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PubMed2004

Medical science and social values.

Social Values, no less than medical science, have shaped the medical management of the pain of childbirth. Nineteenth century feminists fought for greater use of anesthesia in obstetrics at a time when physicians held back for fear of its effects on labor, hemorrhage, rates of infection and the condition of the child. A century later, after physicians became comfortable with the use of anesthesia, a new generation of feminists challenged the use of such drugs, once again citing social considerations. The personalities of colorful and charismatic obstetricians such as James Young Simpson and Grantley Dick-Read played a strong part in the outcome of each confrontation.

Adult↗
PubMed1987

Conceptual and methodological issues in the use of race as a variable: policy implications.

The history, reality, and prolonged effects of racial stratification and its supportive ideology in the United States require systematic study of the impact of racial perceptions in the health sphere and in every facet of American life (Berry 1965; Berreman 1985; Blackwell 1985). In this regard, the use of race as an independent variable in social research is, in principle, similar to the presumed explanatory power of other status characteristics such as class or economic position. Depending on which meaning is intended, the potential policy, health services, and sociopolitical outcomes could be diametrically opposed to one another. Far from being an esoteric subject among intellectuals, any definition of race has fundamental and practical extensions to cultural and political realities. Essentially, studies and discussions of racial similarities and differences in health matters, whether intended or not, go beyond statistical compilations and correlations and reflect norms, values, the country's common beliefs (Praeger 1982), and the structural positions of majority and minority groups. Presumably, these are among the reasons that racial categories are studied in social science. They are assumed to represent socially relevant and unique histories, experiences, and statuses which differentiate black and white Americans in particular. The risks in epidemiologic and in social science research involve the preoccupation with disparities in the health difficulties among them; the attribution of racial biology and genetic traits to virtually all health spheres; the assumed preponderance of disabling conditions for blacks; and the unrelenting focus on only two racial populations despite our having a multiethnic society (Wilkinson 1987). Since health behaviors are directly associated with a group's "way of life," they should be carefully scrutinized within relevant socio-environmental contexts as part of the scientific processes of discovery, for the underlying premises, ideological translations, and practical applications of their studies especially with respect to race-specific health research. It is likely that systematic probing beyond demographic or constitutional factors will enable social scientists and health researchers to discover that for certain behaviors (e.g., prevention), individual attributes such as race and sex--and even knowledge, roles, attitudes, and diets--may explain far less than will environmental hazards and basic structural variables such as the organization of the health care delivery system, availability of and access to care, ability to pay, provider patterns, diagnostic processes, institutional operations, and quality of care.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethnicity↗
PubMed2006

Mapping the literature of nursing education.

OBJECTIVES: As part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies core journals cited in nursing education journals and the indexing services that cover the cited journals. METHODS: Three nursing education source journals were subjected to a citation analysis of articles from 1997 to 1999, followed by an analysis of database access to the most frequently cited journal titles. RESULTS: Cited formats included journals (62.4%), books (31.3%), government documents (1.4%), Internet (0.3%), and miscellaneous (4.6%). Cited references were relatively older than other studies, with just 58.6% published in the 1990s. One-third of the citations were found in a core of just 6 journal titles; one-third were dispersed among a middle zone of 53 titles; the remaining third were scattered in a larger zone of 762 titles. Indexing coverage for the core titles was most comprehensive in CINAHL, followed by PubMed/MEDLINE and Social Sciences Citation Index. CONCLUSIONS: Citation patterns in nursing education show more reliance on nursing and education literature than biomedicine. Literature searches need to include CINAHL and PubMed/MEDLINE, as well as education and social sciences databases. Likewise, library collections need to include education and social sciences resources to complement works developed for nurse educators.

Abstracting and Indexing↗
PubMed2006

When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity.

The influence of physical housing quality on childhood asthma expression, especially the effect of exposure to moulds, allergens, and pollutants, is well documented. However, attempts to explain increasing rates and severity of childhood asthma solely through physical environmental factors have been unsuccessful, and additional exposures may be involved. Increasing evidence has linked psychological stress and negative affective states to asthma expression. At the same time, recent scholarship in the social sciences has focused on understanding how social environments, such as housing, "get under the skin" to influence health, and suggests that psychological factors play a key role. While there is relevant overlapping research in social science, psychology, economics, and health policy in this area, findings from these disciplines have not yet been conceptually integrated into ongoing asthma research. We propose to expand the dimensions of housing considered in future asthma research to include both physical and psychological aspects which may directly and indirectly influence onset and severity of disease expression. This synthesis of overlapping research from a number of disciplines argues for the systematic measure of psychological dimensions of housing and consideration of the interplay between housing stress and physical housing characteristics in relation to childhood asthma.

Asthma↗
PubMed1989

[Qualifications in the occupational field of rehabilitation and aid to the handicapped--presentation of a new concept for graduate study].

Presented are the concept and initial course of post-graduate training open to graduates of the social sciences (i.e. holding a degree in social education, education, or social science), oriented on the occupational pattern of Rehabilitation Counsellor. The course has been set up in Bremen in cooperation with scientific institutions and rehabilitation facilities. Experience made with the first training course point to a need for specialist-based innovation in particular in the field of vocational rehabilitation.

Curriculum↗
PubMed1983

Unemployment and health in the context of economic change.

Evidence relating unemployment to health is found at every level of social science analysis from national population rates to individual psychophysiological stress response. At the population level of analysis, increase in the unemployment rate indicates recession and/or structural economic decline. At the individual level, unemployment is interpreted as a stressful life event. In both cases, inverse associations are found between measures of unemployment and indicators of health. We identify social science literatures associating health indicators with each of the following: economic growth, socioeconomic status, sociocultural change, economic instability, the status of being unemployed, social stress and work stress. Outstanding research issues include the requirements to identify and measure the effects of conditional factors and control variables in multivariate analysis and to examine a broader range of both severity of unemployment and severity of health outcomes. A research agenda proposes studies at the macro, meso and micro levels of analysis. We urge such research for its potential contribution both to analytic social science and to economic and social policy.

Health↗
PubMed2004

The implications for the clinician of adopting a recovery model: the role of choice in assertive treatment.

Theory is something rarely referred to in psychiatric rehabilitation. But the following, though opinion at this point, is meant to be seen as part of a pursuit of theory in psychiatric rehabilitation and in social science. The ideas behind the writing here draw heavily from the work of Patricia Deegan, yet truly are as old as the Declaration of Independence. They are strongly tied to the values of freedom, liberty, and the pursuit of happiness, as choice was expressed as a value in the Bill of Rights, and the Declaration of Independence. The social sciences and the physical sciences are seen as differing, in the same way as the social sciences at root draw from personal experiences while the physical sciences are more objectively determined. Thus, the author believes it not possible to put forward social theory without going beyond the purely objective, and including implicit, non-removable aspects of subjectivity. The author is herein proposing that the implications for the clinician of adopting a recovery model impact the issue of client choice. The Western tradition is now tied to the personal freedom of individual choice and opportunity. This paper explores the benefits of offering people with mental illnesses tangible choices in those areas of life, which impact upon the individual's consequences. The goal is to place the client in maximal control of his/her consequences, to the degree that the individual is capable of comprehending the nature of the choices involved; for the alternative of professionals choosing for their clients will inevitably result in learned helplessness. Although all of case management involves assertive treatment, this paper refers to cases in any modality of treatment in which professionals strongly advocate within the lives of and with the cooperation of clients, with special focus on the clients who encounter the greatest obstacles to successful treatment. The term "client" is employed here as the author is clearly referring to the dynamics of a professional relationship. The existence of helping professionals presupposes the existence of clients.

Choice Behavior↗
PubMed1997

Patterns of alcohol consumption, smoking and illicit drug use in British university students: interfaculty comparisons.

The use of tobacco, alcohol and illicit drugs was investigated by questionnaire in 3699 second year students in ten UK universities. Patterns of use varied considerably between different faculty groups. Tobacco use was most prevalent in arts, social science and biological science students, among whom 36-39% of men and nearly one third of women were regular smokers, and least in female veterinary students (5%). Alcohol consumption was greatest in biological science students: 23% of those who drank exceeded 'hazardous' levels compared with 10-16% in all other faculties. Prevalence of cannabis use was highest in arts and social science students of whom 27% reported regular weekly use compared with 9-22% in other faculties. Experience with other illicit drugs was greatest among arts, social science and physical science students, of whom 64-71% reported experience at least once or twice, and least among veterinary students (42%). Identification of different lifestyles may help to direct appropriate health information to particular student groups.

Alcohol Drinking↗
PubMed2006

A guide and glossary on post-positivist theory building for population health.

This guide and glossary focuses on the role of theory and conceptual models within population health research. Upon discussing the critical need for theory in conducting interdisciplinary research, it provides strategies for crafting theories that can be empirically tested and a glossary of theory building terms that are useful for guiding research. In addition to general concepts, the glossary includes some terminology commonly found in the social sciences, whose well established traditions and practices of formal theory building may be particularly informative for epidemiologists and other population health researchers who have minimal formal social science training, but study social factors in their research.

Empirical Research↗
PubMed1989

Science and social reform: women in public health.

This paper examines the historical role of women in public health, and argues that the recent trend of larger numbers of women entering schools of public health is not so much a new phenomenon as a recovery of some of the traditions of the progressive era. Public health was then seen as compatible with the ideology of womanhood, a legitimate way for middle-class women to participate in public life. Women physicians, nurses, and scientists were prominent in the early public health movement, in such areas as maternal and child health, statistics, bacteriology, and occupational health. This paper highlights the contributions of some of the women involved in public health research and practice. It concludes by noting that the motivations of many women students in schools of public health today are similar to those expressed by the social reformers and scientists of the progressive era.

Female↗
PubMed1995

A balanced curriculum?

Particular emphasis in the United States has been placed on deficiencies in science education. These deficiencies have been widely publicized and the importance must be emphasized; however this is not an isolated problem. Similar deficiencies exist in the area of humanities and social sciences and this study among medical students demonstrates the need for an improved and balanced curriculum. When compared to the top quartile (25%) of the high school group used as a standard, 11.2% of the medical students tested scored below the mark on the humanities subtest and 9.8% on social sciences. Some scores were abysmally low: one with 25 of 115 questions on Form A and another with 19 of 115 questions on Form B.

Curriculum↗
PubMed2001

Exploring the biology of socialization.

How will the social sciences take advantage of the revolution that has taken place in biology during the past two decades? Over the last fifteen years, neuroimaging has allowed the study of human cognition and emotion within psychology to achieve close alliances with biology through the development of cognitive and affective neuroscience. There is little doubt that a similar alliance between psychology and biology will occur in the domain of human brain development. In principle, understanding how the human brain is organized by experience (epigenetic rules) and how societies instruct their young could produce a link between natural and social science. The late David C. McClelland sought methods to base the social sciences on psychological ideas. McClelland sought to connect the values of achievement and power as coded from children's readers and popular ballads to societal economic growth and conflict. These efforts lacked knowledge of brain mechanisms of memory and attention and an understanding of the role of experience in organizing brain circuitry. Understanding of cognitive and brain systems related to knowledge and action may allow a new approach to forging connections between individual minds and social behavior.

Biology↗
PubMed2003

A critical examination of the hospital restructuring process in Ontario, Canada.

Little work has been done to consider the roles of different forms of knowledge and civil society actors in health policy development. Research on the role of knowledge in policy change has focussed on the contributions of social science knowledge and social scientists. This view assumes that the perspectives and knowledge of experts are the only valid input into the process and is non-critical in its analysis of health policy and health inequities. This paper challenges the reliance upon certain types of knowledge that are brought to bear on the health policy change process, and that knowledge and its creation are impartial activities. This paper presents a conceptual framework of health policy change that incorporates broad concepts of knowledge and civil society actors as contributing to health policy development. It also demonstrates the different dynamics that impinge upon knowledge and its use in health policy change. A case study on hospital restructuring in Toronto, Canada, is presented. Women's College Hospital fought recommended closure and merging of its inpatient services with Sunnybrook Health Science Centre. The case study examined the selection and use of knowledge by the Hospital in building its case against closure.

Health Facility Closure↗
PubMed2006

Occupational therapy for patients with problems in activities of daily living after stroke.

BACKGROUND: Occupational therapy aims to help people reach their maximum level of function and independence in all aspects of daily life. OBJECTIVES: To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched January 2006). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), CINAHL (1983 to March 2006), PsycLIT (1974 to March 2006), AMED (1985 to March 2006), Wilson Social Sciences Abstracts (1984 to March 2006) and the following Web of Science databases: Science Citation Index (1945 to March 2006), Social Science Citation Index (1956 to March 2006) and Arts and Humanities Citation Index (1975 to March 2006). In an effort to identify further published, unpublished and ongoing trials we searched The Occupational Therapy Research Index and Dissertation Abstracts register, scanned reference lists of relevant articles, contacted authors and researchers and handsearched relevant journals. SELECTION CRITERIA: We identified randomised controlled trials of an occupational therapy intervention (compared to usual care or no care) where stroke patients practiced personal activities of daily living, or performance in activities of daily living was the focus of the occupational therapy intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data for pre-specified outcomes. The primary outcomes were the proportion of patients who had deteriorated or were dependent in personal activities of daily living and performance in personal activities of daily living at the end of follow up. MAIN RESULTS: We identified 64 potentially eligible trials and included 10 studies (1348 participants). Occupational therapy interventions reduced the odds of a poor outcome (Peto odds ratio 0.67 (95% confidence interval (CI) 0.51 to 0.87; P = 0.003). and increased personal activity of daily living scores (standardised mean difference 0.18 (95% CI 0.04 to 0.32; P = 0.01). For every 11 (95% CI 7 to 30) patients receiving an occupational therapy intervention to facilitate personal activities of daily living, one patient was spared a poor outcome. AUTHORS' CONCLUSIONS: Patients who receive occupational therapy interventions are less likely to deteriorate and are more likely to be independent in their ability to perform personal activities of daily living. However, the exact nature of the occupational therapy intervention to achieve maximum benefit needs to be defined.

Activities of Daily Living↗
PubMed2003

Science and social responsibility in public health.

Epidemiologists and environmental health researchers have a joint responsibility to acquire scientific knowledge that matters to public health and to apply the knowledge gained in public health practice. We examine the nature and source of these social responsibilities, discuss a debate in the epidemiological literature on roles and responsibilities, and cite approaches to environmental justice as reflective of them. At one level, responsibility refers to accountability, as in being responsible for actions taken. A deeper meaning of responsibility corresponds to commitment to the pursuit and achievement of a valued end. Epidemiologists are committed to the scientific study of health and disease in human populations and to the application of scientific knowledge to improve the public's health. Responsibility is also closely linked to reliability. Responsible professionals reliably perform the tasks they set for themselves as well as the tasks society expects them to undertake. The defining axiom for our approach is that the health of the public is a social good we commit ourselves to pursue, thus assuming an obligation to contribute to its achievement. Epidemiologists cannot claim to be committed to public health as a social good and not accept the responsibility of ensuring that the knowledge gained in their roles as scientists is used to achieve that good. The social responsibilities of environmental health researchers are conspicuous in the environmental justice movement, for example, in community-based participatory research. Responsibility is an ethical concept particularly well suited to frame many key aspects of the ethics of our profession.

Environment↗