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PubMedDate not supplied

[Socio-economic inequalities and mental health. I. Concepts, theories, and interpretations].

AIMS: Reconstructing the models used for approaching the inequalities issues in health, identifying the most relevant theoretical and conceptual contributions. METHOD: Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch using the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002; integrated with manual search. The material was classified according to the conceptual and theoretical interpretative models or to the analyses of the association 'inequalities-health' where health was expressed as mortality, morbidity or services utilisation. RESULTS: Four different interpretative models about the genesis of inequalities were identified. Further theoretical developments overcome the distinction among conceptuals contrapositions selection versus causation, statistic artefactual versus real differences, individual behaviours versus material context. Since the 80's the concept of material deprivation has been enlarged to include social deprivation to explain health inequalities. The social exclusion is related to material deprivation and to social fragility enlarging the traditional aspects of poverty. The theories that better adapt to the psychiatric field are the social selection and social causation. CONCLUSIONS: The social exclusion and the new methodologies for measuring the inequalities seems to be an effective way for understanding of the inexplored aspects of the mental health inequalities.

Health Services Accessibility↗
PubMed2003

Where is psychology going? Structural fault lines revealed by psychologists' use of Kuhn.

Psychologists' appropriation of language and ideas from Thomas Kuhn's (1962, 1970b) The Structure of Scientific Revolutions reveals deep and contradictory concerns about truth, science, and the progress of the field. The author argues that psychologists, uncomfortably straddling natural and social science traditions, reference Structure for 2 reasons largely overlooked: first, because it presents an intermediate, naturalistic position in the war between relativist and rationalist views of scientific truth, and second, because it presents a psychologized model of scientific change. The author suggests that the history of this mutual influence--psychologists being influenced by Kuhn and vice versa--may usefully inform current practices of psychological science.

Forecasting↗
PubMed2004

Involving older people in intermediate care.

BACKGROUND: Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. AIM: This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. METHOD: The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. FINDINGS: The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. CONCLUSIONS: The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.

Aged↗
PubMed2000

How are policy makers using evidence? Models of research utilisation and local NHS policy making.

STUDY OBJECTIVE: This paper is based on a qualitative study that aimed to identify factors that facilitate or impede evidence-based policy making at a local level in the UK National Health Service (NHS). It considers how models of research utilisation drawn from the social sciences map onto empirical evidence from this study. DESIGN: A literature review and case studies of social research projects that were initiated by NHS health authority managers or GP fundholders in one region of the NHS. In depth interviews and document analysis were used. SETTING: One NHS region in England. PARTICIPANTS: Policy makers, GPs and researchers working on each of the social research projects selected as case studies. MAIN RESULTS: The direct influence of research evidence on decision making was tempered by factors such as financial constraints, shifting timescales and decision makers' own experiential knowledge. Research was more likely to impact on policy in indirect ways, including shaping policy debate and mediating dialogue between service providers and users. CONCLUSIONS: The study highlights the role of sustained dialogue between researchers and the users of research in improving the utilisation of research-based evidence in the policy process.

England↗
PubMed1980

Labeling theory and community care of the mentally ill in California: the relationship of social theory and ideology to public policy.

The practical merit of a labeling theory approach to mental illness is examined and assessed through an exploration of its application in terms of public policy, i.e., community mental health policy in the state of California since 1968. Primary focus is placed on the impact of the deinstitutionalization of mental health services in that state, and the release of former mental patients into the community. Similarities in the fundamental ideological underpinnings of labeling theory, an associated conspiratorial model of mental illness, and contemporary California mental health policy, are presented and examples of policy input by labeling theorists and researchers are detailed. The impact of the California policy on the mentally ill is generally negatively assessed in terms of three major criteria: (1) rehabilitation; (2) reintegration; and (3) quality and continuity of care. The "translation" of several theoretical misconceptions regarding mental illness, caused by putting labeling theory into official policy, is suggested to lie at the root of many of the policy's implementation problems. The uses of social science theory and research are discussed, and caution is advised in the translation and application of social scientific theory and research to public policy proposals and programs.

Attitude of Health Personnel↗
PubMed1997

The fear of (one's own) history: on the relations between medical anthropology, medicine and history.

Even though for most of medical anthropologists, history of medicine is far from their professional interest, that is not the case in South European and specially in Latin American medical anthropology. For us, history of medicine is a seminal point of academic discussion in the last two decades particularly in those anthropologists who work on the processes of health/disease/care linked to medicalization. Among others interesting consequences, common areas of interest develop. This article aims to explore a main obstacle to the full conquest of interdisciplinarity, namely the persistence of sabaltern discourses and practices related to medical history and to social sciences among the medical professions, which at the same time becomes also an artifact that led social scientists to misunderstand the image of medical history in medical practice.

Americas↗
PubMed1990

[The science of the art of medicine. Qualitative methods in medical research].

Qualitative research methods dominate in the humanities (history, literature), theology, law and some social sciences (ethnography). The authors claim that using such research traditions could expand the scientific field of medical research, and that qualitative methods can be tools for medical scientists to gain knowledge of matters that until now have been obscure. This article presents some characteristics of these research traditions: Qualitative researchers tend more often to formulate questions and hypotheses than provide answers. They produce arguments for a given result, and do not pretend to prove facts. The qualitative researcher works mainly with texts (documents, transcriptions of interviews etc.) not with numbers and statistics. The article presents a survey of qualitative research methods, and gives examples of the use of these methods in medical research in general practice. Finally the authors discuss the problems connected to using the concept of "science" in everyday medical practice.

Humanities↗
PubMedDate not supplied

Measuring subjective social status: a case study of older Taiwanese.

Despite widespread use of measures of social status and increasing interest in the relationship between social status and health, the variables used to denote social status are often inappropriate for use with older populations. This article examines responses to a recently developed measure of subjective social position, known as the MacArthur Scale of Subjective Social Status. The instrument asks respondents to use ten rungs of a ladder to position themselves socioeconomically relative to other people in their country and, separately, in their community. These questions were incorporated into a recent national survey of middle-aged and older adults in Taiwan. The objectives of the analysis were to gain a better understanding of how such subjective assessments are formed (i.e., to explore the contribution of social, economic, and cultural factors in the determination of position within a social hierarchy) and to assess the potential utility of the ladder instrument in social science and health research. This article compares results from Taiwan with those derived from subjective measures of social status in Western populations. The findings support use of the MacArthur Scale of Subjective Social Status as a measure of subjective social status among the older population and suggest that using it may provide further insights into the social gradient in health.

Aged↗
PubMed1984

Modifying and developing health behavior.

The literatures on both behavior modification and behavioral development have engendered innovations in public health programs, addressing problems of patient adherance to preventive and therapeutic regimens, delay in seeking diagnosis of illness symptoms, risk-taking behavior, and other aspects of lifestyle associated with health. Because most of this literature derives from psychology, there has been a distinct bias in the construction of interventions, pointing them directly at individuals, usually in a counseling or small group mode of delivery. These developments served public health well enough during a decade or so when the preoccupation was with utilization of health services and medical management of chronic diseases. With the publication of the Lalonde Report in Canada in 1974, the passage of Public Law 94-317 in 1976 in the United States, and similar initiatives in other English-speaking and European countries, the recognition of the greater complexities of lifestyle development and modification in the absence of symptoms has taken hold. Policy makers and public health workers seek a more efficient and equitable set of strategies to meet the behavioral health challenges of modern society without placing the entire weight of responsibility for behavior on the individual or on therapeutic practitioners. Concurrently, on a more global scale and in the developing countries, a concern has emerged for strategies that give individuals, families, and communities a greater role in deciding their own health priorities. The convergence of these two trends--one seeking to distribute responsibility for lifestyle more equitably and the other seeking to distribute responsibility for planning health programs more equitably --calls for policies, strategies, and interventions that will place similar emphasis on health education and organizational, economic, and environmental supports for health behavior. The combination of these elements of support for behavior calls, in turn, for research and more inventive applications of theory from sociology, political science, economics, and anthropology. Public health workers will need to become more conversant and facile in these social sciences, as they have in psychology and its applications in the recent past.

Adolescent↗
PubMed1996

Appraisal of Risk Perception in Occupational Health and Safety Research in Developing Countries.

This paper addresses scientists in the field of occupational health and safety, with a special emphasis on research in developing countries. The article is based on findings of and a method used in a recent study of occupational health and safety in mines in Africa and Latin America. Dialog between technical experts and social scientists is needed to synthesize the values of society and the facts of nature into policy decisions that are both politically legitimate and consistent with the current state of technical knowledge. The author asks how researchers in the field of occupational health can take two axioms of the social sciences into account: 1) the concept of human agency, and 2) the notion that risk perception is socially constructed: rather than being determined by "real" risks, it is shaped by the adversarial context of, among other factors, the nature of labor relations, values in society, and personal histories. With regard to first axiom, it is shown why actors' risk perceptions and their context need indeed to be taken seriously. With regard to the second, a methodologic outline is given to complement technical research on occupational hygiene with risk-perception appraisal. The method is actor-oriented, building on the perceptions, views, and opinions of the different groups of relevant actors. Systematic integration of this method into technological studies could enrich them, contributing substantially to their applicability.

Journal Article↗
PubMed1997

[Research on social support in health: current status and new challenges].

On the borderline between sociology and psychology, the concept of social support has made it possible to develop a whole research tradition aimed at explaining some of the differences existing in the distribution of mental and physical disease. The concept of social support itself, however, still presents some ambiguities which must be clarified. These problems are discussed and it is showed and shows that the topic can be enriched with the contribution of the social sciences. Different definitions of the concept itself, are briefly analysed and the complexity and multidimensional character of social support are highlighted. The association between social support and health is discussed. The differences and implications of the direct effect model and the buffering effect model are addressed, and the relevance of the construct of social support is enhanced. The need to study social support not only as a likely determinant of some forms of disease, but also as a dependent variable, is brought out. Some recent developments in the study of factors associated with the availability of social support are discussed. It is shown that social support is a product of certain social factors which can be clearly identified by sociological analysis. In order to illustrate this point, the structural determinants of a specific dimension of social support-attention-are discussed. The importance of structural variables like social class and gender in attempting to explain the differential distribution of certain forms of social support is emphasized. It is proposed, on the theoretical level, that the intersection between two related autonomous constructs-social class and social support-may better explain those aspects of these concepts that are of importance to observed heterogeneity in the distribution of mental and physical health. Different theoretical and methodological approaches to the understanding of the determinants of social support and its effect on health are suggested.

Humans↗
PubMed2000

Spencer is dead, long live Spencer: individualism, holism, and the problem of norms.

The debate between the advocates of sociological individualism and those of holism has been pervasive in the development of social theory. This debate is often situated in the false problems of sociology, since it is seen as a particular form of the perennial and irresolvable dilemma between social nominalism and realism, as well as between freedom and determinism. Nevertheless, the debate is far from over within contemporary sociology and other social science, as indicated by the resurgence of individualism in rational action theory and its repudiation by holistic social theories. The aim of this paper is to identify some modern variations on this theme as well as to discern certain common tendencies of two seemingly opposite theoretical perspectives, viz. the convergence upon a normative solution to the problem of social order. This convergence is therefore denoted normative convergence between sociological individualism and holistic sociology.

Freedom↗
PubMed2004

Predicting academic and National Board Dental Hygiene Examination performance based on Academic Factors.

PURPOSE: Numerous studies have explored reliable variables that predict student success in dental hygiene programs and on the National Board Dental Hygiene Examination (NBDHE). However, no studies were found using data collected since the NBDHE format changed in 1998 to investigate if traditional predictors hold true. The objective of this study was to examine the relationship between pre-admission requirements, basic college science requirements, site of academic preparation, cumulative dental hygiene grade point average (CDHYGPA) and the NBDHE score. METHODS: Data from the academic records of 173 graduates of the dental hygiene program at The Ohio State University from 1998 through 2002 were entered into an Excel spreadsheet using identification numbers. Demographic information for the description of the subjects, course transfer data, course grades in program prerequisites and basic science requirements, CDHYGPA, and NBDHE scores were entered. Data were analyzed using the Statistical Package for the Social sciences (SPSS-version 10), Pearson's r correlations, regression analysis, and ANOVA with a predetermined level of significance at .05. RESULTS: Of the 173 records entered, 132 had complete data (76.3%). Results indicate the existing prerequisites for the dental hygiene program remain strong predictors for success. A strong correlation was noted between human nutrition courses and the CDHYGPA. Other core science courses completed while in the program-anatomy, physiology and microbiology--also rendered a moderately strong correlation to the CDHYGPA. The greatest predictors for success on the NBDHE were the student's CDHYGPA and the prerequisite three science GPA. Consistency in site of science preparation also revealed a positive correlation to the CDHYGPA. CONCLUSIONS: This study confirmed the continued use of the three science GPA pre-requisite and entering GPA for predicting success in this dental hygiene program and on the NBDHE even after the format changed to include case-based items. Other predictors for success that were identified in the study may aide dental hygiene program admission committees in their selection process. These committees may also consider the site of science preparation noting that institution consistency played a role in academic performance.

Achievement↗
PubMed1999

Making the case for psychophysiology during the era of molecular biology.

The Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health opened in 1995 to facilitate the advancement of research on social and behavioral influences on health. The establishment of the OBSSR coincided with the ascendancy of molecular biology, with its emphasis on more reductionistic influences on health. This greater emphasis on genetic aspects of health has the potential to produce a widening chasm between biomedical research and social, behavioral, and psychological research. We discuss the chasm between sociobehavioral and biomedical research during what might be considered the era of molecular biology and propose the concept of levels of analysis as a unifying framework for research in the health sciences, using research on hypertension in African Americans as a representative example. We also argue for the primacy of psychophysiological research in bridging the chasm and furthering a multilevel perspective and summarize some of the activities of the OBSSR that are relevant to this perspective.

Animals↗
PubMed2003

Citation analysis and journal impact factors in ophthalmology and vision science journals.

Citation analysis has evolved over the last 50 years as one parameter for assessing the quality of research published in scientific, technology and social science journals. This is based on the assumption that influential research is widely cited by other scientists and clinicians. With the advent of the Internet, Journal Citation Reports from the Institute for Scientific Information (ISI-JCR) have become widely available to individuals and institutions. In an increasingly competitive research environ-ment, aspects of citation analysis have been suggested as simple proxy, objective measures to evaluate the research quality of a journal, published articles, research institutions and even individual researchers. This review article provides an overview of citation analysis, including definitions, uses of these reports, and related controversies and potential abuses. As it has become the most commonly used indicator, there is a particular focus on the use of the Journal Impact Factor (JIF). This is a widely quoted measure indicating the frequency with which the average article published in a journal of interest will be quoted within a specified time frame that therefore allows approximate comparisons of journals within a particular field of interest. Given the relative paucity of information in this area, emphasis is placed on citation analysis within ophthalmology, in particular in regard to the 43 ophthal-mology, vision science and optometry journals that are listed in the ISI-JCR 2001 reports.

Bibliometrics↗