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[The role of plastic surgery in remodeling the body image].

On the basis of comprehensive information on the realistic possibilities and outcomes of esthetic corrective surgery, such operations can contribute to an effective and lasting improvement in the patient's quality of life and self-esteem. However, the esthetic surgeon's scalpel must never be considered an alternative to necessary psychotherapy. Exaggerated expectations, obsessions, and an absent sense of reality coupled with the projection of psychological and social problems on a certain part of the body must be interpreted as dysmorphophobia with a disordered personality structure. For a reputable plastic surgeon they must be considered a contraindication to esthetic surgery. Against a background of constantly changing social conditions and attitudes, too, surgical body sculpting should no longer be uncritically accepted as a legitimate field for esthetic surgery. Currently, the question as to where the lines are to be drawn for the performance of body-modeling surgical interventions remains unanswered.

Body Image↗

[Fatal poisonings among drug addicts in the county of Funen in 1995 and 1996].

The aim of this investigation was to examine the deaths of drug addicts from poisoning in the county of Funen in 1995 and 1996. The cause of death was related to drugs on the illicit market. Social conditions (homelessness, involvement in crime, psychogenic disease, circumstance of death) are discussed. The study included 47 drug addicts. Median age was 34, age span: 20-43. The main cause of death was poisoning by heroin. In 28% of the drug addicts cocaine was detected and in 13% amphetamine. About half had used benzodiazepines. Few were employees, most were criminals and eight were homeless. Thirty-eight percent were found in public lavatories. Eight had a serious psychiatric diagnosis. We can conclude that the drug addicts are socially marginalized. They abused a mixture of drugs. The drugs detected in the drug addicts compared well with the drugs on the illicit market and cocaine had gained access to the market.

Adult↗

Depressive symptoms and occupational role among female groups: a research in a south-east African village.

BACKGROUND: Although the relationships between social and cultural factors and African psychopathology have largely been considered from a theoretical point of view, empirical studies are still few and far between. This paper reports the results of a mental health survey conducted in the village of Namwera (Malawi, South-East Africa) to explore the link between social conditions, in particular occupational role, and psychopathology. METHODS: A modified version of the Self-Reporting Questionnaire translated into Chichewa language was administered to 161 women (23 dressmakers, 46 nurses, 92 housewives). A Socio-Anamnestic Questionnaire and a Clinical Interview were also applied. RESULTS: Dressmakers and housewives appeared more at risk of psychological suffering than nurses. Psychosomatic symptoms are more frequent among housewives, while dressmakers show more typical depressive symptoms, including suicidal thoughts and self-blame. CONCLUSIONS: Data confirm that also in an African context, some social factors are related to depression among female groups.

Adult↗

[A change of paradigms--an empowerment, a challenge for ambulatory psychiatry].

If one changes the paradigm--what should be changed, what has been changed? Even today, the number of beds at the department head's disposal represents power. Is power the purpose of psychiatry? Rather isn't the purpose the adequate treatment of a mentally impaired persons, about adequate support in a natural environment? In our society, and in particular in psychiatry, the striving for power must be questioned. Our memory of the deportation and the disappearance of mentally ill, of the extermination of "unworthy life", of Hartheim, Grafeneck and Brandenburg is still too fresh. It is imperative to convey the idea of a life worth living even then when this seems hopeless to us. Outpatient psychiatric care has bid farewell to outdated conventional structures, which in their time under certain social conditions had proven not to be unreasonable. Outpatient psychiatric care is about the rediscovery of a sense of life that gives reason for hope. Only the joint contemplation of new resources can bring us forward.

Activities of Daily Living↗

Altered activity, social behavior, and spatial memory in mice lacking the NTAN1p amidase and the asparagine branch of the N-end rule pathway.

The N-end rule relates the in vivo half-life of a protein to the identity of its N-terminal residue. N-terminal asparagine and glutamine are tertiary destabilizing residues, in that they are enzymatically deamidated to yield secondary destabilizing residues aspartate and glutamate, which are conjugated to arginine, a primary destabilizing residue. N-terminal arginine of a substrate protein is bound by the Ubr1-encoded E3alpha, the E3 component of the ubiquitin-proteasome-dependent N-end rule pathway. We describe the construction and analysis of mouse strains lacking the asparagine-specific N-terminal amidase (Nt(N)-amidase), encoded by the Ntan1 gene. In wild-type embryos, Ntan1 was strongly expressed in the branchial arches and in the tail and limb buds. The Ntan1(-/-) mouse strains lacked the Nt(N)-amidase activity but retained glutamine-specific Nt(Q)-amidase, indicating that the two enzymes are encoded by different genes. Among the normally short-lived N-end rule substrates, only those bearing N-terminal asparagine became long-lived in Ntan1(-/-) fibroblasts. The Ntan1(-/-) mice were fertile and outwardly normal but differed from their congenic wild-type counterparts in spontaneous activity, spatial memory, and a socially conditioned exploratory phenotype that has not been previously described with other mouse strains.

Amidohydrolases↗

Sociologic perspectives on juvenile violence.

In sum, there are four sets of social factors that help us understand why juvenile violence appears when, and where, it does, and why some communities and entire societies are persistently wracked by youth violence whereas others are largely spared its worst expressions. When it comes to the first three factors in particular--deprivation, disorganization, and brutalization--the evidence for these links is as strong as anything in social science, and that evidence is supported by a variety of sources and a variety of methods of investigation. Such investigation includes the knowledge we gain through social intervention. Some of the most effective violence prevention programs are successful precisely because they confront and deflect the social forces that otherwise often lead to violence. Consider, for example, the home-visiting programs that work with poor parents in disorganized communities to lower the risks of child abuse; and some of the more "holistic" or "multisystemic" efforts to work with violent juvenile offenders. The best of these programs work by tackling the problems of social isolation and lack of supports in the community, as well as immediate issues of economic survival for vulnerable families and children. More generally, we know that the availability of steady and rewarding work in the future, of the kind that can reliably sustain a family, is one of the most important factors allowing some youths to "desist" from violence as they mature. These conclusions give us much to be encouraged about, and much to be alarmed about. On the one hand, understanding that youth violence often is rooted in a set of adverse social conditions that are identifiable, and potentially modifiable, is a fundamentally optimistic message. It reminds us that the level of juvenile violence we suffer in America today is neither fated nor inevitable. Other societies that are in many respects much like us suffer far less of it; so could we, and we increasingly understand some of the ways in which we could make that happen. We know that some programs designed to increase opportunities and supports for high-risk youth and families do work, and we know that there are broader social and economic policies--policies that are not abstract visions, but have actually been put into place in societies much like our own--that can significantly diminish the pressures toward violence that are bred by poverty and social insecurity among the young. But knowing what to do is one thing, and actually doing it is another. In this there is much reason for concern. The 7-year economic boom that began in the early 1990s has had salutary effects on youth violence, mainly by providing improved economic opportunities for low-income youth and, accordingly, diminishing the appeal of illegal activities. Despite that extraordinary burst of sustained prosperity, however, too many of America's youth remain impoverished, sometimes desperately so: the boom has had only limited effect on our disturbingly high rates of family poverty, which continue to tower above those of comparable industrial societies. And if the boom should come to an end, and we enter again into a period of rising joblessness for youth and young adults, then much, or all, of the recent gains could be quickly lost. The positive economic trends that have helped take the edge off serious juvenile violence in the past few years, in short, are both partial and fragile. Worse, some of our recent social and economic policies, at both state and federal levels, are working in the opposite direction. Some variants of welfare reform, for example, have tossed many vulnerable families off of public assistance without offering solid economic opportunities in its place. Many more families face this future as federal time limits on public welfare increasingly come into play. Given what we know about the links between deprivation and youth violence, this is not a development we can celebrate. (ABSTRACT TRUNCATED)

Adolescent↗

Birth order and mortality: a life-long follow-up of 14,200 boys and girls born in early 20th century Sweden.

The present study examines the sex-specific patterns of mortality by birth order in four stages of the life-course, using Poisson and logistic regression analysis. The main question posed is whether there is any continuing social effect of birth order when (a) biological factors at birth, (b) other social factors at birth and (c) socio-economic circumstances in adulthood are adjusted for. The analyses are based on the Uppsala Birth Cohort Study consisting of all 14,192 boys and girls who were born alive at the Uppsala Academic Hospital in Sweden during the period 1915-9. The results showed that all-cause mortality differed according to birth order in all of the four studied age intervals when birth year, mother's age, birth weight, gestational age, diseases of mother, diseases of the infant, social class and mother's marital status at the time of childbirth were adjusted for. The general tendency was for laterborn siblings, particularly girls women, to demonstrate a higher mortality risk than firstborn children. However, in the oldest age group (55-80 years) the previously significant association between birth order and male mortality became insignificant when adult socio-economic circumstances were controlled for. This indicates that the long-term influence of childhood birth order position on mortality is partly mediated by adult social class, education and income. The concluding section of the paper notes that laterborn children, and especially girls, were a disadvantaged group in early 20th century Sweden. Thus, for the subjects in the present study, the childhood social conditions linked to birth order position seem to have had consequences for these individuals' health and survival that extend over the whole life-course.

Adolescent↗

[Assessment of social disability of patients suffering from chronic mental illness with the role play test].

UNLABELLED: Among the chronic mentally ill patients, disabilities invade most parts of their social functioning, and influences their long term course profoundly. It is important clinical issue to improve disability. Social skills training is assumed to be effective method to improve disability, and it has been disseminated over Japan recently. The assessment system to evaluate disabilities objectively at the viewpoint of social skills must be required to verify effects of social skills training, and to develop further effective therapeutic method. A role play test is the assessment tool for social skills through role plays under specific social conditions. It was reported to be useful as the method of functional assessment before treatment, and as the tool to evaluate effects of treatment to improve disability. PURPOSE: We created the Role Play Test (RPT) which was adapted to Japanese cultural background, and we tried to verify feasibility, reliability, and validity of the RPT. SUBJECTS: Thirty out-patients attending in the Day Hospital attached to Tokyo University Hospital. Twenty-six were schizophrenia, and 4 were other diagnoses. METHOD: Subjects were assessed with the RPT, BPRS, SANS, four rating scales for social functioning, and self-efficacy rating scale. The RPT was designed to assess components of social skills--social perception, role play behavior, and self-efficacy. Role play behaviors were recorded with video tapes for analysis of interrater reliability. The RPT is consisted of 12 scenes to evaluate social skills which are required in daily life. Statistical analyses were done with SAS (Statistical Analysis System). RESULTS: (1) The RPT was presumed to be feasible clinically, because the RPT could be practiced easily and responsibilities of both subjects and testers were not so much. (2) Interrater reliabilities assessed with ANOVA-ICC on 12 items was sufficiently high except one item. (3) Construct validity was certified through factor analysis, and criterion-related validity was certified through correlation analysis with other rating scales of social functioning. (4) Individual profile of the RPT should be useful instrument for functional analysis before social skills training. We also discussed on some hypotheses on the causal relationship between positive and negative symptoms and social skills. The RPT could be used as a tool to research causes of disabilities, and to evaluate improvement of social functioning after psycho-social intervention including social skills training, because the RPT can assess social skills quantitatively according to the cognitive-behavioral model.

Adolescent↗

Heritability analyses of IQ scores: science or numerology?

Estimates of IQ heritability are subject to a variety of systematic errors. The IQ scores themselves contain uncontrollable, systematic errors of unknown magnitude. These arise because IQ scores, unlike conventional physical and biological measurements, have a purely instrumental definition. The effects of these errors are apparent in the very large discrepancies among IQ correlations measured by different investigators. Genotype-environment correlations, whose effects can sometimes be minimized, if not wholly eliminated, in experiments with plants and animals, are nearly always important in human populations. The absence of significant effects arising from genotype-environment correlations is a necessary condition for the applicability of conventional heritability analysis to phenotypically plastic traits. When this condition fails, no quantitative inferences about heritability can be drawn from measured phenotypic variances and covariances, except under special conditions that are unlikely to be satisfied by phenotypically plastic traits in human populations. Inadequate understanding of the precise environmental factors relevant to the development of specific behavioral traits is an important source of systematic errors, as is the inability to allow adequately for the effects of assortative mating and gene-gene interaction. Systematic cultural differences and differences in psychological environment among races and among sociocco-nomic groups vitiate any attempt to draw from IQ data meaningful inferences about genetic differences. Estimates based on phenotypic correlations between separated monozygotic twins-usually considered to be the most reliable kind of estimates-are vitiated by systematic errors inherent in IQ tests, by the presence of genotype-environment correlation, and by the lack of detailed understanding of environmental factors relevant to the development of behavioral traits. Other kinds of estimates are beset, in addition, by systematic errors arising from incomplete allowance for the effects of assortative mating and from gene-gene interactions. The only potentially useful data are phenotypic correlations between unrelated foster children reared together, which could, in principle, yield lower limits for e(2). Available data indicate that, for unrelated foster children reared together, the broad heritability (h(2)) may lie between 0.0 and 0.5. This estimate does not apply to populations composed of children reared by their biological parents or by near relatives. For such populations the heritability of IQ remains undefined. The only data that might yield meaningful estimates ot narrow heritability are phenotypic correlations between half-sibs reared in statistically independent environments. No useful data of this kind are available. Intervention studies like Heber's Milwaukee Project afford an alternative and comparatively direct way of studying the plasticity of cognitive and other behavioral traits in human populations. Results obtained so far strongly suggest that the development of cognitive skills is highly sensitive to variations in environmental factors. These conclusions have three obvious implications for the broader issues mentioned at the beginning of this article. 1) Published analyses of IQ data provide no support whatever for Jensen's thesis that inequalities in cognitive performance are due largely to genetic differences. As Lewontin (8) has clearly shown, the value of the broad heritability of IQ is in any case only marginally relevant to this question. I have argued that conventional estimates of the broad heritability of IQ are invalid and that the only data on which potentially valid estimates might be based are consistent with a broad heritability of less than 0.5. On the other hand, intervention studies, if their findings prove to be replicable, would directly establish that, under suitable conditions, the offspring of parents whose cognitive skills are so poorly developed as to exclude them from all but the most menial occupations can achieve what are regarded as distinctly high levels of cognitive performance. Thus, despite the fact that children differ suibstantially in cognitive aptitudes and appetites, and despite the very high probability that these differences have a substantial genetic component, available scientific evidence strongly suggests that environmental factors are responsible for the failure of children not suffering from specific neurological disorders to achieve adequate levels of cognitive performance. 2) Under prevailing social conditions, no valid inferences can be drawn from IQ data concerning systematic genetic differences among races or socioeconomic groups. Research along present lines directed toward this end-whatever its ethical status-is scientifically worthless. 3) Since there are no suitable data for estimating the narrow heritability of IQ, it seems pointless to speculate about the prospects for a hereditary meritocracy based on IQ.

Black People↗

Impact of maternal education and health services on child mortality in Uttar Pradesh, India.

"This article, which examines the effect of maternal education on child mortality [in India], shows that education has direct as well as indirect effects through antenatal care and family formation patterns on neonatal mortality. Maternal education also has a substantial effect on later childhood mortality. While improving maternal education is a means of reducing childhood mortality, an immediate reduction in childhood mortality is feasible even under existing social conditions by enhancing accessibility to maternal and child health services and safe drinking water."

Asia↗

[Health conditions of immigrant women in Italy].

The number of immigrant women in Italy has increased from 260,000 in 1991 to at least 750,000 in 2003. This article describes the health situation of these women, in particular it deals with reproductive health. Immigrant women are generally young, in good health and they go to the health services mainly for pregnancy, delivery, spontaneous and induced abortion. Forty-eight per cent of acute hospital admissions and 56 per cent of day hospital admissions in 2002 were related to reproduction. Among foreign citizens, the induced abortion rate is three times higher than that reported among Italians, while the risk of spontaneous abortion is similar (97 per thousand and 101 per thousand, respectively). In general, the data show that immigrant women in Italy live in deprived social conditions, which can influence their reproductive choices and their access to health services. In order to take account of their particular needs, it is necessary to modify the health services and plan public health interventions especially for the prevention of induced abortion.

Abortion, Induced↗

Greater efficacy of preweaning than postweaning environmental enrichment on maze learning in adult rats.

In order to assess the behavioural effects of environmental stimulation at different stages of development, two groups of rats were exposed to multisensory enrichment on days 10-24 (preweaning) or 25-39 (postweaning). Both groups had four 25-min sessions per day in a large cage with a variety of stimuli, in addition to 3 min of handling before each session. The mother of the preweaning group remained in the home cage during the stimulation sessions. A third group was maintained in a social condition. Testing in a Hebb-Williams maze started when the rats of the 3 groups were 100 days old. Error, latency and running time scores were lowest in the preweaning group.

Aging↗

Sex research and social change.

The history of scientific sex research which emerged at the turn of the century with the exemplary work of Sigmund Freud and Havelock Ellis has been complexly interactive with changing general social conditions, specific trends in sexual conduct, the content of sexual ideologies, and the developing techniques of scientific inquiry. The earliest sex researchers, although serving to bring sexuality out of the Victorian cold and into the center of human development based their views of sexuality on control-repression and drive models. The Freudian tradition was especially influential in general intellectual matters and was probably the most important in the development of twentieth-century sexual ideologies. Beginning in the 1920s and culminating in the work of Kinsey in the 1940s and 1950s, a tradiition of social bookkeeping began focusing on the sexual behavior of relatively normal persons. Methodologically such studies moved away from the case history and from populations who were defined as criminal or neurotic. At the same time, general social changes were occurring that were directly affecting the rates and directions of sexual conduct in the society. The work of Alfred Kinsey charted these changes and in turn influenced public attitudes, public policy, and research interests during the 1950s and 1960s. The work of other researchers began to fill in the picture of sexual conduct in the society from a survey point of view, and some workers began studies in sexual deviance that focused anew on homosexuality and prostitution. The work of William Masters and Virginia Johnson served to open the door to studies of sexual anatomy and physiology by applying well-known techniques to the laboratory study of the sexual. While the biological tradition is still strong in the discussion of the sexual, new emphases are being placed on a cognitive-social learning persepctive that emphasizes the nonbiological factors in sexual development. Major changes have occurred in the sexual backdrop of the society in the 1960s, and while changes in sexual conduct have been less than revolutionary, they have occurred in a number of areas (contraception, abortion) that have directly influenced societal practices. Sex research and the sex researcher have played an important role in providing benchmarks for sexual practices, illuminating general understanding, and providing the content for ideiolicaal debates about the right and wrong of sexuality in the society. In few areas of research have researchers had such an important role in the debate over the measning and significance of the behavior they have studied.

Attitude↗

Toward understanding in postmodern interview analysis: interpreting the contradictory remarks of a research participant.

How is the qualitative research analyst to understand apparently contradictory remarks made by a research participant? Although social scientists in the positivist tradition rely on methods such as triangulation to find "truth," interpretive social scientists listen beyond, between, and underneath participants' words to understand the social conditions that produce apparent contradictions in their accounts. In this article, the author presents a case study of making sense of a research participant's contradictory comments, using a theoretical framework to understand the participant's "logic of practice." Through interpretive listening and reflexivity during the data analysis, she came to understand the participant's contradictory remarks in a way that illuminated the contradictions, as well as a significant process in the participant's life at the time: the transformation from carefree daughter to responsible mother. Such an interpretive analysis does not produce "truth" as positivist social scientists require but offers instead the satisfaction of understanding.

Adolescent↗

Values and fertility change in Japan.

This paper analyses how value change and economic and social change have jointly affected fertility in Japan since 1950, and especially since 1973 when fertility resumed declining after some 15 years at near-replacement level. The resumption of fertility decline since 1973 has been driven primarily by underlying economic and social changes. Value change has tended to lag behind fertility change, and this lag has tended to be larger in Japan than in other advanced nations, primarily because underlying economic and social conditions have evolved more rapidly in Japan, and because it takes time for values to adjust to changes in underlying conditions. Because of Japan's high degree of cultural homogeneity, values tend to be widely and quickly shared, so that under certain conditions value change tends to occur in spurts. In Japan, many of the more important value changes affecting fertility in recent decades are bound up with major educational and job gains by women, which have led to greater economic independence and more emphasis on values of individualism and equality between the sexes.

Fertility↗

Social support lowers cardiovascular reactivity to an acute stressor.

This study examined whether social support can reduce cardiovascular reactivity to an acute stressor. College students gave a speech in one of three social conditions: alone, in the presence of a supportive confederate, or in the presence of a nonsupportive confederate. Systolic and diastolic blood pressure were measured at rest, before the speech, and during the speech. While anticipating and delivering their speech, supported and alone subjects exhibited significantly smaller increases in systolic and diastolic blood pressures than did nonsupported subjects. Supported subjects also exhibited significantly smaller increases in systolic blood pressure than did alone subjects before and during the speech. Men had higher stress-related increases in blood pressures than did women; but gender did not moderate the effects of social support on cardiovascular reactivity. These results provide experimental evidence of potential health benefits of social support during acute stressors.

Adaptation, Psychological↗

Establishing the moral basis of medicine: Edmund D. Pellegrino's philosophy of medicine.

Edmund D. Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is presented in the following areas: methodology, relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes.

Beneficence↗

Evaluation of the prognostic value of the health assessment form among patients clinically ready for discharge.

The aim of the study was to identify patterns of physical, psychological, and social conditions that may be of prognostic value when it comes to assessing continued care of patients clinically ready for discharge; a related aim was to evaluate instruments used for this identification, especially a Swedish version of the health assessment form. The sample consisted of 53 consecutive patients (mean age 82.8 years, SD = 6.6 years) All patients came from their own homes and were admitted to surgical and orthopaedic departments. Interviews were carried out on the day the patients were assessed as medically ready for discharge, and a second time 1 month later. The health assessment form measured the persons' social and environmental situation, health history, and functional health status, and another instrument measured the persons' sense of coherence. Few significant differences in functional health status were noted between persons who could return to their homes (n = 25) and persons who were referred to institutions after discharge (n = 17). However, the persons being referred to institutions showed less favourable scores within the areas of mood, sense of coherence, and worries about their home accommodation situation. When another sub-group was included (patients who died between the interview occasions; n = 8), significant differences were also noted in the health functions breathing, digestion, elimination, and body movement. Sense of coherence had a significant prognostic value for the continued care after discharge irrespective of whether the deceased patients were included or not.

Activities of Daily Living↗