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PubMed1990

Toward applied behavior analysis of life aloft.

This article deals with systems at multiple levels, at least from cell to organization. It also deals with learning, decision making, and other behavior at multiple levels. Technological development of a human behavioral ecosystem appropriate to space environments requires an analytic and synthetic orientation, explicitly experimental in nature, dictated by scientific and pragmatic considerations, and closely approximating procedures of established effectiveness in other areas of natural science. The conceptual basis of such an approach has its roots in environmentalism which has two main features: (1) knowledge comes from experience rather than from innate ideas, divine revelation, or other obscure sources; and (2) action is governed by consequences rather than by instinct, reason, will, beliefs, attitudes or even the currently fashionable cognitions. Without an experimentally derived data base founded upon such a functional analysis of human behavior, the overgenerality of "ecological systems" approaches render them incapable of ensuring the successful establishment of enduring space habitats. Without an experimentally derived function account of individual behavioral variability, a natural science of behavior cannot exist. And without a natural science of behavior, the social sciences will necessarily remain in their current status as disciplines of less than optimal precision or utility. Such a functional analysis of human performance should provide an operational account of behavior change in a manner similar to the way in which Darwin's approach to natural selection accounted for the evolution of phylogenetic lines (i.e., in descriptive, nonteleological terms). Similarly, as Darwin's account has subsequently been shown to be consonant with information obtained at the cellular level, so too should behavior principles ultimately prove to be in accord with an account of ontogenetic adaptation at a biochemical level. It would thus seem obvious that the most productive conceptual and methodological approaches to long-term research investments focused upon human behavior in space environments will require multidisciplinary inputs from such wide-ranging fields as molecular biology, environmental physiology, behavioral biology, architecture, sociology, and political science, among others.

Behavior↗
PubMedDate not supplied

Structural equation modeling and rehabilitation research.

Structural equation modeling (SEM) has been used extensively in the social sciences in the recent past to model human behavior. SEM has been less used by other disciplines, including rehabilitation medicine. This article begins by providing an introduction to structural equation modeling through the discussion of the definition and basic concepts behind SEM using a conceptual model relevant to rehabilitation medicine that describes the pathway from health to disability (the Enabling-Disabling model). The next focus is on several potential pitfalls of which the researcher needs to be aware when using SEM. After this discussion, a hypothetical example is presented using structural equation modeling to evaluate the Enabling-Disabling model. The article concludes with a review of the advantages and disadvantages of using SEM for clinical and social science research. Throughout the article, references are provided for a more detailed examination of SEM.

Humans↗
PubMed1999

[Benefits, costs and analysis in diagnostic radiology: definitions and glossary].

Cost efficiency analyses in clinical radiology require the application of methods and techniques that are not yet part of the academic qualifications of the specialists. The procedures used are borrowed from economics, decision theory, applied social sciences, epidemiology and statistics. Many expressions hail from the angloamerican literature and are presently not yet germanized unequivocally. This survey is intended to present main terms of cost efficiency analysis in the english version as well as a german translation, to give a clear definition and, if necessary, explanatory notes, and to illustrate their application by means of concrete radiologic examples. The selection of the terms is based on the hierarchical models of health technology assessment resp. clinical outcome research by Fryback & Thornbury resp. Maisey & Hutton. In concrete terms, both the differences between benefit, outcomes, and utility and the differences between effectiveness, efficacy and efficiency and the differences between direct, indirect, intangible, and marginal costs are explained. True cost efficiency analysis is compared with cost effectiveness analysis, cost identification analysis, cost minimization analysis, and cost utility analysis. Applied social sciences are represented by the Medical Outcomes Study Short Form-36 and the QALY conception. From decision theory both the analysis of hypothetical alternatives and the Markov model are taken. Finally, sensitivity analysis and the procedures of combined statistical evaluation of comparable results (meta-analysis) are quoted.

Cost-Benefit Analysis↗
PubMed1997

Culture, needs and nursing: a critical theory approach.

This paper will bring the critique of culture, notably that undertaken by the Frankfurt School of Critical Social Science, to bear on the problem of needs, and expose its significance for the practice and discipline of nursing. The paper begins by reviewing ways in which the idea of 'needs' has been depicted in nursing literature, and it is suggested that this depiction is inadequate in fundamental ways. The critique of existing culture is then outlined and the implications for nursing are suggested in terms of the dissolution of hegemonic practices and the development of a concept of need built around the notion of 'praxis'.

Culture↗
PubMed1985

U.S. Marxist scholarship in the analysis of health and medicine.

This article makes a review of 1.) dominant analyses of health and medicine in the social sciences of the U.S. and 2.) Marxist critiques of these analyses. It presents the roots of Marxist scholarship in the study of health and medicine and discusses the main Marxist critiques of the hegemonic pluralist and power elite interpretations of the institutions of medicine and of their corporatization. It also reviews Marxist studies of 1.) the crisis of medicine; 2.) the relationship between production, work, and health; and 3.) imperialism, health, and medicine. It concludes with a discussion of the operational meaning of Marxism in health and medicine, with presentation of current Marxist debates on socialist medicine and their consequences for political praxis.

Communism↗
PubMed2000

Humphry Davy: science and social mobility.

Humphry Davy (1778-1829) was one of the first professional scientists, earning his living and rising spectacularly from an impoverished upbringing in Cornwall to be President of the Royal Society and a baronet. He owed his rise to patronage as well as to his range of abilities: as a lecturer, as a chemical theorist and as a very early applied scientist. But his exalted position brought him little happiness, for he could not satisfy all the hopes put upon him as the successor to Sir Joseph Banks. Admired rather than loved, he became unpopular and was seen as haughty. In his last two years, spent wandering lonely and sickly in Italy and the Alps, he sought to make sense of his life, writing dialogues as his bequest to the new generation.

England↗
PubMed2006

Alcoholism and suicidal behavior: a clinical overview.

OBJECTIVE: The purpose of this paper was to provide a clinical review of the literature on the relation of alcoholism to suicidal behavior. METHOD: Studies of alcoholism and suicidal behavior available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts & Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed. RESULTS: Alcoholism is associated with a considerable risk of suicidal behavior. Individuals with alcoholism who attempt or complete suicide are characterized by major depressive episodes, stressful life events, particularly interpersonal difficulties, poor social support, living alone, high aggression/impulsivity, negative affect, hopelessness, severe alcoholism, comorbid substance, especially cocaine abuse, serious medical illness, suicidal communication, and prior suicidal behavior. Partner-relationship disruptions are strongly associated with suicidal behavior in individuals with alcoholism. CONCLUSION: All individuals with alcoholism should receive a suicide risk assessment based on known risk factors.

Acamprosate↗
PubMed1982

Optimizing the dental delivery system.

This paper examines the application of information and principles derived from social science research to increasing the effectiveness and efficiency of the dental care delivery system. Four major delivery system attributes are considered: the availability, accessibility, appropriateness and acceptability of care. The dentist to population ratio is a major determinant of the availability of dental care and many factors have to be considered in deciding on the appropriate number of dentists needed in a population. Optimum size of dental practices is another aspect of availability. The evidence suggests that practices with 2 or 3 dentists are more efficient than solo practices. However, large group practices appear only to be of equal or even less efficiency than small group practices. The accessibility of dental care is influenced by the geographical location of practices, the convenience of obtaining care during non-working hours, the reduction and dissemination of information on dental fees and, most importantly, the beliefs of people concerning their oral health status. The appropriateness of care concerns the impact of different services on improving oral health. Relatively little clinical research has been published on the costs and benefits of different dental services. The acceptability of dental care concerns both patients who visit the dentist and the larger society. Studies show that patients who visit the dentist are generally satisfied with the care they receive. Societal attitudes about the dental care system have not received much attention. Although social science research on the dental care delivery system is at an early stage of development, some data exist which are relevant to optimizing the practice of dentistry.

Consumer Behavior↗
PubMed2000

Evidence-based health policy-making, hospital funding and health insurance.

An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.

Academies and Institutes↗
PubMed2003

Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results.

Increasing attention is being given to identifying standardised methods of analysis for the economic evaluation of health care programmes and generating generalisable findings from these methods. In this paper, we show how these approaches fail to reflect the social science foundations of the economics discipline and the economic theory of individual behaviour. Using simple examples, we show that the technical efficiency of a particular programme differs between communities, even though the underlying technology is the same for the communities. Similarly, the subjective considerations represented by the utility function are not generally transferable between settings or between individuals within settings. As a result, the efficiency of an intervention will be influenced by the context in which the intervention is experienced, even in the presence of identical production and utility functions. The lack of generalisability includes the validity of the methods used to analyse the subjective component of the evaluation exercise. The adoption of standardised methods of measurement and analysis, together with the use of findings from the application of these methods in other settings, might ease the administrative burden presented in resource allocation exercises. However, these approaches do not accommodate the intellectual substance of the wide range of problems and circumstances that underlie these exercises.

Attitude to Health↗
PubMed2000

Reminiscence therapy for dementia.

BACKGROUND: Reminiscence Therapy (RT) has been defined as vocal or silent recall of events in a person's life, either alone, or with another person or group of people. It typically involves group meetings, at least once a week. in which participants are encouraged to talk about past events, often assisted by aids such as photos, music, objects and videos of the past. There is, often, little consistent application of psychological therapies in dementia services. A number of these 'therapies' were greeted with enthusiasm by health care practitioners in understimulating care environments. They were expected to work miracles and their 'failure' to do this has led to their widespread disuse. A systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base. OBJECTIVES: RT involves groups of elderly people talking of past events, assisted by aids such as videos, pictures and archives, as a means of communicating and reflecting upon their life experiences. The objective of the review is to assess the effects of RT for dementia. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, PSYCHLIT, EMBASE, OMNI, BIDS, Dissertation Abstracts International, SIGLE and reference lists of relevant articles up to 1998, and we contacted specialists in the field. We also searched relevant internet sites and we handsearched Aging and Mental Health, the Gerontologist, Journal of Gerontology, Current Opinion in Psychiatry, Current Research in Britain: Social Sciences, British Psychological Society conference proceedings and Reminiscence database. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised trials of RT for dementia in elderly people. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Two trials are included in the review, but only one trial with 15 participants had extractable data. The results were statistically non-significant for both cognition and behaviour. REVIEWER'S CONCLUSIONS: No firm conclusions could be reached regarding the effectiveness of RT for dementia. The review highlighted the urgent need for more systematic research in the area.

Dementia↗
PubMed2000

Hospital-at-home versus in-patient hospital care.

BACKGROUND: Hospital-at-home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. Hospital-at-home has become a popular response to the increasing demand for acute hospital beds. OBJECTIVES: To assess the effects of hospital-at-home compared with in-patient hospital care for patients. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register, MEDLINE to 1996, EMBASE to 1995, Cinahl to 1996, the Social Science Citation Index (1992 to 1995), EconLit (1969 to 1996), PsycLit (1987 to 1996), Sigle (1980 to 1995), the Medical Care supplement on economic literature (1979 to 1990), and reference lists of articles. SELECTION CRITERIA: Randomised trials of hospital-at-home care compared with acute hospital in-patient care. The participants were patients aged 18 years and over. The outcomes were mortality, clinical complications, re-admissions, cost (to the patient and family, to general practice, to the hospital and to the community), hospital days saved from the provision of hospital-at-home, discharge destination from hospital-at-home, general and disease specific health status, functional status, psychological well-being, patient satisfaction, carer satisfaction, carer burden, and staff views (including the satisfaction of doctors working in primary care). DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Five studies were included involving 866 patients. All studies were small and lacked power. No statistically significant differences were detected for patient health outcomes. Patients discharged early from hospital to hospital-at-home following elective surgery expressed greater satisfaction with care than those who remained in hospital. Carers however expressed less satisfaction with hospital-at-home compared with hospital care. Only one trial formally tested for a difference in cost, with no statistically significant difference detected for overall health care costs. REVIEWER'S CONCLUSIONS: There is insufficient evidence to assess the effects of hospital-at-home on patient outcomes or the cost to the health service. Given the heterogeneity of what hospital-at-home encompasses and the uncertainty over its effects, future research should clearly specify the type of service being provided, both at home and at hospital, and the specific patient groups. Patient health outcomes, patient and carer satisfaction, and costs should be measured, and studies should include a formal, planned economic analysis. Studies should be large enough to detect important differences and to ensure generalisability of the results.

Home Care Services↗
PubMed1982

Epidemiology and the scientific method.

This article refutes the claim that the field of epidemiology and community health would benefit from the application of the scientific method. It is argued that the methods of physics are not appropriate for other disciplines. When applied to the social sciences, positivism is a conservatizing force, causing theory to become based on a mere description of social phenomenon. Since it cannot lead to a deep understanding of social phenomena, positivism is incapable of revealing ways in which society could be radically changed. Moreover, such theory is far from neutral. Rather, it is formed and influenced by the forms of life experienced and practiced in the society. This is illustrated by an analysis of the origin of modern physics at the time when society was changing from a feudal to capitalist form of organization. It is concluded that advances will be made in epidemiology and community health when this field breaks from its focus on the individual and incorporates class into its analysis. However, given the interconnection between social structure and social theory, resistance to such a radical change can be expected.

Epidemiologic Methods↗
PubMed2001

[Methodological issues of health research].

This work aims at presenting a reflection on the method of research in the health field. Some questions are presented which involve the use of the method of natural sciences and that of social sciences in an attempt at understanding some methodological problems concerning the former and the latter. Problems related to the methodological issues in the elaboration of investigation projects in this field and the need for continuous discussion are pointed out as to: the differentiation of the nature of the object of investigation; the context in which a determined problem is identified; the type of question which is asked when it is problematized; technical procedures, the theory and the interpretative scheme on which it is founded; the dichotomy concerning the subject/object of knowledge; the researcher's neutrality; the concept of casualty.

Research Design↗
PubMed2005

Improving food safety in the domestic environment: the need for a transdisciplinary approach.

Microbial food safety has been the focus of research across various disciplines within the risk analysis community. Natural scientists involved in food microbiology and related disciplines work on the identification of health hazards, and the detection of pathogenic microorganisms. To perform risk assessment, research activities are increasingly focused on the quantification of microbial contamination of food products at various stages in the food chain, and modeling the impact of this contamination on human health. Social scientists conduct research into how consumers perceive food risks, and how best to develop effective risk communication with consumers in order to improve public health through improved food handling practices. The two approaches converge at the end of the food chain, where the activities regarding food preparation and food consumption are considered. Both natural and social sciences may benefit from input and expertise from the perspective of the alternative discipline, although, to date, the integration of social and natural sciences has been somewhat limited. This article therefore explores the potential of a transdisciplinary approach to food risk analysis in terms of delivering additional improvements to public health. Developing knowledge arising from research in both the natural and social sciences, we present a novel framework involving the integration of the two approaches that might provide the most effective way to improve the consumer health associated with food-borne illness.

Communication↗
PubMed2005

Inpatient versus other settings for detoxification for opioid dependence.

BACKGROUND: There are a complex range of variables that can influence the course and subjective severity of opioid withdrawal. There is a growing evidence for the effectiveness of a range of medically-supported detoxification strategies, but little attention has been paid to the influence of the setting in which the process takes place. OBJECTIVES: To evaluate the effectiveness of any inpatient opioid detoxification programme when compared with all other time-limited detoxification programmes on the level of completion of detoxification, the intensity and duration of withdrawal symptoms, the nature and incidence of adverse effects, the level of engagement in further treatment post-detoxification, and the rates of relapse post-detoxification. SEARCH STRATEGY: Electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 3, 2004); MEDLINE (January 1966-March 2004); EMBASE (January 1988-March 2004); PsycInfo (January 1967-March 2004); CINAHL (January 1982-March 2004). In addition the Current Contents, Biological Abstracts, Science Citation Index and Social Sciences Index were searched. SELECTION CRITERIA: Randomised controlled clinical trials comparing inpatient opioid detoxification (any drug or psychosocial therapy) with other time-limited detoxification programmes (including residential units that are not staffed 24 hours per day, day-care facilities where the patient is not resident for 24 hours per day, and outpatient or ambulatory programmes, and using any drug or psychosocial therapy). DATA COLLECTION AND ANALYSIS: All abstracts were independently inspected by two reviewers (ED & JI) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria. MAIN RESULTS: Only one study met the inclusion criteria. This did not explicitly report the number of participants in each group that successfully completed the detoxification process, but the published data allowed us to deduce that 7 out of 10 (70%) in the inpatient detoxification group were opioid-free on discharge, compared with 11 out of 30 (37%) in the outpatient group. There was very limited data about the other outcomes of interest. AUTHORS' CONCLUSIONS: This review demonstrates that there is no good available research to guide the clinician about the outcomes or cost-effectiveness of inpatient or outpatient approaches to opioid detoxification.

Hospitalization↗
PubMed1995

The contributions of nursing science to social support.

Nurse scientists have contributed to the theoretical development of social support through concept refinement, creation of measures, and intervention research. Nevertheless, deficiencies persist pertaining to the conceptualization of the construct and the design of intervention studies. Cultural, technological and political contexts have an effect on social support. The significance of social support, nurses' scholarly contributions, and continuing conceptual and methodological challenges are analysed.

Health Policy↗