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PubMed1984

The discovery of Mycobacterium leprae. A medical achievement in the light of evolving scientific methods.

The discovery of M. leprae by G. H. Armauer Hansen (1841-1912) in 1873 represents a link in a chain of development in international medicine that was influenced by two main concepts, namely, that germs may be causes of disease and that social conditions may be related to disease, either as causes or consequences or both. Hansen's work is also a link in a chain of research on leprosy in Norway. Hansen met with serious challenges in addition to those that were purely scientific. To prove the causative effect of the microorganism according to principles that later came to be known as Koch's postulates, Hansen felt compelled to conduct experiments that were deemed illegal by the authorities. At the same time, he was fighting to establish priority for his discovery. Later, Hansen was honored as the discoverer of the bacillus of leprosy and was privileged to see benefits in the public health as a consequence of the discovery. Hansen's epoch-making achievements may serve as an inspiration to all who aspire to combat disease by seeking answers to questions about causes of disease, modes of prevention, and social consequences of disease.

History, 19th Century↗

PubMed2003

Adolescent and young adult tobacco prevention and cessation: current status and future directions.

OBJECTIVE: To summarise the evidence on adolescent and young adult prevention and cessation, and provide future directions for research. DATA SOURCES: Data were collected from published literature. Searches for adolescent prevention were conducted using PubMed, PsycInfo, and ERIC; and for cessation, PubMed, and two major reviews that span January 1978 to May 2002. PubMed, PsychInfo, and SCCI were searched for young adults from January 1990 to May 2002. STUDY SELECTION: Data included smoking prevention studies published from January 1990 to May 2002 and conducted in the USA; all identified smoking cessation studies for adolescents. Young adult data were limited to initiation and cessation studies. DATA EXTRACTION: Extraction of data was by consensus of the authors. DATA SYNTHESIS: Results of the review are qualitative in nature using a consensus approach of the authors. CONCLUSIONS: School based curricula alone have been generally ineffective in the long term in preventing adolescents from initiating tobacco use but are effective when combined with other approaches such as media and smoke-free policies. Prevention research should consider multiple approaches and the social conditions that influence the development of youth problem behaviours including tobacco use. Because youth smoking cessation has been understudied to date, scientifically rigorous adolescent smoking cessation studies need to be conducted with attention to high risk smokers and less than daily smokers. Tobacco prevention and cessation for young adults needs focused attention. Prevention and cessation programmes need to address other tobacco products in addition to cigarettes.

Adolescent↗

PubMed2004

[Breastfeeding: a nature-culture hybrid].

OBJECTIVE: To contribute to the creation of a new theoretical synthesis about the relationship between the biological and social dimensions of breastfeeding, categorizing it as a nature-nurture hybrid. SOURCES OF DATA: The methodological approach of the present article was based on the qualitative health research frame, and data were analyzed on the basis of dialectic-hermeneutic principles. Primary sources, comprising historical documents, books, scientific articles and medical theses written in the 19th and 20th centuries were analyzed. SUMMARY OF THE FINDINGS: Depending on the moment in history and on the expectations that surround the act of breastfeeding, the aspects related to nature and nurture, i.e., to biology and society, sometimes separate out and sometimes intermingle. A comprehensive approach to breastfeeding makes possible to see that it had to be considered instinctive, natural and biological in order to be assimilated as a cultural habit, and thus, it is not open to any kind of questioning. On other occasions, particularly in the course of the past decade, there has been a steady tendency to supplant traditional biological reductionism, which yielded cultural interpretations that do not reduce the human being to the status of a mammal like any other. Under this point of view, breastfeeding, in addition to being biologically determined, is socially conditioned, and thus constitutes an act embedded in ideologies and determinants resulting from the concrete conditions of life. In real life, however, a process apparently so natural, so loaded with affection and emotion is, in fact, affected by the most aggressive market interests, very often presented as scientific knowledge and decked out as health provisions. CONCLUSION: Breastfeeding focused as a nature-culture hybrid symbolizes the theoretical and methodological changes in the field, especially in the late 1990s. These changes reflect a renewed appreciation of biology and a more in-depth approach to interdisciplinary processes.

Brazil↗

PubMed2000

Patterns of alcohol consumption in young Australian women: socio-demographic factors, health-related behaviours and physical health.

OBJECTIVE: To determine which socio-demographic factors, health-related behaviours and physical health conditions are associated with non-drinking, binge drinking and hazardous/harmful drinking in young Australian women. METHODS: Cross-sectional data were obtained from the baseline survey of 14,762 young women (aged 18-23 years) enrolled in the Women's Health Australia study in 1996. Associations between a range of drinking patterns and socio-demographic factors, health-related behaviours and health conditions were examined. RESULTS: Half the women were 'low intake' drinkers, a third 'rarely drank' and 9% were non-drinkers; however, 70% reported binge drinking with one-quarter of the binge drinkers doing so at least weekly. Non-drinkers were more likely than drinkers to be married, pregnant, non-smokers, born in non-English speaking countries, to live in the Northern Territory, and to have lower levels of education, employment, and private health insurance. 'Low intake/binge weekly' drinkers (12%) and 'hazardous/harmful' drinkers (5%) were more likely than 'low risk' drinkers to be unmarried; to live in shared accommodation, alone or with their parents; to live in rural or remote areas; to have ever had any sexually transmitted infection; to be current smokers or ex-smokers and to have used unhealthy weight-control practices. CONCLUSIONS: The results confirm findings from other countries about the importance of social conditions as determinants of alcohol consumption by young women. IMPLICATIONS: Health promotion to reduce young women's alcohol consumption needs to be carefully targeted to take account of their demographies, living environments and beliefs.

Adolescent↗

PubMed2004

[Dental pain as the reason for visiting a dentist in a Brazilian adult population].

OBJECTIVE: The occurrence of orofacial pain and chronic pain are frequent subjects for study today, but few studies have been made on dental pain in Brazil. The objective of the study was to assess the prevalence of dental pain and the associated factors as the reason for visiting a dentist among adults. METHODS: A cross-sectional study was carried out among 860 workers aged 18-58 years at a cooperative located in the State of Santa Catarina, in 1999. The clinical examinations and interviews were carried out by dentists who had received prior guidance. Complaints of dental pain as the reason for the last visit to a dentist were analyzed as the dependent variable, in relation to the socioeconomic and demographic conditions, access to dental services, shift pattern and caries (via the DMFT index), as the independent variables. Non-conditional multiple logistic regression analysis was utilized. RESULTS: The prevalence of dental pain as the reason for the last visit to a dentist was 18.7% (CI 95%: 15.9-20.1) and the mean DMFT index (decayed, missing and filled teeth) was 20.2 (CI 95%: 19.7-20.7), with 54% represented by the 'missing' component. The following were independently associated with the presence of dental pain: schooling of less than or equal to eight years (OR=1.9; CI 95%: 1.1-3.1); four to fifteen teeth lost due to caries (OR=2.6; CI 95%: 1.4-4.9); 16 to 32 teeth lost due to caries (OR=2.5; CI 95%: 1.1-5.8); and not having visited the company's dental service (OR=2.8; CI 95%: 1.6-5.1). CONCLUSIONS: Dental pain reflects the severity of the dental caries, expressed by the 'missing' component of the DMFT and non-usage of the company's dental services. These factors are determined by social conditions and represented by the schooling level.

Adolescent↗

PubMed1995

The child group used as a reference system when analysing frequency of morbidity in day-care centres.

Morbidity frequency was analysed among children attending six day-care centres in a suburb of Stockholm, Sweden. Absence due to illness was calculated annually for each child and correlated with each child's own group. Thus a child was classified as "often sick" or "mainly healthy" in relation to the other children in the child's own group, constituting a reference system. In almost every group a "sick third" was found, whose absence due to illness was twice that of the rest of the group. Children from families of lower social standing, those with a relatively large number of siblings and those living in poor social conditions were found to be among those most often reported as sick. In such families, smoking was more commonplace. These parents more often lived in a rented apartment than in a single detached owner house. Multiple linear regression analysis revealed that young mothers and children with several siblings had the strongest correlation with absence due to illness of the proband child. Increasing maternal age revealed improvement vis-à-vis all socioeconomic parameters investigated, reflecting an improvement in standing correlated to less sick children.

Age Factors↗

PubMed2006

[Nutritional status and social determinants of child height in the Guarita Indigenous Territory, Southern Brazil].

The nutritional status of under-five children and the association between social conditions and child stature were examined using data from the program to control malnutrition and mortality in the Guarita Indigenous Territory, southern Brazil, 2001-2002. Anthropometric indices were calculated in z-scores of the CDC 2000 reference. At entrance into the program, 34.7% of the children presented stunting, 12.9% low weight for age, 4.2% wasting, and 8.7% overweight. Stunting was most prevalent among boys and children older than one year. Multivariate linear regression showed that, on average, children were shorter when the drinking water was collected directly in the environment (p = 0.046), there was no refrigerator for food preservation (p = 0.021), maternal age was less than 16 years at the birth of the oldest child among the under-fives (p = 0.019), and the mother was illiterate (p = 0.083). Sewage facilities only had an effect on the unadjusted model. There was no evidence that the number of under-five children had an effect on stature. Social inclusion policies and health and social provision which takes these factors into account are potentially relevant for improving health and nutrition in this population.

Age Distribution↗

PubMed2004

Welfare reform and female headship.

While much of the focus of recent welfare reforms has been on moving recipients from welfare to work, many reforms were also directed at decisions regarding living arrangements, pregnancy, marriage, and cohabitation. This article assesses the impact of welfare reform waivers and Temporary Assistance for Needy Families (TANF) programs on women's decisions to become unmarried heads of families, controlling for confounding influences from local economic and social conditions. We pooled data from the 1990, 1992, 1993, and 1996 panels of the Survey of Income and Program Participation, which span the period when many states began to adopt welfare waivers and to implement TANF, and estimated logit models of the incidence of female headship and state-stratified, Cox proportional hazard models of the rates of entry into and exit from headship. We found little consistent evidence that waivers affected female headship of families.

Adolescent↗

PubMedDate not supplied

The continuation of home care to severely impaired children and aged in Israel: family attitudes.

There are a growing number of children and aged with severe chronic health problems in the community. Mothers become the prime caregivers to these children and aging spouses or middle-aged offspring the caregivers to these aged. The services offered to these families are determined by economic and social conditions, as well as changing fashions, rather than knowledge of the patients' and caregivers' needs. The purpose of this study was to assess the impact of homecare upon families caring for children versus those caring for aged and these families' attitudes toward continuation of home care versus institutionalization. The families included in the study were drawn randomly from the case load of community nurses in central Israel. In-depth interviews were conducted with 92 families of severely impaired children and 181 families of severely impaired adults and aged in their homes. While the majority of both populations carry a heavy burden of caregiving over years, they also receive gratification from their ability to care for their patient at home. There is little difference between those caring for children and those caring for adults in their attitudes toward continuation of home care. Mental rather than physical impairment, a deteriorating illness trajectory; depression, aggression and tension of the caregiver, the absence of sufficient social support and home care services correspond with negative feelings toward continued home care. The perceived impact of caregiving responsibilities upon the caregivers' lives, the ability to tolerate and manage symptoms and above all the quality of the patient-caregiver relationship influenced the caregivers' attitudes toward institutionalization in both populations. Family attitude toward continued homecare and institutionalization of children and adults are compared and the needs for services discussed.

Aged↗

PubMed1989

Clinical psychiatric assessment of patients with burning mouth syndrome resisting oral treatment.

Of 100 consecutive patients referred for investigation of symptoms related to oral galvanism, 18 with persisting symptoms of burning mouth syndrome (BMS) remained after investigation and treatment (Hugoson 1986). In addition to the oral and medical treatment, 16 (14 women, 2 men) of these patients underwent psychiatric investigation. The results of this investigation are presented in this report. The psychiatric investigation was performed as a semistructured interview, elucidating current symptoms, the patient's opinion as to the onset and causes, previous illnesses and psycho-social conditions. Two hours were reserved for each patient interviewed with the aim of obtaining a holistic picture of each individual. The patients with refractory burning mouth syndrome did not differ from the others with respect to oral status, salivary secretion or calculated galvanic currents. No patient had burning mouth as the only symptom, all reporting many symptoms from different organs. Three patients had had symptoms for at least 20 years, 9 for 5-10 years and 4 patients for less than 4 years. Seven patients related the onset of symptoms to oral treatment. Thirteen of the patients reported one or more medical diagnoses and 10 patients were taking 1-3 medicines. Ten patients reported significant negative experiences in connection with previous contacts with the health services and several considered themselves wrongly diagnosed and treated. Most of the patients had experienced catastrophes in their lives in the form of stillborn children or children born with various handicaps, children injured in accidents or prolonged social problems. One patient was judged to have somatic causes of the symptoms, 8 patients somatic and psychological causes, 6 patients psychological causes and in 1 patient the cause was unknown. Three cases are presented in more detail.

Adult↗

PubMed2026

Association between cumulative social disadvantage, as measured by the social determinants of health score, and epilepsy: a cross-sectional study.

BACKGROUND: Social determinants of health (SDoH) shape access to care, health behaviors, and long-term outcomes, yet their cumulative relationship with epilepsy has not been well quantified. This study examined whether a composite SDoH score was associated with epilepsy in adults. METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey 2013-2018. The SDoH score ranged from 0 to 8 and summarized eight unfavorable social conditions. Epilepsy was identified using medication-based ascertainment. Survey-weighted logistic regression models were applied to evaluate the association between SDoH score and epilepsy. Restricted cubic spline, subgroup, sensitivity, and receiver operating characteristic analyses were also performed. RESULTS: A total of 13,119 participants were included, of whom 114 had epilepsy. Participants with epilepsy had a higher mean SDoH score than those without epilepsy (3.41 ± 0.24 vs. 2.35 ± 0.06, P < 0.001). In the fully adjusted model, each 1-point increase in SDoH score was associated with 31% higher odds of epilepsy (OR 1.31, 95% CI 1.16-1.48). Compared with the low-score group (0-2), the adjusted odds ratios were 2.09 (95% CI 1.06-4.15) for scores of 3-5 and 2.67 (95% CI 1.34-5.33) for scores of 6-8. Spline analysis showed a significant overall association without evidence of nonlinearity. Adding SDoH components to demographic variables improved model discrimination (AUC 0.731 vs. 0.589, P for difference <0.001). CONCLUSION: Greater cumulative social disadvantage, as reflected by the SDoH score, was associated with higher odds of epilepsy.

Humans↗

PubMedDate not supplied

Communication strategy for implementing community IMCI.

In resource-poor developing countries, significant improvements in child survival, growth, and development can be made by: (a) shifting from sectoral programmes (for example, in nutrition or immunization) to holistic strategies such as the Integrated Management of Childhood Illnesses (IMCI) and (b) improving household and community care and health-seeking practices as a priority, while concurrently strengthening health systems and the skills of health professionals. This article focuses on household and community learning, and proposes a communication strategy for implementing community IMCI (c-IMCI) that is based on human rights principles such as inclusion, participation, and self-determination. Rather than attempt to change the care practices and health-seeking behaviour of individuals through the design and delivery of messages alone, it proposes an approach that is based on community engagement and discussion to create the social conditions in which individual change is possible. The strategy advocates for the integration of sectoral programmes rather than the development of new holistic programmes, so that integrated programmes are created from "multiple entry points". As integration occurs, the participatory communication processes that are used in sectoral programmes can be enriched and combined, improving the capacity of governments and agencies to engage community members effectively in a process of learning and action related to child health and development.

Child↗

PubMed2001

The Danish National Birth Cohort--its background, structure and aim.

BACKGROUND: It is well known that the time from conception to early childhood has importance for health conditions that reach into later stages of life. Recent research supports this view, and diseases such as cardiovascular morbidity, cancer, mental illnesses, asthma, and allergy may all have component causes that act early in life. Exposures in this period, which influence fetal growth, cell divisions, and organ functioning, may have long-lasting impact on health and disease susceptibility. METHODS: To investigate these issues the Danish National Birth Cohort (Better health for mother and child) was established. A large cohort of pregnant women with long-term follow-up of the offspring was the obvious choice because many of the exposures of interest cannot be reconstructed with sufficient validity back in time. The study needs to be large, and it is aimed to recruit 100,000 women early in pregnancy, and to continue follow-up for decades. The Nordic countries are better suited for this kind of research than most other countries because of their population-based registers on diseases, demography and social conditions, linkable at the individual level by means of the unique ID-number given to all citizens. Exposure information is mainly collected by computer-assisted telephone interviews with the women twice during pregnancy and when their children are six and 18 months old. Participants are also asked to fill in a self-administered food frequency questionnaire in mid-pregnancy. Furthermore, a biological bank has been set up with blood taken from the mother twice during pregnancy and blood from the umbilical cord taken shortly after birth. Data collection started in 1996 and the project covered all regions in Denmark in 1999. By August 2000. a total of 60,000 pregnant women had been recruited to the study. It is expected that a large number of gene-environmental hypotheses need to be based on case-control analyses within a cohort like this.

Cohort Studies↗

PubMed2002

Carrying capacity as "Informed Judgment": the values of science and the science of values.

Contemporary park and wilderness carrying capacity frameworks rely on formulation of standards of quality, which are defined as minimum acceptable resource and social conditions. Formulation of standards of quality involves elements of both science and values, and both of these elements must be integrated into informed judgments on the part of park and wilderness managers. That is, managers must ultimately make value-based judgments about the maximum acceptable level of visitor-caused impacts to the resource base and the quality of the visitor experience. However, such judgments should be as informed as possible by scientific data on the relationships between visitor use and resulting impacts and the degree to which park and wilderness visitors and other interest groups judge such impacts to be acceptable. Such information represents the "values of science" to managing carrying capacity in parks and wilderness. A growing body of literature has begun to address the corresponding "science of values," and how this type of information might be integrated in park and wilderness management. Visitor-based research has employed normative theory and techniques to explore the acceptability of a range of resource and social impacts related to visitor use, and findings from these studies are being integrated into a body of knowledge and applied in management decision-making. Conceptual and methodological extensions of the normative approach are currently being explored in a variety of park and wilderness contexts, and new theoretical and empirical approaches are being adapted to address trade-offs inherent in carrying capacity. In these ways, the science of values is progressing to meet the opportunities and challenges of the values of science to park and wilderness management. The concept of carrying capacity, along with the theoretical and methodological approaches described in this paper, can be extended to a large number of natural resource and environmental issues.

Conservation of Natural Resources↗

PubMed1993

Helicobacter pylori in the pediatric patient.

H. pylori is the major cause of gastritis in children and adults. Studies in children have demonstrated a specific association between H. pylori and primary gastritis. H. pylori colonization of the gastric mucosa is also important in relation to the natural history of duodenal ulcer disease. Duodenal ulcers do not appear to relapse if H. pylori is cleared from the gastric mucosa. Because of the low incidence of duodenal ulcer disease in children, a multicenter study is required to demonstrate whether this finding is true in children. To date, no specific symptoms have been associated with the presence of H. pylori gastritis in children. H. pylori gastritis may therefore be an asymptomatic condition in the majority of infected children. Further studies in relation to H. pylori gastritis and symptoms in children will be important because it should be easier to identify specific symptoms in children than in adults. H. pylori gastritis in children can be diagnosed by obtaining antral biopsy specimens for culture and histologic study during upper gastrointestinal endoscopy. Serologic study is also a sensitive and specific indicator of H. pylori infection, provided that children's sera are used to standardize the assay. Noninvasive tests such as 13C urea breath tests are very attractive for use in children but are expensive. H. pylori can be cleared from the gastric mucosa in as many as 70% of children by using a combination of metronidazole or amoxicillin with colloidal bismuth subcitrate or bismuth subsalicylate. Studies in children are important in determining the epidemiology of H. pylori. Children in Western societies are not usually colonized. Infection becomes more common with increasing age. Children in underdeveloped countries and those living in poor social conditions in Western countries are much more likely to be infected at a young age. The reason for the increased prevalence of infection among these groups is not known. There is also significant intrafamilial clustering of H. pylori infection. Again, it is unclear why the organism is clustered within households and institutions. Future studies on children will be of importance in determining whether H. pylori gastritis is a cause of specific symptoms, the epidemiology of H. pylori infection, and the possible role of the organism in the natural history of gastric cancer.

Child↗

PubMed1989

Children of mentally ill mothers: social situation and psychometric testing of mental development.

Children of mothers who satisfied the Research Diagnostic Criteria of (1) Schizophrenia, (2) Alcoholism or Drug Use Disorder, (3) Major Depressive Disorder including Mania, (4) Unspecified Functional Psychosis, and (5) Other Psychiatric Disorder and children of obstetric controls were studied with regard to subsequent mental and behavioural development and social conditions. 72 index children and 17 children from the comparison group were examined at an approximate age of six years by a child psychologist. More index children than those from the comparison group showed impaired mental and behavioural development. The children of abusing mothers in particular tended to have a worse outcome. One-half of the index children were not living with their mothers at the time of follow-up.

Child↗

PubMed2003

[The fight against venereal diseases in different political systems].

The fight against venereal diseases (VD) has often been influenced by the prevailing political and social conditions. At the end of 19th century the increase of VD demanded new strategies. In 1902 the German Society for the Control of VD was founded in Berlin. It was then followed by the foundation of the International Society against VD in Brussels in 1899. In the German empire and during the Nazi regime, authoritarian structures dominated the strategies against VD. The individual had to submit the interests of the society. Sociopolitical aspects influenced the discussions in the fight against VD during the Weimar republic. In 1927 the new laws to control VD met liberal demands.

Communicable Disease Control↗

PubMed2000

Maternal separation followed by early social deprivation affects the development of monoaminergic fiber systems in the medial prefrontal cortex of Octodon degus.

The influence of early postnatal socio-emotional deprivation on the development of tyrosine hydroxylase- and 5-hydroxytryptamine-immunoreactive fiber innervation in the medial prefrontal cortex was quantitatively investigated in the precocial rodent Octodon degus. Forty-five-days-old degus from two groups were compared: (i) degus which were repeatedly separated from their mothers during the first three postnatal weeks and after weaning reared in complete isolation; and (ii) degus which were reared under normal undisturbed social conditions. The two monoaminergic fiber systems in the four subregions of the medial prefrontal cortex responded differentially to the deprivation. While the infralimbic cortex was the only subregion that displayed an increase in 5-hydroxytryptamine-positive fiber densities (129.2%) but no changes in tyrosine hydroxylase-immunoreactive fibers, the precentral medial (82.2%), anterior cingulate (74.6%) and prelimbic cortex (86.9%) showed significantly reduced tyrosine hydroxylase-positive fiber innervation, but no changes in 5-hydroxytryptamine-immunoreactive fiber densities. The number of tyrosine hydroxylase-positive somata in the ventral tegmental area and in the substantia nigra remained unchanged. In cortical areas the number of tyrosine hydroxylase-immunoreactive somata was increased (depending on the medial prefrontal cortex subregion between 241.8% and 398.7%) in deprived animals. This altered balance between the serotonergic and dopaminergic cortical innervation in the different subregions of the medial prefrontal cortex may reflect a counter-regulative anatomical and functional adaptation, which may be triggered by an altered activity of these transmitter systems during the phases of maternal separation and social isolation.

Animals↗