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PubMed2002

Telepsychiatry: an overview for psychiatrists.

Telepsychiatry, in the form of videoconferencing and other modalities, brings enormous opportunities for clinical care, education, research and administration to the field of medicine. A comprehensive review of the literature related to telepsychiatry - specifically videoconferencing - was conducted using the MEDLINE, Embase, Science Citation Index, Social Sciences Citation Index and Telemedicine Information Exchange databases (1965 to June 2001). The keywords used were telepsychiatry, telemedicine, videoconferencing, Internet, primary care, education, personal digital assistant and handheld computers. Studies were selected for review if they discussed videoconferencing for patient care, satisfaction, outcomes, education and costs, and provided models of facilitating clinical service delivery. Literature on other technologies was also assessed and compared with telepsychiatry to provide an idea of future applications of technology. Published data indicate that telepsychiatry is successfully used for a variety of clinical services and educational initiatives. Telepsychiatry is generally feasible, offers a number of models of care and consultation, in general satisfies patients and providers, and has positive and negative effects on interpersonal behaviour. More quantitative and qualitative research is warranted with regard to the use of telepsychiatry in clinical and educational programmes and interventions.

Communication↗
PubMed2002

Exercise training and heart failure: a systematic review of current evidence.

Chronic heart failure (CHEF) is a growing public health problem. Current guidelines provide detailed information regarding pharmacotherapy but little guidance about the value of exercise/cardiac rehabilitation programmes for individuals with this condition. To investigate the effects of exercise training upon CHF patients, a systematic literature review was carried out of trials (from 1966 to December 2000) which used as their main outcome measures the effects of exercise training upon: (a) physical performance; or (b) quality of life; or (c) morbidity/mortality. Databases searched include: MedLine; Science Citation Index; Social Sciences Citation Index; BIDS, Bandolier; Cochrane Database of Systematic Reviews (CDSR); NHS National Research Register (NRR); and Current Research in Britain (CRIB). Relevant bibliographic references from identified articles were also reviewed. Thirty-one trials were identified, comprising randomised controlled trials (RCTs) (14/31), randomised crossover trials (8/31), non-RCTs (2/31), and pre-test/post-test (7/31). Sample sizes were: 25 participants or fewer (20/31); 26 to 50 participants (7/31); 51 to 150 participants (4/31). Participants were predominantly younger with a mean age in 23/31 studies of 65 years or less, and male. Patients with comorbidities were often excluded. Positive effects were reported on physical performance (27/31), quality of life (11/16), mortality (1/31), and readmission rates (1/31). No cost-effectiveness analyses were identfied. We conclude that short-term physical exercise training in selected subgroups of patients with CHF has physiological benefits and positive effects on quality of life. This review highlights the continuing problem of clinical trials that include participants who are not representative of the general population of CHF patients seen in primary care. Further investigation of the utility and applicability of exercise training is essential.

Adult↗
PubMed2001

[The role of behavioral sciences in the Hungarian and international medical education: overview and possibilities].

The unilateral bio-medical approach cannot be effective in the prevention and effective treatment of chronic disorders of great epidemiological significance, because the behavioural risk factors are strongly influenced by psychosocial factors too. After the change of the political system in Hungary the most important step in curriculum development was establishing the institutes of behavioural sciences. However, the share of behavioural sciences nowhere exceeds 3% of the curriculum. Yet it has an important role in bridging the gap between the natural and social sciences. Built on the firm basis of natural sciences, the behavioural sciences complement this foundation with aspects of social sciences which emphasize the psychological needs of the patients as well as the psychosocial determinants of health and diseases. The most significant field of behavioural sciences is medical psychology but according to the latest reports on medical education development communication, medical sociology, medical anthropology and bioethics have become increasingly important disciplines in developing medical competence. These fields are organized into an integrated process, arching over the six years of medical training. The present paper gives an overview of the situation and perspectives of teaching behavioural sciences at medical universities.

Academies and Institutes↗
PubMed1965

PSYCHOSOMATIC PRINCIPLES.

There are four lines of development that might be called psychosomatic principles. The first represents the work initiated by Claude Bernard, Cannon, and others, in neurophysiology and endocrinology in relationship to stress. The second is the application of psychoanalytic formulations to the understanding of illness. The third is in the development of the social sciences, particularly anthropology, social psychology and sociology with respect to the emotional life of man, and, fourth, there is an increased application of epidemiological techniques to the understanding and incidence of disease and its causes. These principles can be applied to the concepts of comprehensive medicine and they bid fair to be unifying and helpful in its study. This means that future practitioners, as well as those working in the field of psychosomatic medicine, are going to have to have a much more precise knowledge of the influence of emotions on bodily processes.

Anthropology↗
PubMed1990

Perceived social support and family meeting attendance preferences among family medicine outpatients.

Although there is much social science literature about social support, relatively little is known about the extent and sources of support that family medicine patients perceive to be available to them. A questionnaire requesting ratings of perceived informational, instrumental, emotional, and crisis support in a variety of relationships was administered to 101 family practice center outpatients. Results indicated strong perceptions of available support overall, with highest levels perceived from partners and parents. Notably, however, strong support was also perceived from extrafamilial sources, surpassing that of other categories of biological relatives. Levels of perceived support from particular people also varied according to type of support being rated. Finally, patients expressed strong preferences for inviting both immediate family members and supportive extrafamilial persons to hospital meetings with physicians to discuss serious medical problems. Results are consistent with a multifactorial model of social support and suggest that physicians should take a broad social systems perspective in assessing patient resources and negotiating attendance at family meetings.

Adolescent↗
PubMed1998

Citation analysis in journal rankings: medical informatics in the library and information science literature.

Medical informatics is an interdisciplinary field. Medical informatics articles will be found in the literature of various disciplines including library and information science publications. The purpose of this study was to provide an objectively ranked list of journals that publish medical informatics articles relevant to library and information science. Library Literature, Library and Information Science Abstracts, and Social Science Citation Index were used to identify articles published on the topic of medical informatics and to identify a ranked list of journals. This study also used citation analysis to identify the most frequently cited journals relevant to library and information science.

Bibliometrics↗
PubMed1989

The 'explosiveness' of chain migration: research and policy issues. Introduction and overview.

This is an introduction to Volume 23, Number 4, of the International Migration Review. This issue "focuses on the legislative and social science interface concerning the complex issue of whether the current system of United States legal immigration is promoting or facilitating an 'explosive' multiplication of immigrants.... The purpose of this collection of articles is to present the most current evidence and policy analyses of the size and composition of the immigration 'multiplier.' It assumes that there is merit in focusing attention on the overlapping interests of social science researchers and legislative analysts regarding how the system of legal immigration actually operates in promoting or reproducing future waves of immigrants."

Americas↗
PubMed1987

Theoretical tensions in biopsychosocial medicine.

Orthodoxy traditionally manages to control the potential threat from the unorthodox by a strategy of either marginalisation or incorporation. Having for so long marginalised the social sciences, biomedicine now seeks to incorporate them in a new biopsychosocial alliance. The social sciences should resist such blandishments and, rather than act in complicity with biomedicine, be free to pursue a more critical role in exposing the theoretical and empirical inconsistencies in the biomedical model.

Biological Psychiatry↗
PubMed1998

Is our work dangerous? Should it be?

Three case histories show how work in the medical social sciences--to the extent that such work reveals the origins of health problems in social structures of wealth and power--can become dangerous enough to threaten one's livelihood and in some instances one's very life. In this presentation, I encourage critical and engaged scholarship by referring to examples of dangerous work that should receive more attention: social medicine in Latin America and the critique of managerial ideology in the United States. Although social medicine has become a widely respected field of research, teaching, and clinical practice in Latin America, its accomplishments remain little known in the English-speaking world. For centuries, indigenous cultures in Latin America have held belief systems linking social conditions to patterns of illness and death. Latin American accounts of social medicine's history emphasize its European origins, especially in the contributions of Rudolf Virchow. In the United States, with the impact of the Flexner Report (1910) and its supporters, Virchow's vision of social medicine went into decline. On the other hand, in Latin America, social medicine flourished as a focus of education and research. Since social medicine's "golden age" during the 1930s, teachers, researchers, and practitioners have produced major achievements despite the dangers of this work, which in several instances have included torture, imprisonment, or death. An ideology favoring managerial decision making in the United States has influenced crucial policy decisions, and the justifications for these decisions have manifested symbolic politics in addition to the evaluation of factual evidence. With ambiguous empirical support, managerial ideology has fostered the general growth of managed care, the implementation of Medicaid managed care by state governments, the expansion of managed care in rural areas, and the impact of "evidence-based medicine" on policy and clinical decisions. If the occupational risks of critical work in the medical social sciences are not taken, we forfeit some of the most important gifts offered by "the sociological imagination."

Awards and Prizes↗
PubMed2004

Aids, race and the limits of science.

In the US, HIV is understood as the virus that causes AIDS, the root of a disease syndrome perceived to indicate an immune system that has ceased to function. These understandings reflect the unquestioned hegemony of Euro/American scientific knowledge, a hegemony that precludes alternative interpretations of life and death, health and disease. This paper argues that HIV/AIDS is more complicated than biomedicine allows, and that the "overmedicalization" of treatment and prevention efforts obscures the significant socio-cultural and political-economic realities that shape the global pandemic, including conceptions of race. The paper specifically focuses on the discourses of bio- and socio-pathology that link African diasporic communities around the globe, and which often seamlessly articulate with structural locations, producing a coherent narrative in which social and moral positions justify and substantiate one another. The analysis here occurs on both these levels: the discursive and the structural. If we are to understand the complex relationships that form the AIDS epidemic, the disciplinary lines imagined between scientific paradigms and the clinical focus on the individual body on one hand, and the social sciences and humanities disciplines on the other, must be breached. If what we call AIDS is a socio-cultural and political-economic phenomenon with biological manifestations, then it is essential that the insights of the social sciences and humanities be brought to bear on finding solutions to the epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Disability, facilitated sex and the role of the nurse.

AIM: The aim of this paper is to explore the role that nurses can play in acknowledging and facilitating the sexual needs of disabled patients within an holistic framework of nursing care. BACKGROUND: Contemporary nursing claims to offer patient care within an holistic framework; this framework should encompass the biopsychosocial needs of patients, as defined by patients themselves. In spite of the importance of sexuality and sexual expression to the psychosocial welfare of patients, sexuality is often excluded from nursing practice. METHOD: Literature is reviewed from nursing, disability studies, and a variety of social science disciplines. FINDINGS: The paper begins with a discussion of the concept of 'holistic care' and the ways in which this has been interpreted in the nursing literature. The biopsychosocial approach and the notion of 'whole person' holism seem particularly significant, although the lack of attention to patient sexuality is identified. Literature from the social sciences is used to explore the significance of sexuality to individual self-identity and psychosocial welfare. This literature also highlights the way in which the denial of sexual identity is a significant feature of power relations. The disability studies literature catalogues the way in which disabled people are generally infantilized by society and perceived as asexual. This literature also highlights the professional neglect of disabled sexual identities. Using a variety of literature, the concept of facilitated sex is explored as a continuum of activities and the role of nursing, within a holistic framework, is examined. CONCLUSION: The paper concludes by arguing that an holistic approach to nursing care should include an appreciation of patient sexuality. In particular, it suggests that nurses can play an important role along the continuum of facilitated sex.

Attitude of Health Personnel↗
PubMed2000

The difficulty of sustaining curricular reforms: a study of "drift" at one school.

In 1997, five years after a major curricular reform at the University of Michigan Medical School, the authors revisited the Goals for Medical Education (written by faculty to guide the reform process) to identify factors that had facilitated or hindered their achievement. By reviewing responses to identical questionnaires circulated to faculty in 1993 and again in 1997, they learned that considerably more lectures were being used to deliver curricular content in the first-year curriculum than the faculty thought was ideal, and that less social science, humanities, and ethics material was being presented in the first year than the faculty thought was ideal. The authors also learned that consensus between faculty basic scientists and faculty clinicians about the content that would make up an ideal first-year curriculum had diverged since adoption of the new curriculum. Movement toward decreasing the amounts of social sciences, humanities, and ethics in the first year of medical school was particularly pronounced among the basic scientists, who felt this material was being taught prematurely and at the expense of essential basic science content. In contrast, by 1997 much closer agreement had developed between the two groups regarding time they would allocate for lectures; this agreement unfortunately reflected a stagnation in the adoption of active learning methods. Movement toward increasing the amount of time for lectures in the first-year curriculum was particularly pronounced among the clinicians, who reported feeling more and more pressured to bring in clinical revenues. Based on faculty comments and the school's experience with centralized governance and centralized funding, the authors propose a direct linkage between institutional funding to departments and the teaching effort of faculty in the departments, and sufficient, centralized funding to relieve pressure on faculty and to foster educational creativity. They maintain that this may be the most effective way to guarantee ongoing innovation, support interdisciplinary teaching, and subsequently move the curriculum and teachers completely away from content that is isolated within traditional department structures. At the same time they acknowledge that changing faculty attitudes presents a challenge.

Curriculum↗
PubMedDate not supplied

[Policy and collective health: a reflection on scientific production (1976-1992)].

This study systematizes the theoretical and conceptual foundations in the field of Collective Health that have provided the basis for scientific production in the health policy area. The primary research source is the literature produced in two different contexts in this field, i.e., that of its emergence per se and the scope of the so-called Health Reform. The authors highlight the main concepts and theoretical references from the social sciences used in analyzing the health policy theme, identifying analytical distinctions, concepts pertaining to policy, the state, and health, and changes in the central categories from the various studies. Their analysis of this history indicates a reshaping of the theoretical frame of reference, giving greater flexibility to the structural determinism and macrosocial approach characterizing a major portion of academic production in the context from which the field emerged and thereby questioning the hegemony of the Marxist paradigm. In relation to more recent production, the authors emphasize the incorporation of new analytical references, thus providing greater complexity to the relationship between the social sciences and the field of Collective Health.

Communism↗
PubMed1967

A new school of medicine is born in Quebec.

The new Faculty of Medicine at the University of Sherbrooke accepted its first 32 students in September 1966. The four major objectives of the school are: (1) medical education with emphasis on learning rather than teaching; (2) research in three major fields of endeavour: basic, clinical and medico-social sciences; (3) optimum patient care; and (4) service to society. A new Health Sciences Centre houses the Medical School, 1 420-bed hospital and multidisciplinary laboratories, and eventually will contain the paramedical schools, including a School of Nursing Sciences. The three major divisions of the Faculty are basic, clinical and medico-social sciences. The curriculum of the first two years is correlated and integrated within the "block" system, with participation from all three divisions.

Adult↗