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PubMed1995

Beyond the Ivory Tower: critical praxis in medical anthropology.

Recent discussion in critical medical anthropology has turned to the issue of application beyond the academy. Building on Gorz's notion of "non-reformist reform," that is, applied work that unmasks rather than mystifies the sources of social inequality and ill health, this article argues for the possibility of an applied critical medical anthropology, suggests concrete opportunities for such work in health settings, and identifies problems and social conditions that affect the development of a critical health praxis. These points are illustrated by reviewing case studies of anthropological work with the Farm Labor Organizing Committee in Indiana, the United Farm Workers Union in California, and the Hispanic Health Council in Connecticut. The article concludes with an examination of the skills and resources critical medical anthropology has to offer system-challenging movements in health care.

Anthropology↗
PubMed1993

Social correlates of malnutrition among Filipino street children.

This study has sought to identify subgroups of street children at high risk for nutritional deficiency in metropolitan Manila in the Philippines. A sample of 150 street children ages six through 18 were weighed, measured, and interviewed to establish nutritional parameters and to explore the interrelationships of nutritional status with social conditions. Two variables showed the highest association with low weight for age: children using drugs and children not in school. These variables should be seen as indicative of a range of variation among Filipino street children, in whom those on drugs and not in school represent the sector at greatest risk and one to which nutritional programs should be targeted.

Adolescent↗
PubMed1998

The clinical case management of clients with major depression.

In the field of mental health, clinical case management represents a set of interventions that feature ongoing support to persons with chronic mental disorders. In this paper a specific case management approach to working with persons having major depression is outlined. The causes of depression may be primarily biological, but psychological and social conditions also have impact on the course of the disorder. The clinical case management approach includes a variety of interventions which attend to both counseling and environmental work and accommodate the changing severity of the client's depression over time. The interventions described include ego support, crisis intervention, interpersonal therapy, and cognitive-behavioral techniques. Case examples are included as illustrations.

Adaptation, Psychological↗
PubMed1984

Drug abuse in military conscripts. Prevalence and background.

A questionnaire investigation in 1969/70 concerning drug use among military conscripts constitutes the basis for a study of the course and outcome of drug abuse and of drug-related medical and social conditions. 19% of military conscripts from Gothenburg indicated that they had at some time used drugs compared with 11% in the whole country. Between 4 and 5% of the men in Gothenburg indicated current drug use. Of those with some drug experience, more than 40% had used drugs more than 10 times. Cannabis smoking predominated. These figures are probably an underestimate because of the pattern of selection for military service. Those who had used drugs had more frequently used solvents and also had more advanced habits as regards alcohol consumption and tobacco smoking. Their intelligence level was somewhat higher than others' but they were less well-adjusted at home and at school. They had more frequently been in contact with the police or the Social Welfare Administration and more often had nervous problems.

Adolescent↗
PubMed2000

Development of ARI case management at primary and secondary level in southern Vietnam.

In southern Vietnam it is not uncommon that children under 5 years of age die from pneumonia. Reduction of severity and mortality has to rely on proper case management by mothers and health workers on both grass root level and referral level. The responsibility of training of clinical skills of ARI case management in the southern provinces of Vietnam has been delegated to Pediatric Hospital N1 (PHN1) Ho Chi Minh City (HCMC) by Ministry of Health. A pilot project was carried out by the Danish-Vietnamese Study Group. The immediate objects were: to provide basic epidemiological information about ARI in southern Vietnam, to develop training modules and case management intervention modules at primary and secondary level in order to enable mothers, village workers, health post staff and district hospital emergency department staff to treat moderate and severe pneumonia and acute bronchitis in accordance with the WHO management guide for ARI and to evaluate the effect of those modules after implementation in a limited number of communes. The modules were developed at PHN1. Ten commune health stations were carefully selected. The purpose of the project and the conditions for taking part had been explained to the health workers. The doctors and other commune health workers from the 10 commune health stations and doctors from the connected district hospitals attended the training courses at PHN1, HCMC and also at the belonging provincial hospitals. Essential equipment was provided and a pharmacy with essential drugs established. The registered health statistics was collected yearly during on site visits. The local doctors and commune health workers gave seminars for mothers in the villages of the 10 project communes. The mothers' knowledge, attitude and practice (KAP) was tested in interviews before and two months after the seminars had taken place. The spread of KAP was measured by random interviews of mothers six month later. In the interviews information on social conditions was obtained. The mothers' KAP had risen by 25% two months after attending the seminars. A further increase of KAP by 5-10% within the untrained group appeared in a survey 4-6 months later. It was not possible to obtain reliable statistics on morbidity or mortality of ARI in the project area.

Case Management↗
PubMed2005

How Guillain-Barre patients experience their functioning after 1 year.

OBJECTIVE: To analyze how the patient himself perceives his physical and social situation 1 year after Guillain-Barre syndrome (GBS). MATERIAL AND METHOD: The Dutch patients who participated in an international multicenter trial were asked to complete a self-administered questionnaire containing questions on their physical status at homecoming and at 12 months, as well as questions dealing with various aspects of their social condition. RESULTS: Ninety patients participated. Up to 72% had sensory disturbances and loss of power in part of the arms and up to 89% in part of the legs at homecoming. At 12 months, a significant improvement had occurred, but residua were perceived in 36 and 67%, respectively. The residua ranged from irritating to seriously disturbing in up to 49%, and only 33% felt completely cured. Furthermore, 32% had changed their work due to GBS, 30% did not function at home as well as before and 52% had altered their leisure activities. CONCLUSION: One year after the onset of GBS, a considerable number of patients still perceived a decrease of power and sensation with an often disturbing effect. GBS had an evident impact on daily life and social well-being.

Activities of Daily Living↗
PubMed2001

The effect of short-term depressive episodes on the risk stratification of acute coronary syndromes: a case-control study in Greece (Cardio 2000).

OBJECTIVE: The aim of this study is to evaluate the effect of recent depressive episodes on coronary risk, taking into account the presence of several cardiovascular risk factors and various lifestyles, and social conditions that aggregate in the Greek population. METHODS AND RESULTS: CARDIO2000 is a matched case-control study consisting of 750 patients with a first event of acute coronary syndrome and 778 cardiovascular disease-free hospitalized subjects, randomly and stratified selected from several Greek regions. Assessment of depressive symptoms, during the past month, was based on the CES-D Scale (Radloff S, 1977). 158 (21%) coronary patients and 74 (9%) controls had short-term depressive symptoms (P<0.001). A recent depressive episode increases coronary risk by 12%, after adjusting for several confounders, while the previous outcome seems to differ significantly between sexes (OR-men = 1.09 vs. OR-women = 1.19, P<0.01). The effect of the interaction between depression and various components of social class (education, occupation, income) increases the coronary risk from 55% to 132%, while the interaction with marital status increases the previous risk by 167%, in divorced/widowed men, and by 123%, in women. Also, significant additive effects were observed between depression and smoking (25% increased coronary risk per pack-year), alcohol consumption (+97%), physical inactivity (+137%) and obesity (+127%). CONCLUSION: This study showed the moderate effect of recent depression on the risk of developing non-fatal acute coronary syndromes in the investigated population. Also, sex differences and the additional effect of the interactions between short-term depressive episodes and several emerging or established cardiovascular risk factors occurred.

Case-Control Studies↗
PubMed1997

Behavioral effects of prematurity.

This report reviews the evidence for an increased incidence of behavior and social problems in infants and children born prematurely. The contribution of biological and social factors to the development of behavior problems in this population is also examined. The available evidence indicates that preterms more often than full-terms exhibit negative temperament characteristics, symptoms of Attention-Deficit Hyperactivity Disorder, and lower levels of social competence. The risk for these problems appears to be limited to those infants with a birth weight of less than 1,500 g. Adverse social conditions also impact the expression of these problems. Preterms do not appear to be at as much risk for emotional or conduct problems or abnormal attachment to their mothers. Both the experience of a preterm birth and the characteristics of the infant can alter the perceptions and behavior of parents. Appropriate interventions should involve the child, the parents, and the school.

Adaptation, Psychological↗
PubMed1990

[Sociomedical aspects of primary Sjögren's syndrome].

Forty patients with primary Sjögren's syndrome were interviewed. Poor social conditions during adolescence were not predisposing factors. A significantly higher number of patients grew up in urban than in rural districts, but this difference may be because most of these patients were from Zealand. Patients over the age of 35 years had left school later than the normal population. The matrimonial status did not differ from the normal population, except that the patients had significantly fewer children. The first symptoms of disease were recorded at an age of 20-50 years by 73%. More than half of the patients employed at commencement of the disease had to give up, and received disability pensions or retired early. A number of patients found less demanding jobs. The reasons were extreme fatigue (54%), arthralgia (42%), ocular- (17%) or oral dryness (8%). Social isolation was a problem for many patients and about 50% reported psychological problems. Drug expenses were moderate, whereas dental treatment was often considered to be a major economic problem.

Adolescent↗
PubMed1996

High risk behavior related to HIV transmission among recently diagnosed TB patients in Jakarta.

This study investigated the demographic and high risk behavior characteristics among recently diagnosed pulmonary tuberculosis patients aged 18-40 years old in Jakarta, Indonesia. Three hundred and four participants were recruited voluntarily from two general hospitals. Among the study population, 38.5% were unemployed, 69.7% were in low socio-economic condition, and 69.7% had a high school or higher level of education. About 8% had received a transfusion, 0.3% were intravenous drug users (IVDU) and had sex with other IVDU's no males admitted to being homosexual, 3.2% of males were bisexual, 20.1% (35.5% of males, 4% of females) engaged in extramarital heterosexual intercourse, and 3.6% (7.1% of males) had one or more sexually transmitted diseases (STD). We found very strong associations between gender and extramarital heterosexual activity (p < 0.001, prevalence odds ratio (POR 13.11), between occupation and extramarital heterosexual activity (p < 0.001, POR 3.84), and between extramarital heterosexual contact and a history of an STD (p < 0.001, POR 20.86). High risk activities were common among these TB patients, especially among males. These results suggests that the necessary social conditions for transmission of HIV are common in Jakarta.

Adult↗
PubMed1983

Stress, coping, and Black mental health: preliminary findings from a national study.

Despite the fact that blacks are disproportionately exposed to social conditions considered to be antecedents of psychiatric disorder, epidemiologic studies have not conclusively demonstrated that blacks exhibit higher rates of mental illness than whites. The present paper employed a research approach which considered not only rates of psychological distress, but also the stressors that blacks face and the various coping strategies used to adapt to those stressors. The data were obtained from the National Survey of Black Americans, the first study of a national probability sample of the adult black population. The information on mental health and coping was collected within the context of a single stressful personal problem. The analysis indicates that prayer was an extremely important coping response used by blacks especially among those making less than $10,000, above the age of 55 and women. The informal social network was used quite extensively as a means of coping with problems. This was true for all sociodemographic groups studied. The young (18-34) were less likely than those age 35 and above to seek professional help, while women were more likely than men to seek formal assistance. Income was not related to professional help seeking. With respect to the use of specific professional help sources, hospital emergency rooms, private physicians and ministers were used most frequently. The implications of these findings for research on black mental health and primary prevention are discussed.

Black or African American↗
PubMed1984

Alcoholic doctors.

Doctors are more vulnerable than the average citizen to alcohol dependence. Causal factors may include social conditioning, the patterns of drinking in medical schools and in early professional life, the responsible nature of the work and the associated emotional control. Statutory controls are an unfortunate necessity but informal schemes to provide help may have a valuable therapeutic and preventive function. For the future the hope may lie in promoting more intensive education concerning alcohol issues at all stages of medical education. The Medical Council on Alcoholism has an important part to play in this connection.

Adult↗
PubMed1995

Effects of prolonged social isolation on responses of neurons in the bed nucleus of the stria terminalis, preoptic area, and hypothalamic paraventricular nucleus to stimulation of the medial amygdala.

The studies presented demonstrate changes in hypothalamo-pituitary-adrenocortical secretion, and in electrical activity and synaptic responses of neurons in the bed nucleus of the stria terminalis, preoptic area, and hypothalamic paraventricular nucleus of rats exposed to early, long-term social isolation. Rats isolated from all social contact from an early preweaning time showed reduced basal plasma corticosterone concentrations, compared with littermate controls raised under social conditions. Isolated animals also exhibited a selective decrease in the spontaneous electrical activity of neurons within the hypothalamic paraventricular nucleus and lateral preoptic area, but not in adjacent structures. Moreover, isolation also altered the response of neurons in certain nuclei to electrical stimulation of the medial amygdala. Thus, a reduction in excitatory responses, and an increase in inhibition and nonresponsiveness, of preoptic area and paraventricular nucleus neurons was recorded, compared with control rats. Neurons in the bed nucleus of the stria terminalis were less affected, but showed an increase in the duration of excitatory responses following medial amygdala stimulation. These results, obtained from urethane-anesthetized rats, together with the reduced basal plasma corticosterone concentrations, suggest a reduction in limbic-hypothalamo-pituitary-adrenocortical (LHPA) activity following maternal deprivation and prolonged social isolation. This may result from altered limbic activity, specifically in the amygdala and its pathways to the paraventricular nucleus (PVN). Such alterations may include the stria terminalis, in so much as increased efficacy of inhibitory components and reduced efficacy of excitatory components was observed. The neural mechanisms underlying these alterations could involve an altered synaptology of the regions examined and/or a disruption of glucocorticoid feedback events.

Amygdala↗
PubMed2005

[What is the origin of inequalities in work and health?].

There has been an enormous increasing trend of widening gap of social inequalities since economic crisis at the end of 1997 in Korea. Since then, Korean society has deteriorated in economic and social conditions; the unemployment rate, temporary or casual workers and absolute poverty have increased. This paper presents the origin of inequalities in work and health in Korea. The origin of inequalities in work begins with the relationship between the capitalist and labourers in the capitalist mode of production. The conception and execution are dissolved in the work process in the capitalist mode of production. Thus, captitalists become control over ther labour process from workers. An alienation of the work process from the workers. The distribution of work is the majour source if inequalities in many countries as well as Korea. This paper presents the increasing tendency of unhealthy states such as mortality, early death, morbidity, physical work load, workplace injury amongst the under-privileged: ordinary workers, unemployed people, casual workers and socially deprived people in Korea.

Health Status↗
PubMed2000

The dangerousness of youth-at-risk: the possibilities of surveillance and intervention in uncertain times.

This paper will explore the dangerous possibilities provoked by the popular and promiscuous construction of the category of "youth-at-risk". In an age of large-scale and profound social changes, narratives of uncertainty and risk dominate popular, political and theoretical discourses about youth. Under these social conditions, the discourse of youth-at-risk is mobilized from a variety of intellectual and political positions in various attempts to regulate the behaviors and dispositions of youth. The paper will argue that these discourses provoke dangerous possibilities for the increased surveillance of, and intervention into, young people's lives by regulatory authorities (schools, police, health services, and juvenile justice systems) and the forms of expertise recruited by these agencies.

Adolescent↗
PubMed1989

Female labour force activity and the sex differential in mortality: comparisons across developed nations, 1950-1980.

This paper examines the macro-level relationship between female labor force activity and the sex differential in mortality among developed nations. Discrimination, protection, and null relationship hypotheses are tested using aggregate data for 18 high income nations over 7 time points from 1950 to 1980. High levels of female labor force activity--controlling for a variety of general social conditions--increase the longevity advantage women have over men. In some models the effects are immediate; in other models the effects occur after a substantial lag; but in no cases are there harmful effects for women's longevity. Also important for the differential are consumption of cigarettes and alcohol, and the level of income inequality in a society.

Alcohol Drinking↗
PubMed1995

[A comparative study on fertility transitions in China and Taiwan in historical perspective].

"Mainland China and Taiwan have both successfully undergone remarkable transitions from high to low fertility in recent decades. Comparing the transitions of the two Chinese populations brings out striking similarities in the changes in age patterns of fertility, but distinctive contrasts between the trends and speed of declines.... An overview of the history of population dynamics in the past 500 years reaffirms the assertion that fertility and mortality rates in ancient China were primarily reflections of biological responses to population pressure on resources. The results of the regression analysis of this study demonstrates that this density-dependent relationship has gradually vanished as the deliberate control of fertility prevails in contemporary China and Taiwan. The prevalence of fertility control is in large part attributable in Taiwan to the rational response of the population to changes in economic and social conditions that favor fewer children while the size of families in China is largely prescribed by the government there." (SUMMARY IN ENG)

Asia↗
PubMed2006

Oral myiasis: a case report.

Oral Myiasis is a rare pathology in humans and is associated with poor oral hygiene, alcoholism, senility, suppurating lesions, severe halitosis and others conditions. The treatment is a mechanical removal of the maggots one by one but a systemic treatment with Ivermectin, a semi-synthetic macrolide antibiotic, have been used for treatment for oral myiasis. We present a case report of a 32-year-old man indigent, alcohol-dependent with an extensive necrotic area and acute swelling in upper lip and fetid odor. The patient's management included topic use of gentian violet, oral therapy with ivermectin (6 mg orally), surgical exploration to remove the larvae and necrotic tissue. After the complete larvae removal the swelling and the wounds were healing normally, the patients was referred to plastic surgery to repair tissue damage. The prevention of human myiasis is by education, but unfortunately in the developing countries some people live in low social condition, predisposing the occurrence of the infestation.

Adult↗