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PubMed1993

Thomas McKeown and Archibald Cochrane: a journey through the diffusion of their ideas.

In the 1970s Thomas McKeown and Archibald L Cochrane were two of the most influential voices in criticizing the dominance of medical thinking. A bibliometric study of the citations to McKeown's The Role of Medicine: Dream, Mirage or Nemesis and Cochrane's Effectiveness and Efficiency: Random Reflections on Health Services was performed from the publication of each book until 1988 to study how their ideas have been disseminated. During the study period 430 papers in the Science Citation Index or the Social Sciences Citation Index cited Cochrane's book, 133 cited McKeown's, and 166 cited both. The citations came mainly from original papers published in journals of internal medicine or public health and epidemiology (35%) and written by authors from the United States or the United Kingdom. Cochrane's book was cited most frequently in medical journals, suggesting a higher degree of penetration of his ideas among medical scientists. Although the dominance of original papers among the citations suggests that these books have been important in stimulating new knowledge, the main problems that McKeown and Cochrane identified--namely, the relatively small impact of clinical medicine on health outcomes and the poor use of scientific methods in clinical practice--are still with us.

Bibliometrics↗

PubMed2006

[Brazilian biomedical and epidemiological research vis-à-vis the UNGASS targets].

The focus of the present study is the Brazilian response within science, technology and innovation to the targets formulated in the UNGASS document. An analysis was made of items 70-73 of the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001), which defined science, technology and innovation targets relating to HIV/AIDS. The main topics listed in these items were put into operation in the form of keywords, in order to guide systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The success of Brazilian research within the field of characterization and isolation of HIV-1 is undeniable. Phase II/III vaccine studies have been developed in Rio de Janeiro, Belo Horizonte and São Paulo. Empirical studies on the monitoring of primary resistance have been developed in specific populations, through the Brazilian HIV Resistance Monitoring Network. Within the field of monitoring secondary resistance, initiatives such as the National Genotyping Network have been highlighted. Two national systems--the Mortality Information System and the Notifiable Diseases Information System (Aids)--and some studies with wider coverage have given rise to work on trends within the epidemic. The production of high-quality generic medications and their free distribution to patients have been highlighted. Brazil has implemented a consistent and diversified response within the field of HIV/AIDS, with studies relating to the development of vaccines, new medications and monitoring of the epidemic.

AIDS Vaccines↗

PubMed2006

[Phenomenology and systemic approaches in socio-anthropological studies of illness: a brief critical review].

This paper aims to identify the ways by which the principal frames of reference in the social sciences explain the structure of social actors' knowledge, practices, values, and behaviors regarding health care. The article begins by examining some of the assumptions underlying studies produced within what are called systemic theories. It then proceeds to discuss phenomenological approaches to the health and illness experience. The goal is to clarify how these approaches focus on experience and depart from prevailing systemic models.

Anthropology↗

PubMed2005

What is eHealth (4): a scoping exercise to map the field.

BACKGROUND: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service. OBJECTIVES: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends. METHODS: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings). We used the search query, "Ehealth OR e-health OR e*health". The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity. RESULTS: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations. CONCLUSIONS: We surmise that the field -- as it stands today -- may be characterized by the global definitions suggested by Eysenbach and Eng.

Delivery of Health Care↗

PubMed2004

Socio-economic factors predisposing under five-year-old children to severe protein energy malnutrition at the Moi Teaching and Referral Hospital, Eldoret, Kenya.

BACKGROUND: Malnutrition is one of the leading causes of morbidity and mortality in children aged five years and below. Risk factors for severe protein energy malnutrition (PEM) have been identified as ignorance, family size, mothers and fathers education, poverty, residence, chronic infections, and congenital defects or malformations. The role of such social factors as the caretaker, extended family, homestead surroundings, and family cohesiveness have not been studied in Kenya. OBJECTIVE: To determine the social and economic factors that predispose children to severe PEM as seen at the Moi Teaching and Referral Hospital (MTRH), Eldoret. DESIGN: Prospective and case control study. SETTING: The MTRH, Eldoret, Paediatric wards, outpatient and MCH clinics over a 12 month period (June 2001 to June 2002). SUBJECTS: Sixty six children aged 3 to 36 months with severe PEM attending the MTRH outpatient clinics and those admitted in the Paediatric wards were age-matched with 66 controls. METHODS: A standard pretested questionnaire was used to interview caretakers with severely malnourished children and age-matched controls. The children were weighed after interviewing the caretakers. The data was entered on a computer and analysed using the statistical package for social sciences (SPSS) programme. RESULTS: The social risk factors for PEM were single mothers (Odds Ratio) OR 14.93, p= 0.00001), young mothers aged 15-25 years (OR 3.95, p= 0.00020), the child's living conditions such as living in a temporary house (OR 3.627 p= 0.00257), caretaker who was not married to the child's parent (OR 0.10, p= 0.00005) and not staying with both parents in the past six months (OR 0.28606, p=0.00101). The economic risk factors were father's lack of ownership of land (OR 0.401, p= 0.01732), cattle (OR 0.24, p=0.00022), not growing maize (OR 0.15, p=0.00013), not growing beans (OR 0.36, p=0.00484) and ownership of small piece of land by grandfather (OR 6.00, p= 0.02274). Other risk factors were incomplete immunization (OR 3.87, p= 0.00151) and female sex (p=0.03721). CONCLUSION: Poverty, social conditions under which the child was living, sex of the child and incomplete immunizations were risk factors for the severe protein energy malnutrition.

Age Distribution↗

PubMed1997

A selection test for Australian graduate-entry medical schools.

One of the selection criteria for the three Australian medical schools with graduate-entry programs is performance in a common entry test, the Graduate Australian Medical School Admissions Test (GAMSAT). We found that scores for GAMSAT in 1996 (its second year) varied significantly with candidate sex, age, highest degree level and main subject in first degree. Mean scores were highest for men, younger candidates, honours graduates and those with a physical sciences background. However, arts and social sciences graduates (9.8% of applicants) comprised 11.4% of the 200 top-scoring candidates.

Adult↗

PubMed1976

[The concept of health and disease].

1. The author reviews some current concepts concerning the definitions and uses of the concepts of health and illness. Starting from the definitions in Psychiatry, "normality" is considered from the statistic, the normative and the clinical standpoints, and as a part of a continuum stretching from health to illness. Several approaches are analyzed, among which Wittaker's, who sets forth the following indicators of normality: a) self-knowledge; b) self-esteem; c) self-security; d) capacity for giving and receiving affection; e) satisfaction of corporal needs; f) productivity and capacity for happiness; g) lack of tensions and of hipersensitivity. 2. The concept of illness as an operative concept is also analyzed, leading to the following statements: a) it is inexistent in non-biological sciences; b) it appears in social sciences only through extrapolation; c) in medicine it means the breacking of homeosthasis; d) in psychology and dynamic psychiatry it means the abnormal stressing of normal mechanisms, common to all persons. 3. The concept of health as equilibrium is also analyzed, with the following precisions: a) equilibrium is defined within a system as affecting the whole of it, and implying transformation and self-regulation; b) homeosthasis is a case of equilibrium for steady complex systems; c) adaptation is the maintenance of equilibrium when there are exchanges with the evironment. 4. Finally, those concepts are applied to mental illness and its limits, and the following criteria are set forth: a) amount of anguish; b) depression related to its motives, intensity, persistence and frequency; c) regression to previous development stages; d) use of defense mechanisms in an inadequate or stereotyped way.

Adaptation, Biological↗

PubMed2000

Immunization (EPI) in Ethiopia: acceptance, coverage, and sustainability.

Ethiopia has been engaged in expanding immunization services against the six childhood diseases since 1980. According to plans set at the beginning of the program, the country should have achieved universal child immunization by now. However, the child immunization coverage has never reached the level that is desired to curtail disease transmission and to reduce the morbidity burden associated with the target diseases. This study used the potential of social science research methods in understanding social, cultural, political and economic factors that influence the efficiency and effectiveness of immunization programs in the Ethiopian context. A better understanding of these factors is believed to improve the quality and sustainability of immunization programs. This research focused on relevant issues at micro- and macro-levels. The study basically utilized qualitative research methods involving multiple data collection tools and information sources. Factors related to acceptors, immunization service providers and organization of health services that influence the successful implementation and sustainability of the immunization program in the Ethiopian context are identified and discussed. Strengthening efforts to improve technical capacity of service providers, increasing social mobilization activities, instituting quality assurance schemes and improving management of resources (human, finance and material) are among the major recommendations.

Child↗

PubMed2002

Kenneth B. Clark in the patterns of American culture.

Kenneth B. Clark is most well-remembered as the social scientist cited by the U.S. Supreme Court in footnote 11 of its decision in Brown v. Board of Education in 1954. His presence in that decision came to symbolize the role that social science could play in changing social policy and public attitudes. As an African American social scientist who was prominent during a time of great turmoil over racial issues in the United States, Clark also became a "participant-symbol" in America's discussion of race. Clark contributed to this discussion in the three books he wrote for the general public: Prejudice and Your Child (Clark, 1955), Dark Ghetto (Clark, 1965), and Pathos of Power (Clark, 1974). In this article, the author discusses how these works document Clark's growing pessimism about the prospects for improving race relations. In addition, Clark's place in contemporary American debates about Brown v. Board of Education and the persistence of racial equality is considered.

Black or African American↗

PubMed2004

Structure of the 2003 impact factor for Croatian medical journal.

According to the Journal Citation Report from the Institute for Scientific Information (ISI), the last year's (2003) impact factor (IF) of the Croatian Medical Journal (CMJ) was 0.943. To determine the factors that contributed to this significant increase in the IF, we analyzed the structure of citations to CMJ in the ISI's publications, Science Citation Index (SCI), and Social Science Citation Index (SSCI). Thematic issues generally acquired more citations than regular issues. Furthermore, citation number varied for different article types. The citations to the original scientific articles corresponded to the average number of citations for the current IF value, whereas reviews and especially case reports were cited less frequently, and negatively contributed to the IF of the journal. Only half of all articles published in two previous years were cited in 2003. The majority of these articles were cited once or twice, whereas only 15 articles received more than three citations. Journal self-citations are still an important contributor to the CMJ's IF (39.6%). Their proportion may decrease in time, by further improving the visibility of the journal, and thus acquiring greater number of independent citations. In future, we can expect year-to-year variations in the journals IF. This trend may be positive on a long-term basis, but expectation of a value significantly higher than 1 is unrealistic. CMJ is small general medical journal whose quality-oriented editorial policy may in the long-term result in the increase in the IF.

Bibliometrics↗

PubMed2005

[Epidemiology and social epidemiology].

Social epidemiology is a sub-discipline of epidemiology explicitly investigating social determinants of population distributions of health, disease, and well-being. Persistent pattern of social inequalities in health in spite of the broad improvement in the physical environment over the last centuries necessitated the development of this field as an approach to understand disease etiology that incorporates social experiences as more direct determinant of health. Social epidemiology incorporates theories, measurement tools, and techniques from a wide variety of other social sciences. A population perspective, the social context of behavior, contextual multilevel analysis, a developmental and life-course perspective, and general susceptibility to disease are the most important guiding concepts in social epidemiology.

Epidemiologic Methods↗

PubMed1990

Who are the peer reviewers and how much do they review?

To assess the nature and work load of reviewers for the American Journal of Public Health, I surveyed a sample of 276 reviewers in the latter half of 1988, with a 96% response rate. Respondents reported reviewing papers for 274 other journals in 1987, 81% of which were monitored by the Science Citation Index or the Social Science Citation Index. They reviewed most often for The Journal of the American Medical Association (27%), the American Journal of Epidemiology (26%), and the New England Journal of Medicine (23%). The median number of journals for which they reviewed was 3.6, the median of their estimated review time was 2.7 hours, and the weighted average review time (adjusted for number of reviews) was 2.4 hours. The range of review time was broad and inversely related to the number of papers reviewed. Respondents donated an estimated 3360 hours of uncompensated labor to the American Journal of Public Health in 1987, and a total of 6439 hours (26.8 hours per reviewer) to reviewing for all journals. Of the reviewers for the American Journal of Public Health, only 31% were not listed as an author of a source publication in the 1987 Science Citation Index and only 15% were not cited.

Peer Review↗

PubMed2000

HIV/AIDS social and behavioural research: past advances and thoughts about the future.

This paper is an introduction to the various contributions in this special issue of Social Science & Medicine which are an attempt to synthesise the main debates of the 2nd European Conference on Social and Behavioural Research on AIDS held in Paris, in January 1998. The paper discusses how the recent advent of highly active antiretroviral therapies (HAART) and new trends in the epidemic (its concentration in the socially most vulnerable groups and countries) have affected the research agenda of European social and behavioural sciences (SBS) in HIV/AIDS. Questions which had already been thoroughly studied by SBS (like determinants of HIV-related risk behaviours, or impact of gender and socio-economic inequities as well as discrimination on the diffusion of HIV) will have to be "revisited" in light of these recent changes. New issues (such as risk behaviours among already infected patients. impact of therapeutic advances on psychosocial and daily life management of their disease by people living with HIV/AIDS, adherence to treatment, or "normalisation" of AIDS public policies) will have to be strongly and quickly dealt with, in order for SSB to keep the pace with the rapid evolution of the epidemic and of the societal responses to it. Finally, the paper argues that to face these challenges, new theoretical and methodological advances will have to go beyond the classical oppositions in internal debates among SSB between individualistic and holistic approaches, or between radical criticism of the existing state of the world and practical involvement in public health decision-making.

Forecasting↗

PubMed1982

Methodological controversies between social and medical sciences.

If doctors find sociological methods unreliable, the results unsound, and the approach irrelevant, this is due to essential differences between the procedures and interests of the exact and the social sciences. When sociologists raise doubts concerning the one-sidedness of the medical approach, its exaggerated professionalism, lack of concern for the social context of cure, those are latent requirements which do not match the current paradigm of medical knowledge. It is assumed here that the difference between experimental method and the interpretive procedures of sociology has a basic character and cannot be overcome by the methodological refinement of the latter. Understanding sociological knowledge must be based only against a background of a special interest in practical social affairs. Doubts are raised whether such an interest can develop within the prevailing paradigm of medical practice. Nevertheless, some improvements in the presentation of sociological research and in its method, especially as related to conclusiveness and applicability, can enhance the chances of its effective use in medical practice. Possible postulates addressed to medical research do not have methodological consequences requiring a change in the organization of medical services in the relations with associated industry for the needs of the health care system.

Philosophy, Medical↗

PubMed1999

Leadership perspectives on the philosophy and rationale of diversity in the United States.

The uneasy civil rights consensus of the 1960s and 1970s has become frayed in civic and legal culture, and now it somehow must be mended. Defining discrimination, condemning it, regulating it, and remedying it are complicated issues. To find a solution is not rocket science; it is harder than rocket science. What is the moral cost of making decisions about people based on immutable characteristics like race and gender? In a 1995 review of affirmative action conducted by the author for President William Clinton, one issue was that discrimination can take place without the victim being aware of it. Victims of discrimination cannot litigate what they cannot see. This is but one justification for voluntary affirmative action. The debate about such measures, however, is fueled by sharp differences regarding basic questions of values, and perceptions of how much discrimination exists. Not many prejudices will be abandoned when people are presented with rational, social science evidence about crime, victimization, and the extent of discrimination. Experiences, including experiences with people who are different, are the most powerful tool for changing people's sense of community and people's values.

Attitude↗

PubMed2002

Social genomics: genomic inventions in society. The nature of what's to come.

This paper identifies several kinds of intellectual mistakes that proponents of genetic engineering make, in defending their views and characterizing the views of their opponents. Results from research in the social sciences and humanities illuminate the nature of these mistakes. The mistakes themselves play a role in allowing proponents to gather support from other protagonists in the social controversies involving science and technology. Understanding the controversies requires understanding that innovations are components of complex and ill-structured social problems; the "right answer" does not follow from scientific or technological breakthroughs. If the problems are identified correctly, issues of non-economic or non-market values and political and individual rights will need to be addressed.

Ethics, Medical↗

PubMed2004

The Nash equilibrium: a perspective.

In 1950, John Nash contributed a remarkable one-page PNAS article that defined and characterized a notion of equilibrium for n- person games. This notion, now called the "Nash equilibrium," has been widely applied and adapted in economics and other behavioral sciences. Indeed, game theory, with the Nash equilibrium as its centerpiece, is becoming the most prominent unifying theory of social science. In this perspective, we summarize the historical context and subsequent impact of Nash's contribution.

Economics↗

PubMed2004

Psychology defined.

A new form of knowledge technology is used to diagnose psychology's epistemological woes and provide a solution to the difficulties. The argument presented is that psychology has traditionally spanned two separate but intimately related problems: (a) the problem of animal behavior and (b) the problem of human behavior. Accordingly, the solution offered divides the field into two broad, logically consistent domains. The first domain is psychological formalism, which is defined as the science of mind, corresponds to animal behavior, and consists of the basic psychological sciences. The second domain is human psychology, which is defined as the science of human behavior at the individual level and is proposed as a hybrid that exists between psychological formalism and the social sciences.

Animals↗