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PubMed1980

The use of inferential statistics in health and disease: A warning.

Community health is an increasingly important subject in the curricula of medical students. The roots of this discipline can be traced to public health and social and preventive medicine. Definition of its boundaries is being sought. Within these boundaries are epidemiology and biostatistics. Community health has reached into the social sciences and adopted their research methodology as a tool for the study of variables influencing disease in communities. This adoption has brought advantages to the practice of community health. It has also brought with it the controversy surrounding the use of the agricultural-botany paradigm in the study of human problems. With the incorporation of social science research methodology into community health, cognizance must be taken by medical educators and community health practitioners of the criticisms surrounding the use of inferential statistics.

Epidemiologic Methods↗

PubMed1999

Theory, method, and power in drug and HIV-prevention research: a participant-observer's critique.

Why do most substance misuse and HIV-prevention researchers not practice what they preach concerning the complementarity of quantitative and qualitative methods? Why does most of the public health literature fail to address the important intellectual and political debates that substance misuse and HIV infection confronts? Why is the entire field so timid with respect to social science theory? Most drug researchers, and virtually all the anthropologists working on the subject, publicly acknowledge the need to combine quantitative and qualitative methodologies. Surprisingly, however, there are almost no successful examples of substance misuse and HIV prevention research projects that meld quantitative methods with participant-observation approaches organically. While this methodological schism also holds true for most of the social sciences more broadly, in few other fields besides that of substance misuse research is the complementarity of quantitative and qualitative methods more urgently and obviously necessary. On the one hand this methodological dialogue has practical utility for creating better public health interventions that might relieve human suffering; and on the other hand this applied dialogue has the potential for a critical, multidisciplinary, theoretical impact on academia.

Anthropology, Cultural↗

PubMedDate not supplied

The Institute of Medicine, National Academy of Sciences: formulating AIDS policy.

In 1985 the Institute of Medicine, National Academy of Sciences devoted its annual meeting to an exploration of acquired immunodeficiency syndrome (AIDS). The questions raised at the meeting propelled the IOM/NAS to initiate an assessment of the dimensions of the AIDS epidemic and to propose an appropriate national response. The Committee on a National Strategy for AIDS issued its report, "Confronting AIDS: Directions for Public Health, Health Care, and Research," in October 1986. The report detailed strategies for curbing the spread of infection, and for accelerating biomedical and social science research into the causes and possible cures for AIDS. In March 1987, the IOM/NAS established the AIDS Activities Oversight Committee to monitor and assess the nation's progress against AIDS and to coordinate the Academy's growing program of AIDS-related activities. Studies, conferences, and workshops are planned in the areas of drug and vaccine development, modeling the course of the epidemic, research in the behavioral and social sciences, equitable financing of care, pediatric AIDS, early cognitive impairment in HIV infection, IV drug abuse, and other topics.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Universities as resources to state health agencies.

In a survey of the 50 State health agencies in the spring of 1992, officials were asked about their manpower and research needs in the specific areas of administration, behavioral and social science, education and information, environmental health, environmental protection, epidemiology, laboratory, law, occupational health, policy and planning, and statistics. In all, 40 agencies (80 percent) responded. Indepth telephone interviews to determine whether universities and schools and graduate programs in public health filled these needs completed the data collection process. Agency officials indicated that their resources were least adequate in environmental protection, behavioral and social science, and occupational health. They did not feel their research needs were being met. There was a general feeling that universities and schools and programs in public health have different agendas than State agencies and that practical solutions to the shortage of research resources are not forthcoming from these sources. Suggestions are made as to what can be done to improve relationships between those who train public health personnel and those who employ them.

Data Collection↗

PubMed1986

[The administration of knowledge. The biological and the social in the training of health personnel in Latin America].

The article starts with the concept of the management of knowledge, a component of the mission of PAHO as formulated in 1982. The purpose of the article is to consider what ideas have been formulated on the biological and social elements in medicine and how, and to what extent, they have been put into practice. The first part of the document discusses the theory of medicine and the social sciences, and the biological and social nature of the health-disease process. The second part traces the historical development of the biological and social approaches in relation to the degree to which these elements have been isolated and integrated in instruction. The first stage, the decade of the fifties, was characterized by the influence of the Flexner Report: instruction was organized in a cycle of the basic and clinical sciences; there was almost complete separation between medicine and society, and seminars in the Hemisphere proposed the inclusion of an integrated approach. The second stage, the decade of the sixties, was one of the great advances in theory and practice. Hemispheric meetings among health authorities, professional associations and groups of social scientists, physicians, and educators explicitly expounded the need for integration of the social and biological elements into medical education. The biological basis of study plans was reinforced as well. The third stage, the decade of the seventies, was one of consolidation of social medicine in the profession and the intensification of studies in that discipline. The idea then emerged of interdependence between medical education, medical practice, and the organization of health services in a social context. The authors examine the years of the eighties as an unfinished stage of culmination of the integration of the social and biological elements in medicine with inclusion of the idea of the physician's commitment to society.

Biology↗

PubMed1997

A new paradigm for nursing: the potential of realism.

Realism has been the dominant approach in the philosophy of science for the last 20 years. Realist philosophy has also been widely employed across a range of social sciences. Unfortunately, these powerful intellectual currents have not reached the shores of nursing which appears trapped in a time-warped debate about 'qualitative' (constructivist) and 'quantitative' (positivist) approaches. This paper argues that both positivism and constructionism are seriously flawed as philosophies of social and natural science. This is in marked contrast with realism which is a philosophy of both the natural and social sciences. I therefore propose that realism should be adopted as a radically different new paradigm for a unified biopsychosocial nursing.

Humans↗

PubMed2001

Built for speed, not for comfort. Darwinian theory and human culture.

Darwin believed that his theory of evolution would stand or fall on its ability to account for human behavior. No species could be an exception to his theory without imperiling the whole edifice. The ideas in the Descent of Man were widely discussed by his contemporaries although they were far from being the only evolutionary theories current in the late nineteenth century. Darwin's specific evolutionary ideas and those of his main followers had very little impact on the social sciences as they emerged as separate disciplines in the early Twentieth Century. Not until the late twentieth century were concerted, sophisticated efforts made to apply Darwinian theory to human behavior. Why such a long delay? We argue that Darwin's theory was rather modern in respects that conflicted with Victorian sensibilities and that he and his few close followers failed to influence any of the social sciences. The late Twentieth Century work takes up almost exactly where James Baldwin left off at the turn of the century.

Behavior↗

PubMed2006

Telling cultures: 'cultural' issues for staff reporting concerns about colleagues in the UK National Health Service.

Recent UK health policy initiatives promote a 'no blame culture' and learning from adverse events to enhance patient safety in the NHS. Similar initiatives exist in the USA and Australia. Changing the 'blame culture' in the NHS has been advocated in policy documents and inquiry reports for over a decade. Some key concepts that are used in the policy discourse -'blame'; mistakes, errors and misdemeanours; and 'culture'- are examined and considered in the light of pertinent social science literature to question some of the assumptions concerning these terms in the policy discourse, and to suggest some alternative questions and perspectives. The Three Inquiries, a recent series of statutory inquiries held in the UK, are used as a case study to explore some of the intra- and inter-professional difficulties of reporting errors and misconduct by medical practitioners. The paper offers an interpretive social science perspective as an alternative to more policy oriented and managerial approaches to patient safety issues, focusing on deeper structural aspects of organisational phenomena implicated in the ability or otherwise of medical and other healthcare staff to report mistakes and misconduct as one aspect of patient safety.

Health Policy↗

PubMed1995

Group interview methods in community health research.

Scholarly development of group interview techniques within the social sciences has lagged behind the rapid popularization of this method. This article offers conceptual clarification regarding different types of group interviews and analyzes case examples to highlight important methodologic issues in the application of group interviews to community health research. Selected problem areas and desirable future directions in the refinement of group interview methods are discussed. An appendix traces the historical development of focus group interviews in social science research.

Case-Control Studies↗

PubMed1995

Biological research on sexual orientation: a critique of the critics.

Evolutionary biologists are tired of being accused of being too biologically deterministic, by critics who have little understanding of what biological or evolutionary theories actually imply. Misunderstandings came about because social-science disciplines often do not share evolutionary biology's tendency to build into their models multiple "normal" paths of development. Sociobiologists first explained homosexuality adaptively because they first try to explain everything adaptively. Most nonbiologists are unaware of this very strong evolutionary tradition. It is now fashionable to discount scientific objectivity, but there are many examples of where such an attack is unwarranted. Kinsey produced a nontypological theory of sexual orientation in spite of his history as a taxonomist. Sociobiologists produced a nonpathological explanation of nonreproductive homosexuality in spite of the centrality of reproductive success in their models. In judging whether a discipline is particularly likely to be misused in social debates, one must perform the appropriate intellectual "controls". One must examine appropriate uses as well as misuses, and one must examine other disciplines to see whether there are differences in the relative likelihood of abuse. Indeed, many social-science theories have been even more clearly abused than biological ones.

Animals↗

PubMed1978

Clinical relevance of anthropological and cross-cultural research: concepts and strategies.

The author presents a method through which findings from anthropological and cross-cultural research can be applied to problems affecting patient care. The clinical social science approach emphasizes the distinction between disease and illness and cultural influences on the ways "clinical reality" is conflictingly construed in the ethnomedical models of patients and the biomedical models of practitioners. The relevance of such research extends beyond special clinical concerns arising from ethnic differences to ubiquitous problems that result from cultural influences on all aspects of health care. Consultation-liaison psychiatry is a particularly appropriate vehicle for introducing clinical social science into medical and psychiatric teaching and practice.

Anthropology, Cultural↗

PubMed2002

Doing qualitative research in general practice: methodological utility and engagement.

General practice uses an eclectic range of research methodology. This includes increasing reliance upon qualitative research methods. There seem to be two distinct treatments of qualitative research within primary care and, in particular, within general practice research. The first is characterized by a purely utilitarian and technical focus, using a qualitative method because it is the most appropriate means of realizing the aims of the research, while the second is characterized by in-depth engagement with the philosophical and paradigmatic aspects of qualitative methodology. In-depth engagement with methodology and theory, and theory building, is an important aspect of masterate and doctoral research within social sciences such as education and anthropology, and in the discipline of nursing, but has not been a feature of qualitative research in medicine. A practical difficulty encountered within postgraduate programmes such as the one in which the author teaches is that when innovative qualitative techniques are used by GPs in their postgraduate research dissertations and theses, it is often beyond GP examiners' own knowledge and experience, yet it fails to measure up to standards established in social sciences, particularly in sociology and anthropology where in-depth reflexive engagement with the theory and philosophy of qualitative methodology is expected. This paper suggests that the value of in-depth engagement with methodology when conducting qualitative research results in creative and innovative ways of conducting research that are consonant with the nature of general practice itself, and strengthens research findings. Therefore, as teachers of research methods and supervisors of research theses, it is important to encourage students conducting qualitative research to engage fully with theoretical and methodological issues.

Family Practice↗

PubMed2002

Girls' spatial abilities: charting the contributions of experiences and attitudes in different academic groups.

BACKGROUND: Gender-related differences in spatial abilities favouring males are well established but have also generated a great deal of controversy. Cross-cultural research, meta-analyses and training studies could show the influence of socio-cultural and experiential factors on spatial-test performance. However, little is known about how experiences and gender-role stereotypes mediate performance differences in this area. AIM: The relationship between specific experiences (spatial activities, computer experience), achievement-related attitudes, and spatial abilities, i.e., mental-rotation ability was investigated with males and females in different academic subgroups. SAMPLE: The sample comprised 112 female and 71 male undergraduates, majoring in arts, humanities and social sciences, sports, psychology and computational visualistics. METHODS: A redrawn version of the Vandenberg and Kuse Mental Rotations Test (MRT) was administered and the participants completed a questionnaire about their spatial activities, computer experience, self-ratings regarding everyday spatial abilities, and attitudes towards mathematics and physics. RESULTS: Mental Rotations Test performance was mainly affected by academic programme and gender, but the effect size of gender differences varied. It was largest with students majoring in arts, humanities and social sciences and smallest with those majoring in computational visualistics. Data analyses revealed statistically significant correlations with spatial activities and computer experience only for females. The relationship between test performance and scales of achievement-related self-concept also depended on gender. CONCLUSIONS: Compared to males, females' spatial abilities are extremely vulnerable to and thus modifiable through attitudinal and experiential factors. This has considerable consequences for intervention programmes that could help to overcome the gender gap in spatial abilities.

Adolescent↗

PubMed1990

Public perceptions of criminal justice policy: does victimization make a difference?

In this paper we examine public perceptions of criminal justice policy and public attitudes toward victims. We are particularly interested in exploring the relationship between the use of social science data and the adoption of public policy affecting victims of crime. To do this we analyze a representative sample of over 450 residents of the Chicago metropolitan area in 1983. The specific issues examined include attitudes toward rape (e.g., whether caused by victim's behavior), prosecution of marital rape, plea bargaining, sentencing of predatory offenders, and the relative importance and efficacy of rehabilitation, incapacitation, and retribution as goals of punishment. Overall, the results suggest that age and education have the most important influence on public attitudes regarding these criminal justice policies. Surprisingly, victimization status does not emerge as a salient predictor of criminal justice perceptions. We conclude with a call for greater use of social science surveys as information input into local and federal decision making on criminal justice policy.

Adolescent↗

PubMed2004

Instrumental variables and inverse probability weighting for causal inference from longitudinal observational studies.

Inferring causal effects from longitudinal repeated measures data has high relevance to a number of areas of research, including economics, social sciences and epidemiology. In observational studies in particular, the treatment receipt mechanism is typically not under the control of the investigator; it can depend on various factors, including the outcome of interest. This results in differential selection into treatment levels, and can lead to selection bias when standard routines such as least squares regression are used to estimate causal effects. Interestingly, both the characterization of and methodology for handling selection bias can differ substantially by disciplinary tradition. In social sciences and economics, instrumental variables (IV) is the standard method for estimating linear and nonlinear models in which the error term may be correlated with an observed covariate. When such correlation is not ruled out, the covariate is called endogenous and least squares estimates of the covariate effect are typically biased. The availability of an instrumental variable can be used to reduce or eliminate the bias. In public health and clinical medicine (e.g., epidemiology and biostatistics), selection bias is typically viewed in terms of confounders, and the prevailing methods are geared toward making proper adjustments via explicit use of observed confounders (e.g., stratification, standardization). A class of methods known as inverse probability weighting (IPW) estimators, which relies on modeling selection in terms of confounders, is gaining in popularity for making such adjustments. Our objective is to review and compare IPW and IV for estimating causal treatment effects from longitudinal data, where the treatment may vary with time. We accomplish this by defining the causal estimands in terms of a linear stochastic model of potential outcomes (counterfactuals). Our comparison includes a review of terminology typically used in discussions of causal inference (e.g., confounding, endogeneity); a review of assumptions required to identify causal effects and their implications for estimation and interpretation; description of estimation via inverse weighting and instrumental variables; and a comparative analysis of data from a longitudinal cohort study of HIV-infected women. In our discussion of assumptions and estimation routines, we try to emphasize sufficient conditions needed to implement relatively standard analyses that can essentially be formulated as regression models. In that sense this review is geared toward the quantitative practitioner. The objective of the data analysis is to estimate the causal (therapeutic) effect of receiving combination antiviral therapy on longitudinal CD4 cell counts, where receipt of therapy varies with time and depends on CD4 count and other covariates. Assumptions are reviewed in context, and resulting inferences are compared. The analysis illustrates the importance of considering the existence of unmeasured confounding and of checking for 'weak instruments.' It also suggests that IV methodology may have a role in longitudinal cohort studies where potential instrumental variables are available.

Antiretroviral Therapy, Highly Active↗

PubMed2004

Assessment of relevant cultural considerations is essential for the success of a vaccine.

This paper explores applications of social science research to international vaccine development and implementation. The paper discusses examples of vaccine-implementation controversies, suggesting that many of these issues could have been avoided with a greater focus on cultural issues regarding perceptions of disease, vaccination, and health services. The paper also discusses the relationship of theory-based behavioural interventions with the development of an overall vaccine strategy and examines experience of growing vaccine research with regard to perceptions of medical decision-making, acceptable practices, and authority and how these perceptions impact vaccine usage. The importance of social science in the ethical conduct of research is also discussed.

Cultural Diversity↗

PubMed1996

Anticipating public reaction to the use of genetic engineering in infant nutrition.

Public acceptance of new food products will be the major determinant of their commercial success. I present selected findings from two national social science research projects aimed at gauging consumer knowledge of and understanding consumer attitudes about biotechnology, as well as about the specific use of genetic engineering in milk production. People are more willing to accept products if they understand them and are assured by credible sources that such products are safe and effective. Perceived health concerns and ethical issues will be important to many people and are an important challenge to acceptance. Women tend to be more skeptical about these new products than are men. I make recommendations for more-effective educational efforts, based on social science research, that could increase acceptance by key consumer groups and, ultimately, the commercial success of bioengineered food products.

Biotechnology↗

PubMed2003

Managing animal trypanosomosis in Africa: issues and options.

This paper discusses past and present approaches to managing tsetse-transmitted animal trypanosomosis in Africa and describes the three main weaknesses of these approaches, i.e., inappropriate objectives, inadequate links between research and policy-making and a lack of recognition that trypanosomosis should be high up on the social science research agenda. Making progress in managing trypanosomosis has been difficult and the authors argue that the weaknesses of the approaches must be corrected if Africa is to benefit from the few advances made so far, and for the continent to make further sustained efforts to combat the disease. The authors explain that this can be achieved by replacing the current widespread preoccupation among researchers and policymakers with controlling (or eradicating) trypanosomosis with a focus on managing (or coping with) the disease. In addition, ways of achieving greater coherence between research and policy-making must be explored. Finally, the social science issues raised by the question of which practical steps need to be taken to manage trypanosomosis in Africa should be placed at the forefront of research efforts.

Africa↗