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PubMed1992

Challenges to understanding spatial patterns of disease: philosophical alternatives to logical positivism.

Most studies of disease distribution, in medical geography and other related disciplines, have been empirical in nature and rooted in the assumptions of logical positivism. However, some of the more newly articulated philosophies of the social sciences, and of social theory, have much to add in the understanding of the processes and mechanisms underlying disease distribution. This paper represents a plea for creative synthesis between logical positivism and realism or structuration, and uses specific examples to suggest how disease distribution, as a surface phenomenon, can be explained using deeper analysis.

Cross-Cultural Comparison↗
PubMed2006

Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review.

BACKGROUND: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse? METHODS: We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review. FINDINGS: Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel. CONCLUSION: Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question.

Adolescent↗
PubMed2002

What do citation counts count for in the field of addiction? An empirical evaluation of citation counts and their link with peer ratings of quality.

AIMS: This study investigated the value of citation counts as an index of quality in the field of addiction and examined factors that contribute to papers being cited more or less frequently. DESIGN: The number of times papers published by the journal Addiction in 1995-98 that had been cited up to May 2000 were counted using the Science and the Social Science Citation Indexes. Articles in nine of the monthly issues from 1997 were rated by two independent expert raters for quality. Factors related to citation counts were also examined including: country of origin of the paper, substance type, solicited versus unsolicited papers and methodology used. FINDINGS: A total of 417 unsolicited research reports were included in the citation analysis, of which 79 were also subjected to quality ratings. The experts showed a moderate level of agreement in their ratings (intraclass correlation = 0.39. p < 0.001). However, there was no correlation between number of citations and expert ratings of article quality (R < 0.1). Papers from developing countries received significantly fewer citations than papers from other countries but substance type (e.g. nicotine, opiate, alcohol) and methodology (e.g. survey, treatment trial) were not related to number of citations. CONCLUSIONS: This study involved just one journal but raised an important issue: the number of citations received by papers on addiction appears to reflect the geographical region of study rather than what experts would consider as 'quality'. If these findings are found to generalize they call into question the use of citation-related indices as measures of quality in this field and perhaps in others as well. To our knowledge our methodology has not been used before and could be adapted to study the value of citations more widely.

Behavior, Addictive↗
PubMed1997

Children's perceptions of purposes for studying different subjects in school.

Examiners explored 4th and 6th graders' perceptions of studying 6 subjects in school: language, math, science, social studies, music, and visual arts. Participants were asked to indicate whether they agreed or disagreed with each of 12 reasons for studying each of the 6 subjects. Five of the reasons included general educational goals that were applicable to all subjects (cross-curricular goals), 5 included objectives established for a particular subject (subject-specific objectives), and 2 represented goals irrelevant to the subject. Both 4th and 6th graders selected mainly subject-specific objectives (e.g., "learn about different rhythms") as reasons for studying music and visual arts. Many children used some of the general cross-curricular goals (e.g., "do well in school in the future"), in addition to the subject-specific goals, to describe why they were studying core subjects: language, math, social studies, and science.

Achievement↗
PubMed1996

Educators must take the electronic revolution seriously.

The advanced fields in the physical sciences and quantitative social sciences began using computers years ago. But only recently has the electronic revolution reached the point where educators in both medicine and the humanities must take it seriously. This is because (1) computers have finally become powerful enough to permit the creation of teaching machines (called multimedia packages) that can manipulate the massive amounts of information involved in medicine and the humanities; and (2) the Internet is now fast enough and widely distributed enough to change teaching practices. Multimedia packages will drastically change traditional teaching and learning; the author reviews these and other likely impacts of these packages. For example, faculty members' effective contact with students will not be bound by time and place; students can learn at their own paces in their preferred modes; and the distinction between elementary and advanced learning will be virtually impossible to maintain. The Internet makes it possible to offer classes to students no matter where they or the teacher are located, to ignore strict constraints of time (a class discussion can go on for days), and to create "electronic communities" of students and faculty. The author reviews the great advantages of these capabilities, but states that this development of the virtual university could seriously undermine actual universities (e.g., difficulties of maintaining faculty competence in their disciplines; impossibility of deciding issues of department size and diversity; questions of the effectiveness of learning that does not take place face-to-face; problems of students' and teachers' time management, on which the traditional structures of curricula and teaching methods are built). Despite the fundamental adjustments that will be necessary, the author sees the electronic revolution in education as a necessary consequence of what is already taking place in research, where multimedia packages and the Internet are being used extensively, because in professional education, teaching and learning arise directly from research. Just as scholars and scientists have embraced this revolution, educators should embrace it in their educational programs and practices.

Attitude to Computers↗
PubMed2004

The Society for the Study of Addiction (SSA).

The Society for the Study of Addiction (SSA) is a learned society which is a company limited by guarantee with charitable status, an independent organization promoting the cause of research, public policy and treatment of addiction. Founded in London in 1884 with the aim of promoting a research-based understanding of inebriety, it is the oldest society of its kind. The pursuit and enhancement of evidence-based policy and treatment informed its work in the early days and has remained its organizing principle throughout its history. Led initially by medical political interests, the Society has grown to encompass a broader disciplinary base, reflecting the expansion of interest in addiction from biological, psychological and social science into nursing, social work, probation, other arms of criminal justice work and voluntary sector professionals. Today its membership is made up of researchers, practitioners and policy makers from all these disciplines, the majority of whom reside and work in the United Kingdom; its international membership makes up nearly one-third of the total membership and there are current endeavours to expand collaboration with other national societies in the field. Its activities are focused upon the Society journals, Addiction and Addiction Biology, other publishing activities, the annual symposium and a number of policy initiatives.

Behavior, Addictive↗
PubMed2005

The impact of international placements on nurses' personal and professional lives: literature review.

AIM: This paper presents a critical review of research literature on the impact of international placements on the lives and practice of nurses. BACKGROUND: Health care institutions are progressively more aware of the need to respond to diverse patient populations and cultivate leaders to enrich the nursing profession, both locally and globally. One response has been to establish international exchange programmes for nursing students to give them experience of different cultures and health care systems. METHODS: A search of the literature from 1980 to 2003 using electronic databases was undertaken using the databases CINAHL, ERIC, British Nursing Index, Web of Science, the BIDS Social Science Citation Index and Medline. The keywords used were 'international exchange experience', 'international studies', 'international education', 'international placement(s)', 'exchange programme(s)', combined with 'nurses/nursing', combined with 'evaluation', 'practice', 'education' and/or 'policy'. The papers retrieved used both qualitative and quantitative approaches and were scrutinized for recurring themes. FINDINGS: Nurses reported significant changes in their personal development, perspectives on nursing practice and critical appraisal of health care systems. They also indicated an increased appreciation and sensitivity towards cultural issues and cross-cultural care. Moreover, differences in placement programmes, such as duration, preparation and debriefing were found to have affected the reported overall international placement experience. However, the primary effects of international placements were identified as personal development and transcultural adaptation. CONCLUSION: Students should be exposed to a variety of nursing experiences within the host country. This would give them a broad spectrum for comparisons between cultures, nursing practice and health care delivery in those cultures. Therefore, educational institutions are strongly encouraged to provide opportunities for students to participate in nursing care and education in another country.

Cognition↗
PubMed2000

Systematic review of studies of patient satisfaction with telemedicine.

OBJECTIVE: To review research into patient satisfaction with teleconsultation, specifically clinical consultations between healthcare providers and patients involving real time interactive video. DESIGN: Systematic review of telemedicine satisfaction studies. Electronic databases searched include Medline, Embase, Science Citation Index, Social Sciences Citation Index, Arts and Humanities Citation Index, and the TIE (Telemedicine Information Exchange) database. SUBJECTS: Studies conducted worldwide and published between 1966 and 1998. MAIN OUTCOME MEASURES: Quality of evidence about patient satisfaction. RESULTS: 32 studies were identified. Study methods used were simple survey instruments (26 studies), exact methods not specified (5), and qualitative methods (1). Study designs were randomised controlled trial (1 trial); random patient selection (2); case-control (1); and selection criteria not specified or participants represented consecutive referrals, convenience samples, or volunteers (28). Sample sizes were </=20 (10 trials), </=100 (14), >100 (7), and not specified (1). All studies reported good levels of patient satisfaction. Qualitative analysis revealed methodological problems with all the published work. Even so, important issues were highlighted that merit further investigation. There is a paucity of data examining patients' perceptions or the effects of this mode of healthcare delivery on the interaction between providers and clients. CONCLUSIONS: Methodological deficiencies (low sample sizes, context, and study designs) of the published research limit the generalisability of the findings. The studies suggest that teleconsultation is acceptable to patients in a variety of circumstances, but issues relating to patient satisfaction require further exploration from the perspective of both clients and providers.

Humans↗
PubMed2001

A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97.

OBJECTIVES: To appraise findings from studies examining the impact of computers on primary care consultations. DESIGN: Systematic review of world literature from 1980 to 1997. DATA SOURCES: 5475 references were identified from electronic databases (Medline, Science Citation Index, Social Sciences Citation Index, Index of Scientific and Technical Proceedings, Embase, OCLC FirstSearch Proceedings), bibliographies, books, identified articles, and by authors active in the field. 1892 eligible abstracts were independently rated, and 89 studies met the inclusion criteria. MAIN OUTCOME MEASURES: Effect on doctors' performance and patient outcomes; attitudes towards computerisation. RESULTS: 61 studies examined effects of computers on practitioners' performance, 17 evaluated their impact on patient outcome, and 20 studied practitioners' or patients' attitudes. Computer use during consultations lengthened the consultation. Reminder systems for preventive tasks and disease management improved process rates, although some returned to pre-intervention levels when reminders were stopped. Use of computers for issuing prescriptions increased prescribing of generic drugs, and use of computers for test ordering led to cost savings and fewer unnecessary tests. There were no negative effects on those patient outcomes evaluated. Doctors and patients were generally positive about use of computers, but issues of concern included their impact on privacy, the doctor-patient relationship, cost, time, and training needs. CONCLUSIONS: Primary care computing systems can improve practitioner performance, particularly for health promotion interventions. This may be at the expense of patient initiated activities, making many practitioners suspicious of the negative impact on relationships with patients. There remains a dearth of evidence evaluating effects on patient outcomes.

Bibliometrics↗
PubMed2003

Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry.

OBJECTIVE: To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact. DATA SOURCES: Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. STUDY SELECTION: 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. DATA EXTRACTION: Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. DATA SYNTHESIS: In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. CONCLUSION: All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.

Commerce↗
PubMed2006

Microbicides 2006 conference.

Current HIV/AIDS statistics show that women account for almost 60% of HIV infections in Sub-Saharan Africa. HIV prevention tools such as male and female condoms, abstinence and monogamy are not always feasible options for women due to various socio-economic and cultural factors. Microbicides are products designed to be inserted in the vagina or rectum prior to sex to prevent HIV acquisition. The biannual Microbicides conference took place in Cape Town, South Africa from 23-26 April 2006. The conference was held for the first time on the African continent, the region worst affected by the HIV/AIDS pandemic. The conference brought together a record number of 1,300 scientists, researchers, policy makers, healthcare workers, communities and advocates. The conference provided an opportunity for an update on microbicide research and development as well as discussions around key issues such as ethics, acceptability, access and community involvement. This report discusses the current status of microbicide research and development, encompassing basic and clinical science, social and behavioural science, and community mobilisation and advocacy activities.

Journal Article↗
PubMed2005

Scientific perspectives on music therapy.

What needs to be done on the long road to evidence-based music therapy? First of all, an adequate research strategy is required. For this purpose the general methodology for therapy research should be adopted. Additionally, music therapy needs a variety of methods of allied fields to contribute scientific findings, including mathematics, natural sciences, behavioral and social sciences, as well as the arts. Pluralism seems necessary as well as inevitable. At least two major research problems can be identified, however, that make the path stony: the problem of specificity and the problem of eclecticism. Neuroscientific research in music is giving rise to new ideas, perspectives, and methods; they seem to be promising prospects for a possible contribution to a theoretical and empirical scientific foundation for music therapy. Despite the huge heterogeneity of theoretical approaches in music therapy, an integrative model of working ingredients in music therapy is useful as a starting point for empirical studies in order to question what specifically works in music therapy. For this purpose, a heuristic model, consisting of five music therapy working factors (attention modulation, emotion modulation, cognition modulation, behavior modulation, and communication modulation) has been developed by the Center for Music Therapy Research (Viktor Dulger Institute) in Heidelberg. Evidence shows the effectiveness of music therapy for treating certain diseases, but the question of what it is in music therapy that works remains largely unanswered. The authors conclude with some questions to neuroscientists, which we hope may help elucidate relevant aspects of a possible link between the two disciplines.

Acoustic Stimulation↗
PubMed2006

Workplace, household, and personal predictors of pesticide exposure for farmworkers.

In this article we identify factors potentially associated with pesticide exposure among farmworkers, grade the evidence in the peer-reviewed literature for such associations, and propose a minimum set of measures necessary to understand farmworker risk for pesticide exposure. Data sources we reviewed included Medline, Science Citation Index, Social Science Citation Index, PsycINFO, and AGRICOLA databases. Data extraction was restricted to those articles that reported primary data collection and analysis published in 1990 or later. We read and summarized evidence for pesticide exposure associations. For data synthesis, articles were graded by type of evidence for association of risk factor with pesticide exposure as follows: 1 = association demonstrated in farmworkers; 2 = association demonstrated in nonfarmworker sample; 3 = plausible association proposed for farmworkers; or 4 = association plausible but not published for farmworkers. Of more than 80 studies we identified, only a third used environmental or biomarker evidence to document farmworker exposure to pesticides. Summaries of articles were compiled by level of evidence and presented in tabular form. A minimum list of data to be collected in farmworker pesticide studies was derived from these evidence tables. Despite ongoing concern about pesticide exposure of farmworkers and their families, relatively few studies have tried to test directly the association of behavioral and environmental factors with pesticide exposure in this population. Future studies should attempt to use similar behavioral, environmental, and psychosocial measures to build a body of evidence with which to better understand the risk factors for pesticide exposure among farmworkers.

Agriculture↗
PubMed1997

[Citizenship and modernity: the emergence of the social issue on the public agenda]

The guiding thread of this article is the inclusion of the so-called "social issue" on the public agenda from modernity through its more current developments. The study seeks to demonstrate that one of the meanings of modernity is precisely the radical inversion of the meaning of public and private, providing for the broadening of public space. Far from being associated with a given bourgeois capitalist model, modernity thus projects itself as a reinvention of rights, citizenship, and contemporary democratic experience. Over this long course, the individualization process has been seen as a crucial factor for understanding both the ideology of modern societies and - paradoxically - the very emergence of social sciences. The individualist concept, emphasizing the specificity of modern representation of the social sphere, i.e., its characteristic as a self-instituting society, allows for a broadened understanding of the public domain. In this sense, the ideological polarization between liberal conceptions (favoring individualism) and Marxist ones (linked to holistic representations of the social sphere) should be reviewed, since this polarization has repercussions on the very analytical tools used by social sciences.

Journal Article↗