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PubMedDate not supplied

Political issues in emergency medicine: the United Kingdom.

A recent issue of this Journal published two papers on political issues facing the specialty of emergency medicine in the USA and in Canada. This paper continues the theme from a UK perspective. In recent years there has been significant change in the National Health Service, which has had (or will have) both direct and indirect consequences for the specialty of emergency medicine and the delivery of emergency care in the UK. This article describes some of the recent National Health Service initiatives and their implications for emergency medicine.

Advisory Committees↗
PubMedDate not supplied

The inside story: a simulation game on ethical, legal, and political decision making in health policy for nurse practitioners.

This game can be conducted with as many as 50 and as few as 15 players. The optimum size includes 4-5 Board members and 4-6 participants in each of the four small-group scenarios. The game takes about 11/2-2 hours to play. This includes a break between Part I and Part II. Existing state and national laws and policies are used in the game so that participants may understand their effects and limitations. The game has no winners or losers. Everyone gains if the decision markers are able to consider the needs of the individuals and the needs of the public, though some individuals may or may not benefit as much as others. This, however, is reality and is inherent in the policy-making process. In primary care, nurse practitioners (NPs) have a crucial responsibility to weigh the impact of their decisions on their clients and the community. The "Inside Story" integrates recommended NP curriculum content such as ethical decision making and health policy into a creative and powerful educational experience. This simulation game could be adapted for other topics with ethical, legal, and political implications such as issues regarding allocation of scarce resources. It could be played among students or professionals from many disciplines as part of their curriculum or in a continuing education offering.

Decision Making↗
PubMed2006

The politics of sexual orientation issues in American schools.

Schools are increasingly expected to address the needs of gay, lesbian, bisexual, and transgender students. However, the controversial nature of sexual orientation programs and policies makes this a politically sensitive undertaking. This empirical study analyzes the extent to which public school districts across the United States have implemented policy recommendations and describes, according to 4 theoretical policy models, factors that influence their ability to do so. The survey found that most districts have not institutionalized recommended policies or programs. Recommendations for school health professionals based on factors found to be significantly associated with the implementation of programs are discussed.

Adolescent↗
PubMed1996

Water fluoridation results in Basel since 1962: health and political implications.

The population of the canton Basel-City has been provided with fluoridated water since May 1962. This paper presents a summary of basic findings from evaluations of this public health intervention. Standard methods were used for assessing dental caries, enamel fluorosis, urinary fluoride, and other data. Caries prevalence of schoolchildren declined until 1977 because of water fluoridation, after which it continued to decline until the late 1980s due to reasons other than water fluoridation. Caries prevalence in Basel was at least as low as in those other parts of Switzerland where either school-based dental health education programs or comprehensive salt fluoridation programs had been implemented for many years. Enamel fluorosis was seen in 38 percent of the children, similar to regions with comprehensive salt fluoridation, but higher than in low-fluoride regions. Overlap of salt and water fluoridation in families consuming both fluoridated water and fluoridated salt has occurred, but has not resulted in problems. Fluoride concentrations (close to, but mostly below 1.0 ppm) and excretions (0.45-0.80 mg F per day in children, around 1 mg in adults) corresponded to expected levels. Statistics from both the School Dental Service and the Public Dental Clinic indicate a dramatic reduction in the amount of conservation dentistry being done and, in adults, prosthetic services. Political steps to remove water fluoridation were taken in 1976, 1982, 1989, and 1993, but have not been successful. Water fluoridation has resulted in the expected benefit and continues to exist beside salt fluoridation used in the other cantons of Switzerland.

Adolescent↗
PubMed1989

The politics of evaluating Aboriginal Health Services.

Evaluation of Aboriginal Health Services (AHSs) has become a topic of importance to service providers and governments in recent years. This paper examines some of the difficulties AHSs have in conducting evaluation and presents an example of an inappropriate evaluation methodology as proposed by the Commonwealth Department of Aboriginal Affairs (DAA) in 1986. The paper examines the contradictory nature of the DAA proposal and the mistrust it has engendered in many AHSs. It then highlights some of the political difficulties in developing meaningful national and community health objectives as a basis for sound evaluation of health services. The paper concludes by identifying some of the processes whereby more appropriate evaluation methodologies might be developed and suggests that negotiation and consultation with the Aboriginal communities and their health services are imperative to successful evaluation.

Australia↗
PubMed1995

Family planning: personal and political perspectives from Choiseul Province, Solomon Islands.

Rapid population growth has put family planning on personal and political agendas in the Solomon Islands. With the release of a population policy in 1988, national leaders sanctioned the concept of family planning as a key strategy in reducing the rate of population growth. On a personal level, Solomon Islanders share their government's concern about population problems. There is a shortage of arable land, health services are stretched, and there are limited places in school for children. A study in Choiseul Province, a rural area in Solomon Islands, suggests that people want smaller families but have limited means to control their fertility. Meagre resources and infrastructure, compounded by geography, climate, culture and religion, constrain the development of family planning services.

Adolescent↗
PubMed2004

The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities.

OBJECTIVE: To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities. DESIGN: Cross sectional ecological study. OUTCOME MEASURES: All cause death rates and death rates attributable to preventable or immediate causes for people under age 75. PREDICTOR MEASURES: Income inequality, city spending, and social factors. SETTING: All central cities in the US with population equal to or greater than 100 000. RESULTS: Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads. CONCLUSIONS: Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.

Adolescent↗
PubMed1978

Political neutrality and international cooperation in medicine.

International cooperation is an integral part of furthering medical and scientific progress. Many specilist societies exist for that purpose and have written into their constitutions that such cooperation and coordination is their aim. They hope to achieve their aims by exchange, in all languages, of information and by so doing strengthen the relations between individual physicians and scentists as well as between corporate professional bodies from different countries. However, at the same time emphasis is laid on the political neutrality of such organsations. Increasingly, this 'neutrality' is being questioned as doctors and scientists become aware of abuse and distortion of their profession taking place in other countries. H Merskey highlights the problems and offers his opinion on the ethics of maintaining these professional relationships with colleagues abroad who are involved in such abuse and distortion.

Ethics, Medical↗
PubMed2001

Political economy of tobacco control in Thailand.

Thailand has some of the world's strongest anti-tobacco legislation. This paper examines the political economy of tobacco control in Thailand, emphasising the identification of forces which have supported and opposed the passage of strong anti-tobacco measures. It argues that while a powerful tobacco control coalition was created in the late 1980s, the gains won by this coalition are now under threat from systematic attempts by transnational tobacco companies to strengthen their share of the Thai cigarette market. The possible privatisation of the Thailand Tobacco Monopoly could threaten the tobacco control cause, but the pro-control alliance is fighting back with a proposed Health Promotion Act which would challenge the tobacco industry with a hypothecated excise tax dedicated to health awareness campaigns.

Health Promotion↗
PubMed1997

Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13.

OBJECTIVE: To prepare a history of the enactment of California Assembly Bill 13 (AB 13), a state law prohibiting smoking in most workplaces passed in 1994, and to discuss its initial impacts. METHODS: Data were gathered from open ended interviews with representatives of voluntary health organisations, local government organisations, and principal legislators involved in the process, as well as observers around the state who could provide insight into the legislative process. Information was also obtained from legislative hearings and debates, public documents, letters and personal communications, internal memoranda, and news reports. RESULTS: The success of local tobacco control legislation in California led to a situation in which some health groups were willing to accept state preemption in order to attract the support of the state restaurant association for a bill. The decision to accept this preemption compromise was made by the state level offices of the voluntary health agencies without consulting the broader tobacco control community within California. In contrast, local tobacco control advocates did not accept this compromise, in part because of their belief that local legislation was a better device to educate the public, generate media coverage, and build community support for enforcement and implementation of clean indoor air and other tobacco control laws. Enactment of AB 13 was associated with a slowing of all local tobacco control legislation, including youth oriented laws. CONCLUSIONS: Because its supporters initially doubted that AB 13 would pass, there was never an effort to reconcile the policy differences between state oriented and locally oriented tobacco control policies. This lack of consensus, combined with the political realities inherent in passing any state legislation, led to a bill with ambiguous preemption language which replaced the "patchwork of local laws" with a "patchwork of local enforcement."

California↗
PubMed2000

New perspectives and evidence on political communication and campaign effects.

We review recent empirical evidence that shows political campaigns are more potent than widely believed, focusing on the conceptual and methodological advances that have produced these findings. Conceptually, a broader definition of effects--that includes learning and agenda-control, as well as vote choice--characterizes contemporary research. This research also features two kinds of interactive models that are more complex than the traditional hypodermic (message-based) approach. The resonance model considers the relationship between message content and receivers' predispositions, while the strategic model highlights the interactions between competing messages. Finally, we attribute the emergence of stronger evidence in favor of campaign effects to the use of new methodologies including experimentation and content analysis, as well as the more sophisticated use of sample surveys.

Communication Barriers↗
PubMed2006

Neural bases of motivated reasoning: an FMRI study of emotional constraints on partisan political judgment in the 2004 U.S. Presidential election.

Research on political judgment and decision-making has converged with decades of research in clinical and social psychology suggesting the ubiquity of emotion-biased motivated reasoning. Motivated reasoning is a form of implicit emotion regulation in which the brain converges on judgments that minimize negative and maximize positive affect states associated with threat to or attainment of motives. To what extent motivated reasoning engages neural circuits involved in "cold" reasoning and conscious emotion regulation (e.g., suppression) is, however, unknown. We used functional neuroimaging to study the neural responses of 30 committed partisans during the U.S. Presidential election of 2004. We presented subjects with reasoning tasks involving judgments about information threatening to their own candidate, the opposing candidate, or neutral control targets. Motivated reasoning was associated with activations of the ventromedial prefrontal cortex, anterior cingulate cortex, posterior cingulate cortex, insular cortex, and lateral orbital cortex. As predicted, motivated reasoning was not associated with neural activity in regions previously linked to cold reasoning tasks and conscious (explicit) emotion regulation. The findings provide the first neuroimaging evidence for phenomena variously described as motivated reasoning, implicit emotion regulation, and psychological defense. They suggest that motivated reasoning is qualitatively distinct from reasoning when people do not have a strong emotional stake in the conclusions reached.

Acoustic Stimulation↗
PubMedDate not supplied

Somatoform disorders and DSM-V: conceptual and political issues in the debate.

This article furthers the debate on the future of somatoform disorders by critically reviewing the relevant terminology and validity for the separate grouping and classification of these disorders. It is suggested that political pressures to change certain terms should be resisted, and that such changes should be made only if the alternatives have clear advantages.

Attitude↗
PubMed1981

Reactive entitlement in elective public office: a possible precursor to political corruption.

Observations, by a psychoanalyst who has served as an elected public official, reveal that exposure to conflicting demands from constituents may arouse a sense of depletion. Common reactions are feelings of entitlement and self-indulgent behavior which might include political corruption. Further research and preventive and therapeutic interventions are suggested.

Conflict, Psychological↗
PubMed1976

The politics of program evaluation: the mental health experience.

The authors discuss evaluation studies of the community mental health centers program. The emphasize that program evaluation is a political activity to influence the allocation of public resources. They examine its relationship to decision-making, power conflicts, and bureaucratic goals. They point out that the evaluator is seldom totally objective. They also emphasize the increasing use of evaluation by politicians.

Community Mental Health Services↗
PubMed1991

Politics, society and medicine in the 18th century.

Medical theory and practice in the 18th century reflected the thought and culture that the Renaissance had fashioned. This article draws attention to the political and social changes of the period and notes their inter-relationship with the changes that occurred in medicine.

History, 17th Century↗