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PubMed2003

[Bioethics and the Hippocratic oath].

Throughout the long centuries of medical activity, the Hippocratic Oath always had a distinguished place and role within the self definition of curative practice: it contains in a condensed form those ethical principles and moral norms that determine the doctors' behavior and their relationships with their patients and colleagues. The Hippocratic Oath is not the only oath but it is surely the best known and most famous one, that contains both timeless and age dependent norms. The ceremonial taking of the Oath is still a symbol of moral commitment for doctors. The millennia long adherence to the Oath perhaps suggests a timeless stature above all changes of society, but tracing its history, it becomes apparent that, though the text remained essentially the same, the interpretation is greatly influenced by the values and norms of the given age. Even so, the Oath's deontological, normative attribute has made it possible to fulfill its morally regulating role both of level of the profession and the individual, up to the middle of the 20. century. Today, however, classic, bipolar medicine has become complex and varied. Medicine and society have both undergone changes. Bioethics has appeared and become widely accepted. All this raises the question whether the Oath is still suitable for a modern statement of the moral identity of medical practitioners. Does it still have a compulsory force beyond keeping the tradition, and can its norms still be realized in practice? Both the study of texts used for the Oath in Hungarian universities, and the international proposal for modernization--together with the arguments that followed--indicate that if the traditional oath wishes to fulfill its function in the age of modern medicine, it has to adhere to the more up-to-date principles of bioethics, that better correlate with today's expectations.

Bioethics↗
PubMed2004

Rewarding safe behavior: strategies for change.

Effective, sustainable safety incentives are integrated into a performance management system designed to encourage long term behavior change. Effective incentive program design integrates the fundamental considerations of compensation (i.e., valence, instrumentality, expectancy, equity) with behavior change theory in the context of a strong merit based performance management system. Clear expectations are established and communicated from the time applicants apply for the position. Feedback and social recognition are leveraged and used as rewards, in addition to financial incentives built into the compensation system and offered periodically as short term incentives. Rewards are tied to specific objectives intended to influence specific behaviors. Objectives are designed to challenge employees, providing opportunities to grow and enhance their sense of belonging. Safety contests and other awareness activities are most effective when used to focus safety improvement efforts on specific behaviors or processes, for a predetermined period of time, in the context of a comprehensive safety system. Safety incentive programs designed around injury outcomes can result in unintended, and undesirable, consequences. Safety performance can be leveraged by integrating safety into corporate cultural indicators. Symbols of safety remind employees of corporate safety goals and objectives (e.g., posted safety goals and integrating safety into corporate mission and vision). Rites and ceremonies provide opportunities for social recognition and feedback and demonstrate safety is a corporate value. Feedback opportunities, rewards, and social recognition all provide content for corporate legends, those stories embellished over time, that punctuate the overall system of organizational norms, and provide examples of the organizational safety culture in action.

Accidents, Occupational↗
PubMed2004

Using "Bud World Party" attendance to predict adolescent alcohol use and beliefs about drinking.

This study explored the association between attendance at the "Bud World Party," a family entertainment venue created by Anheuser-Busch for the 2002 Winter Olympics, and alcohol-related beliefs and current drinking behaviors for a group of 7th and 8th graders who attend a middle school in close proximity to the downtown Salt Lake City plaza where the exhibit and related events were located. Data were collected via a questionnaire administered to 283 students 30 days after the closing ceremonies.. Logistic regression was used to predict recent alcohol consumption. Significant predictors were race (non-white) (OR = 3.9), religiosity (OR = .72), having a parent who drinks (OR = 4.8), the number of best friends who drink (OR = 2.5), and the interaction for "Bud World Party" attendance and gender (OR = 33.2). Post-hoc analysis of the interaction effect indicated that the relationship between "Bud World Party" attendance and recent alcohol consumption is moderated by gender. Girls who visited "Bud World Party" were more likely than the boys to have consumed alcohol in the past 30 days. In addition, the girls who visited "Bud World Party" were more likely to believe that drinking would increase their chances of popularity at school than the students who did not.

Adolescent↗
PubMed1991

The Family Medicine Game: using humor to teach residents about endings.

Graduation and the emotional process of termination are developmental milestones in the family practice resident's training. This article describes one example of a behavioral sciences curriculum, "The Family Medicine Game," which facilitates this process through the use of humor. The Family Medicine Game aims to kill two educational birds with one stone. First, a process for negotiating developmental milestones is actually modeled, emphasizing mutual sharing of feelings with significant others and ritual ceremony to punctuate experience. Second, the vehicle of humor, with its intrinsic palliative qualities, affords the expression of vulnerable affect within the milieu of a darned good time.

Curriculum↗
PubMed2003

Eat Smart! Ontario's Healthy Restaurant Program: a survey of participating restaurant operators.

Eat Smart! Ontario's Healthy Restaurant Program is a standard provincial health promotion program. Public health units grant an award of excellence to restaurants that meet designated standards in nutrition, food safety, and non-smoking seating. The purpose of this study was to assess whether program objectives for participating restaurant operators were achieved during the first year of program implementation, and to obtain operators' recommendations for improving the program. Dillman's tailored design method was used to design a mail survey and implement it among participating operators (n = 434). The design method, which consisted of four mail-outs, yielded a 74% response rate. Fifty percent of respondents operated family-style or quick-service restaurants, and 82% of respondents learned about the program from public health inspectors. Almost all respondents (98%) participated in the program mainly to have their establishments known as clean and healthy restaurants, 65% received and used either point-of-purchase table stands or postcards to promote the program, and 98% planned to continue participating. The respondents' suggestions for improving the program were related to the award ceremony and program materials, media promotion, communication, education, and program standards. Program staff can use the findings to enhance the program.

Consumer Behavior↗
PubMed2004

[A trial of a smoking rate survey using the coming-of-age ceremony for evaluating action plans to prevent tobacco use in the young].

PURPOSE: To assess a smoking rate survey using the coming-of-age ceremony to examine the practicality for estimating the under twenties' smoking rate as a baseline and a long term assessment index for action plans to prevent smoking in the young. METHODS: We undertook the survey at village A (with a population of about 6,500) and town B (with about 12,000 residents) in Niigata Prefecture. Village A started a comprehensive anti-smoking policy featuring cooperation between schools and the community. Subjects were twenty-year young adults (69 in village A and 118 in town B) who attended rural coming-of-age ceremonies in 2002. The self-rated questionnaire included smoking habits, age of first smoking experience, and age of becoming a regular smoker (only in village A). RESULTS: Smoking rates were 68.0% for men and 48.6% for women in village A. Of these, approximately 90% smoked daily and more than 70% became regular smokers before the age of 20. Smoking rates in town B were similar. The results were about 20% higher than found by a smoking rate survey performed at high schools. CONCLUSION: Smoking rate surveys at coming-of-age ceremonies offer a practical and easy approach to estimate under twenties' smoking rate and assess the effects of smoking prevention strategies among the young.

Adolescent↗
PubMedDate not supplied

Lessons learned from dirty diapers.

This essay by Amy Gaudet is the winning entry in the annual Humanism in Medicine Essay Contest at LSU School of Medicine in New Orleans. Amy is a second year student and writes about everyday humanism in the context of everyday problems involving two patients and their families--one she had never met and a second much closer to home. The essay contest was initiated in the spring of 2001 by the students in the School of Medicine to inspire fellow students to embrace the humanism displayed around them and to incorporate the humanistic spirit into their daily lives. The top five finalists are recognized at our White Coat Ceremony in July every year. The winning author receives a prize and presents his or her essay at the ceremony, as the keynote speaker. What is humanism? Simply, as described by our students, it is a concern with the needs, well-being, and interests of people. In our profession, humanism can take on many shapes, among them--displaying compassion, empathy, and utmost respect in the delivery of healthcare, serving as a role model by displaying professional behavior and ethical composure, showing sensitivity to diverse ethnic or religious backgrounds, effectively communicating complex medical diagnoses and treatments to patients and in turn, possessing excellent listening skills, caring for a patient's emotional and psychological well-being, possessing a work ethic that earns trust and confidence from all colleagues and patients, and being willing to help others, but also willing to seek help when necessary. These are values that we share as a profession and that we should reflect on as we do our work, day in and day out, in an environment that makes following them more and more difficult and for that reason more and more important.

Delivery of Health Care↗
PubMed1997

Types of hypnotically (un)susceptible individuals as a function of phenomenological experience: towards a typology of hypnotic types.

Subjects were 194 nursing students who experienced the HGSHS A (Shor & Orne, 1962) in which was embedded a 2-minute sitting quietly interval subsequent to the eye catalepsy item, but prior to the "counting out" sequence. After the HGSHS:A, subjects completed the Phenomenology of Consciousness Inventory (PCI) (Pekala, 1982, 1991c) in reference to the sitting quietly interval embedded in the hypnotic induction ceremony. Subjects were divided into low and high susceptible groups. K-means cluster analysis of the subjects' responses to the PCI revealed nine different cluster groups. These groups had different patterns of phenomenological experiences that cut across individual subjects' actual HGSHS:A scores. Implications of the above for (a) working with clients who may not score that high on standard behavioral measures of hypnotizability (such as the HGSHS:A), or (b) understanding how hypnosis "works," are discussed.

Adult↗
PubMed2000

Patterns and predictors of HIV risk among urban American Indians.

A preliminary survey of HIV risk and service preferences among American Indians residing in the New York metropolitan area included 68 women and 32 men (M age=35.8 years). Overall, the sample was knowledgeable about the mechanisms of HIV transmission, and 58 percent reported having taken an HIV test. However, of the 63 percent who reported sexual activity in the last six months, 73 percent reported engaging in vaginal or anal sex without a condom with at least 1 partner, and 52 percent used condoms none of the time during vaginal and anal sex. Almost half (43 percent) reported alcohol or other drug (AOD) use for non-ceremonial purposes in the last six months. Alarmingly, 44 percent reported lifetime trauma, including domestic violence (20 percent) and physical (29 percent) or sexual (26 percent) assault by a family member or stranger. Bivariate and multivariate analyses indicated trauma and drug use were factors that may place respondents at risk for sexual transmission of HIV. Trauma variables were better predictors of HIV risk behaviors than social cognitive variables providing preliminary support for the use of a postcolonial framework in American Indian HIV studies.

Adolescent↗
PubMedDate not supplied

Lovemaking as a ceremony of accreditation.

In this article, the significance of lovemaking as a ceremony of mutual accreditation is explored, as well as some ramifications of viewing it as such. The article (a) summarizes a well-researched formulation of the nature of romantic love; (b) provides a detailed view, based on this formulation, of what lovemaking is all about for lovers and thus the enormous importance its presence (or absence) has in most people's lives; (c) explicates the relevance of the above to understanding the powerful attraction that some ostensibly non-loving sexual behavior (e.g., that of the conquest seeker or the pornography addict) exercises over certain individuals; and (d) demonstrates how the present account clarifies an essential characteristic common to all sexual disorders and thus may be used to define the notion of "sexual disorder" itself.

Coitus↗
PubMed2006

Washing away your sins: threatened morality and physical cleansing.

Physical cleansing has been a focal element in religious ceremonies for thousands of years. The prevalence of this practice suggests a psychological association between bodily purity and moral purity. In three studies, we explored what we call the "Macbeth effect"-that is, a threat to one's moral purity induces the need to cleanse oneself. This effect revealed itself through an increased mental accessibility of cleansing-related concepts, a greater desire for cleansing products, and a greater likelihood of taking antiseptic wipes. Furthermore, we showed that physical cleansing alleviates the upsetting consequences of unethical behavior and reduces threats to one's moral self-image. Daily hygiene routines such as washing hands, as simple and benign as they might seem, can deliver a powerful antidote to threatened morality, enabling people to truly wash away their sins.

Emotions↗
PubMed1998

[The Hippocratic Oath].

The impact of Hippocratic Oath on medical practice is universally recognized. However, some physicians raise questions about its validity and few medical schools use it in graduation ceremonies. It is postulated that this oath does not harmonize with present bioethical concepts and that the principles of beneficence, lack of harm, autonomy and justice, elaborated by Anglo-Saxon philosophers, would do so. The Hippocratic Oath contains these principles and many others, such as gratitude, compassion, justice, honesty, humbleness, sanctity, integrity, confidentiality, fidelity to the bond, and respect for human life and dignity. These are ethical values that apply to modern dilemmas in medicine. As a whole, the oath expresses an ideal of medical behavior and a life project. It must be interpreted in the context of ancient Greek culture and history. Some uncertainties about its relevance are due to a lack of understanding of its exceptional content of values. Modified versions of the oath or original texts presumptuously pretend to replace a document that has lasted 2500 years and that meant a revolution, not only to medicine, but for all mankind. Students should have the opportunity to analyze its content and the way its values are related to concrete situations of present medical practice. Medical schools should shelter it without objections, as the expression of a reflexive compromise acquired by physicians during their studies and to be applied in medical practice.

Education, Medical↗
PubMed2005

Teaching professionalism within a community context: perspectives from a national demonstration project.

Most medical schools now include some component of professionalism in their curriculum, ranging from "white coat" ceremonies to didactic and small-group, case-based discussions. Often this format does not provide a context for the course content nor does it necessarily make the curricular themes relevant to population groups and communities most vulnerable to the inequities and injustices present in health care. The authors describe a community-based professionalism curriculum for preclinical and clinical year medical students and report evaluation data from three years (2001-2003) of this national demonstration project. The curriculum emphasized four themes: service, community, advocacy, and ethical behavior and was based on a service-learning pedagogy applied within community-based organizations. As part of the program evaluation, 95 students from 33 medical schools between the years 2001 and 2003 (response rate: 84.8%) completed an anonymous questionnaire. When asked what did they learn about professionalism that they did not learn (or expect to learn) in their medical school curriculum, the most common themes were (1) factors and influences affecting professional behavior, with many specifically citing pharmaceutical companies and insurance carriers (46.3%); (2) the role and importance of physician advocacy on behalf of their patients (37.9%); and (3) issues specific to the needs of vulnerable and disadvantaged populations (20.0%). This project demonstrates that community-based experiences can provide unique and relevant learning in a professionalism curriculum that can complement existing medical-school-based efforts.

Adult↗
PubMed2001

Dietary patterns and risk factors of diabetes mellitus among urban indigenous women in Fiji.

The dietary patterns of indigenous Fijians are changing rapidly. Dietary relationships in regard to the prevalence of diabetes are poorly studied in Fiji. A survey was conducted to show the relationship of dietary patterns and other lifestyle factors for the development of diabetes among urban indigenous women in Fiji. A sample of 200 Fijian women aged 30-39 who agreed to participate were interviewed by the use of semiquantitative food frequency, 3 day-24 h recall study. Physical activity and ceremonial dietary customs were also taken into consideration. Anthropometry included measurements of height, weight, waist and hip. Total percentage bodyfat measurements and glycosuria tests were also conducted. The results showed high rates of obesity manifested in high percentage bodyfat, high body mass index (BMI) and high waist and hip ratio (WHR). The mean 24 h dietary intake exhibited a moderate intake of protein, high intake of fat and a low intake of carbohydrate. The carbohydrate reduction was a result from the decline in consumption of traditional staples. Consumption of cereals and related products favored the high intake of butter and margarine and also encouraged the use of cooking oil in frying varieties of flour products. The daily intake of anti-oxidant vitamins of beta-carotene and vitamin E were low, however there was a high intake of vitamin C. The food frequency study revealed cassava, bread and sugar were consumed daily as the main carbohydrate foods. Fish and meat were the most frequently consumed protein foods. The main beverage was sweet tea with whole-cream milk. Butter, margarine, coconut cream, cheap lamb flaps and cooking oil provided the main sources of fat. Levels of physical activity included high sedentary lifestyles with a high rate of subjects being overweight and obese. Ceremonial dietary customs showed a high consumption of meat and fish. Fruits were rarely consumed. Glycosuria existed among the age group under study. The impact of dietary transition, coupled with dietary excesses and physical inactivity, seem to be potential risk factors of diabetes among the indigenous women in the urban area.

Adult↗
PubMed2004

[What is impaired consciousness? Revisiting impaired consciousness as psychiatric concept].

For decades, psychiatrists have considered that concepts of impaired consciousness in the study of psychiatry were inconsistent with those applied in the field of neurology, in which the usefulness of the concept of consciousness has long been seriously doubted. Gloor concluded that the concept of consciousness does not further the understanding of seizure mechanisms or brain function, which is the current representative opinion of most epileptologists. Loss of consciousness tends to be reduced to aggregates of individual impairments of higher cognitive functions, and the concept of consciousness is preferably avoided by neurologists by assigning various behavioral disturbances during disturbed consciousness to particular neuropsychological centers. In contrast, psychiatrists, especially those in Europe, are more likely to include phenomena involving problems related to phenomenological intentionality in impaired consciousness. For the present study, we first divided consciousness into vigilance and recursive consciousness, and then attempted to determine what kind of impaired consciousness would be an ideal candidate to represent pure disturbance of recursive consciousness. Then, 4 patients, 1 each with pure amnestic states followed immediately by complex partial seizures, an akinetic mutistic state caused by absence status, and mental diplopia as a manifestation of postictal psychosis, as well as a patient with Alzheimer's disease who gracefully performed Japanese tea ceremony, were studied. Based on our findings, we concluded that impaired consciousness as a generic term in general medicine does not indicate any unitary entity corresponding to some well-demarcated physiological function or constitute a base from which recursive consciousness emerges as a superstructure. From that, we stressed that a pure form of impairment of recursive consciousness could occur without the impaired consciousness named generically in general medicine. Second, following observation of an additional 3 cases, descriptions of naissance of the first word (taken from the autobiography of Helen Keller), visual object agnosia, and chronic schizophrenia with schizophasia were discussed to examine the relationship between impairments of recursive consciousness and semantic generation dysfunction. Attempts to bridge semantic generation and recursive consciousness, performed by psychopathologists such as Bin Kimura and Hiroyuki Koide, were also briefly discussed. In light of these case presentations and related discussions, we re-examined traditional theories of impaired consciousness, including Mayer-Gross's Gestalt theory, later replaced by Conrad and Henri Ey's theory related to intentionality. Furthermore, we attempted to link Denett's theory of consciousness to those traditional theories as well as to our own postulations, and neuropsychological data such as those of implicit memory and blindsight. Finally, the significance of Freud's unconsciousness in the framework of neuroscience was discussed.

Adult↗
PubMed1996

Kenya cardinal burns condoms.

Kenya's top Roman Catholic church official burned condoms and safe sex literature in a ceremony organized by a group opposed to contraception and sex education. About 250 people watched as Cardinal Maurice Otunga and two gynecologists prayed and sang before setting fire to several boxes of condoms and 100 copies of pamphlets promoting safe sex. The pamphlets encouraged condom use to fight the spread of HIV. The World Health Organization has estimated that 1 million of Kenya's 26 million people are infected with HIV or AIDS.

Africa↗
PubMed1998

Risk factors for spirit possession among school girls in southern Thailand.

In September 1993, at a school in the south of Thailand, an outbreak of spirit possession suddenly afflicted 32 girls aged 9-14 years. A case-control study was done to investigate factors that predispose a child to spirit possession. Psychiatric evaluation was done on 32 cases and 34 matched controls. Parents were interviewed regarding the child's psychosocial history. Results of the study were as follows. Children with spirit possession were first-born and came from small families with 1-3 children. Compared with the controls their family life was characterized by more psychosocial stressors and there were significantly higher rates of psychiatric disorders, anxious and fearful character traits, histrionic character traits and history of recurrent trance states. The history of traumatic experiences and exposure to spirit possession ceremonies were more frequent in spirit-possessed children than in the control group but the difference was not significant. This study showed that being first-born from a small family, individual vulnerability especially psychiatric disorders, problematic character traits and dissociative tendency were significant risk factors in the development of possession states in children.

Adolescent↗