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PubMed1979

From reform to relativism: a history of economists and health care.

During the first half of this century economists who studied health care were primarily concerned with reducing the financial burden of illness and making services more accessible. In recent decades, "scholarly research" by professional economists has become characterized by the exchange of social advocacy for scientific neutrality. Historical analysis of the assumptions underlying this shift--assumptions about the worth of resources and alternative ways to allocate resources--shows parallel changes in other social sciences and medicine. As commitment to reform is tempered by relativism, scientific inquiry may benefit at the cost of social justice.

Delivery of Health Care↗
PubMed1993

The social context of HIV transmission in the African-American community.

The concept of acquired immune deficiency syndrome (AIDS) as a behavioral problem, and the emphasis placed by researchers on race and ethnicity as "risk factors," have led to research focused on the "risk behaviors" of historically oppressed groups and a continuing social policy thrust that "blames the victim." Disproportionate numbers of AIDS cases have been reported among African Americans, and these cases are not evenly distributed throughout the nation. This geographical variation and distribution of AIDS among African Americans suggests that there are forces in society that impact African-American communities in differential ways. A review of alternate models presented in the scientific literature reveals that some attention is being given to reconceptualizing AIDS as a disease to be understood within the context of factors that affect the African-American community, rather than as a problem of personal behavior. The current status of "contextual approaches" found in the health and social science literature over a 5-year period (1987 to 1992) was assessed. Literature surveyed includes studies from the fields of social epidemiology, public health, and social science that address the issue of AIDS in the African-American community from a contextual perspective--that is, studies that seek to explain key issues within a framework that allows a "community-in-environment" analysis, as opposed to a behavioral perspective. Analysis of these contextual approaches indicates that dynamics external to individuals must be clarified to better understand the disparate pattern of AIDS among African Americans and whites.

Black or African American↗
PubMed1998

The relationship between parental occupation and bone cancer risk in offspring.

BACKGROUND: Bone cancers in children are serious and highly fatal conditions, yet relatively little is known about their causes or methods of prevention. METHODS: The relationship between parental occupation and bone cancer in offspring was explored in a case-control study. Cases were identified from the Ontario Cancer Registry; population-based controls were matched on sex and age. Data were collected from their parents through the use of a mailed self-administered questionnaire. RESULTS: The odds ratio estimates (OR) for bone cancer were elevated for fathers in the social sciences (OR = 2.5, 95% confidence interval [CI]: 0.7-8.4). Risk of Ewing's sarcoma was significantly high among children with fathers in social sciences (OR = 6.2, 95% CI: 1.6-24.5) and mothers in teaching (OR = 3.1, 95% CI: 1.1-8.7) or farming (OR = 7.8, 95% CI: 1.9-31.7). Osteosarcoma risk was increased for fathers in farming (OR = 2.1, 95% CI: 0.8-5.7), and mothers in managerial and administrative work (OR = 2.3, 95% CI: 0.6-8.1), and product fabricating, assembling, and repairing (OR = 2.0, 95% CI: 0.6-7.2). CONCLUSIONS: Certain methodological problems plague studies of bone cancer in children (e.g. small studies, low statistical power, analysis of multiple occupational categories, difficulty in identifying specific carcinogenic agents). These associations require further investigation, especially as elevated risks have been reported previously for agricultural occupations.

Adult↗
PubMed1998

Internal structure of a measure of self-efficacy in physical activity among high school students.

The preliminary development of a measure of self-efficacy to participate in vigorous physical activity when confronted with specific perceived barriers to physical activity is described. Measures used in previous research ([Hofstetter, C.R., Hovell, M.F., Sallis, J.F., 1990a. Social learning correlates of exercise self-efficacy: Early experiences with physical activity, Social Science and Medicine, 31, 1169-1176.]; [Hofstetter, C.R., Sallis, J.F., Hovell, M.F., 1990b. Some health dimensions of self-efficacy: Analysis of theoretical specificity, Social Science and Medicine, 31, 1051-1056.]; [Reynolds, K.D., Killen, J.D., Bryson, M.S., Maron, D.J., Taylor, C.B., Maccoby, N., Farquhar, J.W., 1990. Psychosocial predictors of physical activity in adolescents, Preventive Medicine, 19, 541-551.]; [Sallis, J.F., Pinski, R.B., Grossman, R.M., Patterson, T.L., Nader, P.R., 1988. The development of self-efficacy scales for health-related diet and exercise behaviors, Health Education Research, 3, 283-292.]) were adapted and original items were developed. The 20-item measure has a 5-point Likert format ranging from not at all confident (1) to very confident (5). An earlier pilot study of 200 secondary school students showed that the measure was free of social desirability. The data were derived from a survey of 1041 secondary school students from a Metropolitan Toronto board of education. Principal component analysis (PCA) with oblique rotation of the data yielded two factors: self-efficacy to overcome external barriers and self-efficacy to overcome internal barriers. The 12-item external barriers subscale had a coefficient alpha of 0.88 and the 8-item internal barriers subscale had a coefficient alpha of 0.87. The subscales significantly correlated with the frequency of participation in vigorous physical activity. In summary, the results provide some support for the internal consistency reliability, construct validity, criterion validity, and discriminant validity of the measure. Though further psychometric research is warranted, the self-efficacy measure shows promise for physical activity research.

Adolescent↗
PubMed2000

Neural network modeling of risk assessment in child protective services.

The advantages of using neural network methodology for the modeling of complex social science data are demonstrated, and neural network analysis is applied to Washington State Child Protective Services risk assessment data. Neural network modeling of the association between social worker overall assessment of risk and the 37 separate risk factors from the State of Washington Risk Assessment Matrix is shown to provide case classification results superior to linear or logistic multiple regression. The improvement in case prediction and classification accuracy is attributed to the superiority of neural networks for modeling nonlinear relationships between interacting variables; in this respect the mathematical framework of neural networks is a better approximation to the actual process of human decision making than linear, main effects regression. The implications of this modeling advantage for evaluating social science data within the framework of ecological theories are discussed.

Child↗
PubMed2004

Harvesting the living?: separating "brain death" and organ transplantation.

The chronic shortage of transplantable organs has reached critical proportions. In the wake of this crisis, some bioethicists have argued that there is sufficient public support to expand organ recovery through use of neocortical criteria of death or even pre-mortem organ retrieval. I present a typology of ways in which data gathered from the public can be misread or selectively used by bioethicists in service of an ideological or policy agenda, resulting in bad policy and bad ethics. Such risks should lead us to look at alternatives for increasing organ supplies short of expanding or abandoning the dead donor rule. The chronic problem of organ scarcity should prompt bioethicists to engage in constructive dialogue about the relation of the social sciences and bioethics, to examine the social malleability of the definition of death, and to revisit the question of the priority of organ transplants in the overall package of healthcare benefits provided to most, but not all, citizens.

Bioethics↗
PubMedDate not supplied

[The "Well-being paradox" in quality-of-life research].

In quality-of-life research an empirical phenomenon has been observed independently in medicine and in the social sciences which is so contrary to what intuition tells us that it has been called paradoxical. In medicine it is called the "satisfaction paradox" and in the social sciences the "well-being paradox". What is meant in both cases is that objectively negative factors in one's life have relatively little effect on subjective quality of life. In the present paper examples are given of relevant research findings from both fields. An attempt is then made to explain the phenomenon, with the topic being examined not only from a methodological but also from a personality, cognition and social psychology perspective. Finally, the implications for research and clinical work are discussed.

Cognition↗
PubMed1993

Community intervention. Creating opportunities and support for cancer control behaviors.

Much of the potential for reducing cancer mortality is dependent on the adoption of new behavioral patterns. Such changes demand application of the behavioral-social sciences. A shift from univariate reductionist models of causation toward multivariate systems models is needed. Decisions (and behavior) are the focus of much of the behavioral-social sciences. Determinants of decisions are delimited by controlling systems. Health care is only one of many possible influences on controlling systems, and its influence is only marginal for the behavior of the general public. Thus, community interventions that address multiple determinants within controlling systems are needed to influence most behaviors. Belief saliency hierarchies appear to psychologically mediate controlling systems. Changes in these saliency hierarchies lead to changes in behaviors. Person-valued beliefs, social-valued beliefs, and feasibility beliefs serve as the informational basis for the hierarchies. Needs activation is a primary means by which hierarchies shift. Changing environmental cues and signals also impart such shifts. Experience, persuasive communication, and value extracted from the environment also change hierarchies. Needs activation, community presence, persuasive communication, facilitation, inhibition, and experience-based interventions are discussed for tobacco use control, dietary change, and breast and cervical cancer screening behavior. Emphasis is given to how the health care system can become a part of the controlling system that influences community behavior. Issues concerning successful implementation of community education programs are raised.

Community Health Services↗
PubMedDate not supplied

[Opinions of a group of university students about science and technology].

OBJECTIVE: To learn the opinions of university students of four different areas on the impact of science and technology on society. SUBJECTS: One Hundred and sixty three close to graduate students of the Universidad Autonoma Metropolitana campus Iztapalapa, distributed as follows: Administration 59, Biology 50, Social Sciences 36 and Engineering 18. METHODS: For the survey we translated into spanish part of a questionnaire employed in several countries to explore ideas on the impact of science and technology on society of several groups. It contained general questions such as. Do you believe that science and technology are equally good or bad to society, or degree of knowledge of several technologies such as computation or in vitro fertilization. It includes also more specific questions, such as would your have problems with the use of genetically modified vegetables? RESULTS AND DISCUSSION: The results suggested that Administration and Social Sciences students had less interest in Science and Technology than the other, and that in general, the knowledge of all students is rather limited including biotechnology, genetic enginering and gene therapy. We compared the results with those obtained previously in a group of Mexican Physicians and Biology students from India, Thailand and Singapor.

Acquired Immunodeficiency Syndrome↗
PubMed1964

THE IMPACT OF THE BEHAVIORAL SCIENCES ON THE COLLECTING POLICY OF MEDICAL SCHOOL LIBRARIES.

The scope of medical science has broadened to embrace subject areas in the behavioral and social sciences. Medical school curricula have responded to this trend, and the response is inevitably making itself felt in the medical school library. One medical school library's efforts to identify significant library materials in this area are presented as an example of a technique and as an indication of an order of magnitude. A master list of appropriate journal titles is appended.

Behavioral Sciences↗
PubMed1996

New draft code for research involving humans proved a major challenge.

A new draft code of conduct for research involving humans aims to bring a fresh vision to the ethics field. The code is a joint endeavour of the Medical Research Council, the Natural Sciences and Engineering Research Council and the Social Sciences and Humanities Research Council and supersedes all three agencies' earlier ethics statements. Once the draft code is revised and approved, likely by the end of the year, investigators will have a more refined understanding of the ethical limits of acceptable research.

Advisory Committees↗
PubMed1978

Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described as illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.

Adult↗
PubMed2003

Autopoiesis: a review and a reappraisal.

The aim of the paper is to review critically the notion of autopoiesis as presented by Maturana and Varela. In particular, recognizing that there are difficulties in obtaining a complete and clear picture from the primary literature, an effort is made to present a coherent view-also based on many years of personal contact with Francisco Varela. The paper begins with a few historical notes to highlight the cultural background from which the notion of autopoiesis arose. The basic principles of autopoiesis as a theory of cellular life are then described, emphasizing also what autopoiesis is not: not an abstract theory, not a concept of artificial life, not a theory about the origin of life-but rather a pragmatic blueprint of life based on cellular life. It shown how this view leads to a conceptually clear definition of minimal life and to a logical link with related notions, such as self-organization, emergence, biological autonomy, auto-referentiality, and interactions with the environment. The perturbations brought about by the environment are seen as changes selected and triggered by the inner organization of the living. These selective coupling interactions impart meaning to the minimal life and are thus defined by Maturana and Varela with the arguable term of "cognition". This particular view on the mutual interactions between living organism and environment leads these authors to the notion of "enaction", and to the surprising view that autopoiesis and cognition are two complementary, and in a way equivalent, aspects of life. It is then shown how cognition, so defined, permits us to build a bridge between biology and cognitive science. Autopoiesis also allows one to conceive chemical models of minimal cellular life that can be implemented experimentally. The corresponding work on "chemical autopoiesis" is then reviewed. The surprising impact of autopoiesis in the social sciences ("social autopoiesis") is also briefly discussed. This review also comments on why the theory of autopoiesis had, and still has, a difficult time being accepted into the mainstream of life-science research. Finally, it is pointed out that the new interest in system biology and complexity theories may lead to a reappraisal of autopoiesis and related notions, as outlined also by other authors, such as Tibor Ganti and Stuart Kauffmann.

Cell Cycle↗
PubMed2004

[Spanish scientific output in medicine in the years 1994-1999].

OBJECTIVES: A study through bibliometric indicators of the 1994-1999 Spanish international medical scientific output is presented. METHOD: The international bibliographic databases Science Citation Index and Social Sciences Citation Index were used as data source. RESULTS: The Spanish production in Health Sciences rose in the period studied to 53,878 documents, distributed between Basic Medicine (54%), Clinical Medicine (53%) and Social Medicine (2.7%). Among the Spanish communities with greater production Madrid (31%) and Catalonia (29%) pointed out, followed by Andalusia (12%) and Valencia (9%). The principal institutional sectors involved in research were hospitals (51%) and university (44%). An important increase in the publications from foundations and companies was observed. The disciplines of Biochemistry/Molecular biology, Internal/General medicine and Pharmacology/Pharmacy pointed out by their high production. With regard to the centers of greater production its increase during the period studied, the clinical or basic character of research and the average impact factor of their documents shown to detect centers of excellence. CONCLUSIONS: The analysis carried out shows the growth of clinical and social Medicine, makes possible to identify the principal actors in Health Sciences, detect centers of excellence in the disciplines, and analyze the specialization of Spain in the European context. The publications are more abundant in the journals of the first quartile of each specialty.

Bibliometrics↗