perversion and aberrant acts. These traits are peculiar for the Italian scenario.

Homicide↗

PubMed1985

Long-term enalapril--a new converting enzyme inhibitor--in the treatment of mild to moderate essential hypertension, results of a worldwide multiclinic study. Comparing two ways of analyzing data.

The antihypertensive effect of enalapril maleate, a new converting enzyme inhibitor, was evaluated in a multiclinic, double-blind, randomized study in patients with mild to moderate essential hypertension. The analyses were done in two ways, with patients who violated the entry criteria of the protocol excluded, and according to the intention to treat principle. Enalapril in dosages of 10 to 40 mg daily administered alone or concomitantly with hydrochlorothiazide was compared to propranolol (80 to 240 mg daily) alone or concomitantly with the diuretic. The study showed that enalapril significantly lowered both systolic and diastolic blood pressure. At each timepoint measured in the course of 26 weeks of therapy, the patients in the enalapril group consistently had greater decreases in blood pressure than patients in the propranolol group although not always significantly. The enalapril treatment group had a decrease in the mean arterial blood pressure of 22.2 mmHg compared to the propranolol group of 17.9 mmHg at the end of the study. These results were similarly independent of the way the data were analyzed. Fewer patients in the enalapril group required the addition of hydrochlorothiazide to maintain optimal control of blood pressure. Enalapril was found to be safe and well tolerated over the long-term of 48 weeks. Side effects such as leukopenia and taste perversions believed to be sulfhydryl-related were not encountered. The occurrence of rash and proteinuria was rare. Thiazide-induced hypokalemia, hyperuricemia and hyperglycemia appeared to be attenuated by enalapril. The favorable efficacy and side-effect profile provide the basis for enalapril to be a drug of choice when initiating antihypertensive therapy.

Adult↗

PubMed1982

Westend, a methadone clinic: structural aspects of addiction.

A case of a 1970s methadone clinic is presented within the context of a theory of family dynamics which includes a "perverse triangle." The study of the clinic, its clients, and their families reveals a number of pervasive conflicts and covert coalitions. In the clinic, clients and paraprofessionals combine to undercut professionals and limit the effects of any meaningful treatment. Nontherapeutic alliances, first experienced in the family of the addict, are replicated not only in the clinic but in the treatment system as a whole. The effects of these pathogenic relationships, at any organizational level, are to inhibit the maturation of the addict.

Adult↗

PubMed1995

Occupational back pain--an unhelpful polemic.

In most industrialized countries, disability and work absence due to occupational back pain have risen steadily in recent decades. Conventional views of the causes of this slow epidemic tend to fall into one of the following three areas: (i) the clinical pathology view, which attributes the level of pain and disability to either the severity of the initial injury or to psychosomatic conditions; (ii) the biomechanical exposures view, which attributes the problem to hazardous and preventable conditions of work; and (iii) the perverse incentives view, which suggests that reporting and disability are influenced by a combination of work dissatisfaction and accessible disability benefits. This paper reviews, from an epidemiologic perspective, the specific methodological hurdles faced during investigations of the etiology of occupational back pain. It is argued that methodological issues have contributed to the perpetuation of the three distinct but incomplete views of the problem. New research directions are suggested and a broader interdisciplinary perspective is proposed to help resolve the existing polemic.

Back Pain↗

PubMed1978

Clay eating by Aboriginals of the Northern Territory.

Eleven Aboriginal patients from the Northern Territory, in whom radiological examination of the abdomen demonstrated opaque masses of clay in the colon are described. This was due to the eating of white clay which is found only in streams, springs and billabongs of the coastal areas of the Territory. The habit does not appear to be a perversion of appetite, nor is it related to anaemia or pregnancy. The clay is eaten mainly for medicinal purposes or to allay hunger. The results are not always beneficial, since clay caused complications (including obstruction and perforation of the colon) in five of our 11 patients.

Adolescent↗

PubMed2006

Rapid HIV testing at home: does it solve a problem or create one?

The U.S. Food and Drug Administration (FDA) is considering approval of an over-the-counter, rapid HIV test for home use. To date, testimony presented before the FDA has been overwhelmingly supportive. Advocates have argued enthusiastically that there is value in empowering individuals to manage their HIV risks and have suggested that the availability of a rapid home HIV test will dramatically increase rates of disease detection in communities that have proven difficult to reach and to link to appropriate care. The authors offer a more cautious perspective. According to what is already known about the market demand for over-the-counter HIV testing kits, their costs, and the performance of rapid HIV tests in that market, the authors do not anticipate that the rapid home test will have a profound impact either on the HIV public health crisis or on the populations in greatest need. Home HIV testing will attract a predominantly affluent clientele, composed disproportionately of HIV-uninfected new couples and "worried well" persons, as well as very recently infected persons with undetectable disease. The authors illustrate how testing in these populations may have the perverse effect of increasing both false-positive and false-negative results. A poorly functioning home HIV test may thereby undermine confidence in the reliability of HIV testing more generally and weaken critical efforts to expand HIV detection and linkage to lifesaving care for the estimated 300,000 U.S. citizens with unidentified HIV infection.

Costs and Cost Analysis↗

PubMedDate not supplied

The NHS English National Service framework for older people: opportunities and risks.

The English National Service Framework (NSF) for Older People conforms to the emerging pattern of NSFs as hybrids of policy and evidence, drafted and edited within the Department of Health, albeit with external advisory input. Physicians welcome its much-needed focus on the needs of older people, but its dynamic differs from that underlying the evolution of comprehensive services to date, raising concerns that its declared objectives may be unrealised or perversely interpreted. This applies to the first three (of eight) 'standards' currently being applied: rooting out ageism, the single assessment process and intermediate care. With each, there are problems of concept, operational feasibility, expertise and accountability for standards. Conversely, the standards for subspecialty service models (stroke, falls, mental health) are more significantly underpinned by evidence and operational experience. Success overall will depend on more clearly defined resource flow and accountability, career recruitment, research direction and engagement with specialist physicians than are immediately apparent in the document.

Aged↗

PubMed1991

Containing health costs in a consumer-based model.

The assumption that consumer choice cannot be used to achieve cost control in health care is invalid. It does not do so today because the tax treatment of health care leads to perverse consumer incentives that encourage cost escalation. By reforming the tax treatment of insurance and out-of-pocket medical costs, it is possible to design an efficient and universal system in which consumer choice is a powerful restraint on cost.

Community Participation↗

PubMedDate not supplied

Medical technology meets managed competition.

Medical technology is an integral part of health care, not an expensive add-on or afterthought. Therefore, technology policy must be consistent with the approach to health care reform. Our present market has failed to generate adequate information on new technologies and perverse economic incentives have led to overutilization. In managed competition, health plans, not government, are best suited to make most technology decisions. The federal government can provide a safety valve for specific coverage decisions and can facilitate the acquisition, evaluation, and dissemination of information on new technologies.

Community Participation↗

PubMed1993

Health and efficiency.

Measuring efficiency is essential but purchasers and providers should treat the perverse incentives of the efficiency index with caution, warn John Appleby and Val Little.

Abstracting and Indexing↗

PubMed1994

Futility, autonomy, and informed consent.

If clinicians deem a treatment medically futile, is it appropriate to mention such a treatment to patients? Do healthcare professionals violate informed consent if they do not offer patients an opportunity to decline futile treatments? The notion of futility involves an assessment of patient best interest--both short-term and long-term therapeutic benefit for a patient and the community in which he or she intends to survive and flourish. Although survival interests may be construed as long term, a treatment that offers survival without any promise of flourishing is not the goal of medicine and is futile. Flourishing requires some cognitive and affective function. The goal of informed consent practices is to ensure that patients accept the benefits of treatment with cognizance of the burdens and risks. Given the impact of illness on the emotional and psychological states of patients and their families and their resultant vulnerability, the omission of futile options from treatment plans is logical and exemplifies the best of paternalistic behavior. The claim that requests for futile treatment must be honored is based on a perverse understanding of patient autonomy. Rational medicine demands that patients' requests be reasonable from a clinical perspective, as well as from a subjective one. The practice of informed consent can be implemented as a balance between these two interests.

Disclosure↗

PubMed1994

Twelve questions to ask about your outcomes monitoring system--Part I.

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.

Data Collection↗

PubMedDate not supplied

Making mission possible. A response to Rev. Richard A. McCormick's article on the preservation of Catholic hospitals.

In "The Catholic Hospital Today: Mission Impossible?" (Origins, March 16, 1995, pp. 648-653), Rev. Richard A. McCormick, SJ, STD, questions whether Catholic hospitals can continue their missions in a society with so many factors and influences that seem to oppose efforts to perpetuate the healing ministry of Christ. As Fr. McCormick states, the matrix of good medicine is centered on the good of the individual. But too often, the patient has been considered an individual isolated from others. The rights of families, people who belong to the same insurance program, and the society funding much of healthcare must also be considered. Fr. McCormick points out that an obstacle to the healing mission arises because healthcare is often treated as a business instead of a service. If not-for-profit healthcare facilities come to exist for the well-being of the shareholders, as do for-profit healthcare facilities, then a perversion of values results. This should lead us to renounce for-profit healthcare and the behavior that some Catholic health organizations have borrowed from the for-profit sector. In addition, Fr. McCormick calls attention to our society's denial of death and tendency to call on medicine to cure personal, social, or economic problems. This denial-of-death phenomenon helps us realize the need for the mission of Catholic hospitals. Continuing the mission of Catholic hospitals will require the attention of all involved in them-physicians, trustees, nurses, administrators, and ancillary personnel. These healthcare providers must not be distracted from the mission by joint ventures and economic issues.

Catholicism↗