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PubMed1989

Home care nursing: integration of politics and nursing.

Home care is an important player in the health care arena because of its desirability and potential for cost savings. Today, home care nurses are joining physicians, hospitals, and nursing homes at the table in policy discussions with government, business, insurers, and consumers. Home care nurses are speaking up and demanding a piece of the health care pie, on behalf of their patients. By virtue of their frontline position in the community, on the street, and in the patient's home, home care nurses are often the first to see unmet needs or identify inequities. They are taking these to the public, if needed, to effect the necessary change to ensure access, promote quality of care, and improve quality of life. They are also holding payers, such as government, accountable when promises to patients are broken. Home care nurses are doing what they have always done, doing what they have to do to find services for patients. Today that means becoming political.

Aged↗
PubMed1993

Informal carers: a Marxist analysis of social, political, and economic forces underpinning the role.

Increasingly, families are being called to provide care to their elderly family members. Nursing has an important role to play in enabling families to assume such responsibilities. In this article, however, it is argued that nursing needs to examine its goals for nursing care and approaches to care delivery in their broader social, political, and economic context. Marxist theory is introduced and used to raise questions about taken-for-granted aspects of nursing practice and trends in health policy as they relate to family carers for the elderly. The article specifically examines assumptions about family, women, and household economies that are inherent in traditional nursing theory. It is argued that nursing needs to move its focus of action beyond work at the individual and family level to include work at system and policy levels. To do so, nursing must examine theoretical perspectives that enable such an inquiry into practice.

Aged↗
PubMed2000

Thermophilic bacteria strictly obey Szybalski's transcription direction rule and politely purine-load RNAs with both adenine and guanine.

When transcription is to the right of the promoter, the "top," mRNA-synonymous strand of DNA tends to be purine-rich. When transcription is to the left of the promoter, the top, mRNA-template strand tends to be pyrimidine-rich. This transcription-direction rule suggests that there has been an evolutionary selection pressure for the purine-loading of RNAs. The politeness hypothesis states that purine-loading prevents distracting RNA-RNA interactions and excessive formation of double-stranded RNA, which might trigger various intracellular alarms. Because RNA-RNA interactions have a distinct entropy-driven component, the pressure for the evolution of purine-loading might be greater in organisms living at high temperatures. In support of this, we find that Chargaff differences (a measure of purine-loading) are greater in thermophiles than in nonthermophiles and extend to both purine bases. In thermophiles the pressure to purine-load affects codon choice, indicating that some features of their amino acid composition (e.g., high levels of glutamic acid) might reflect purine-loading pressure (i.e., constraints on mRNA) rather than direct constraints on protein structure and function.

Adenine↗
PubMed1998

Mad King George: the impact of personal and political stress on mental and physical health.

Both historians and psychiatrists have tried to explain the recurrent attacks of mental and physical illness experienced by King George III of Great Britain. Although the porphyria hypothesis is widely accepted, this diagnosis assumes that the king's breakdowns were not precipitated by extreme stress. This assumption was tested using single-case historiometric methods. Biographical data were compiled to form two extensive chronologies of the monarch's life, one for stressful events and the other for pathological symptoms. From this information 22 independent judges reliably assessed fluctuations in stress (total, personal, and political) and health (total, physical, and mental) across 624 consecutive months between 1760 and 1811. The cross-correlations were then calculated for the raw, first-differenced, and prewhitened time series. A consistent tendency appeared for the king's health to deteriorate after increases in stress, most frequently with a 9-month delay. The current study demonstrates the utility of applying quantitative techniques to a psychobiographical debate hitherto examined solely by qualitative approaches.

Data Interpretation, Statistical↗
PubMed1997

Doing the right thing: relief agencies, moral dilemmas and responsibility in political emergencies and war.

In recent years a new generation of relief workers and relief agencies has become embroiled in the heat of civil wars and political emergencies, and the humanitarian community has had to revisit its fundamental principles and address the ethics of what it does. This paper sets out to continue this important debate by emphasising that ethical analysis should always be an essential part of humanitarian practice. The paper seeks to recognise the difficult moral choices relief agencies are facing today and gives some practical guidelines to relief agency staff when confronting the ethics of a given situation. In particular, it hopes to introduce some ethical principles into the debate about humanitarianism and contribute to the moral vocabulary which is being developed to improve relief agencies' ethical analysis. The paper starts by looking at the essential characteristics of a moral dilemma, and the way in which other types of tough choice can masquerade as moral dilemmas. It then introduces some basic moral principles surrounding the key ethical notions of action consequences and moral responsibility in an effort to show how relief agencies might begin to develop a process of ethical analysis in their work. Finally, it explores how relief agencies might develop a more intuitive form of ethical analysis based on an organisational conscience and moral role models.

Decision Making↗
PubMed1984

Doctor-patient communication: a social and micro-political performance.

In the United States the medical relationship is asymmetrical. Doctors not only control medical knowledge, they also have an institutionally based authority which allows them to act as gatekeepers, providing options to some while denying them to others. This study, conducted in a model family practice clinic of a teaching hospital, examines how decisions to do, or not to do, Pap smears are negotiated as residents and a potentially high-risk group of patients communicate. Decision-making occurs in layered phases--opening, medical history, physical examination, and closing. Each phase expresses the doctor's control and the patient's trust. Doctors initiate phases, develop topics and make key choices. They decide when patients undress--a choice which shapes the later Pap smear decision. Decisions to undress patients and to perform Pap smears or decisions not to undress patients and not to perform Pap smears produce no conflict. When there is a conflict, avoidance strategies--bowing to higher-level specialists, selling and unselling, and letting silence speak--are used negotiating devices. The doctor's choice and the patient's agreement produce a specific and a more general outcome--managing the presenting complaint and providing medically adequate health care, respectively. Although interactionally accomplished, these outcomes are institutionally constrained, and, thus are both a social and a micro-political performance.

Female↗
PubMed2003

Vulnerability and risk: some thoughts from a political and policy perspective.

Public policies to mitigate the impacts of extreme events such as hurricanes or terrorist attacks will differ depending on whether they focus on reducing risk or reducing vulnerability. Here we present and defend six assertions aimed at exploring the benefits of vulnerability-based policies. (1) Risk-based approaches to covering the costs of extreme events do not depend for their success on reduction of vulnerability. (2) Risk-based approaches to preparing for extreme events are focused on acquiring accurate probabilistic information about the events themselves. (3) Understanding and reducing vulnerability does not demand accurate predictions of the incidence of extreme events. (4) Extreme events are created by context. (5) It is politically difficult to justify vulnerability reduction on economic grounds. (6) Vulnerability reduction is a human rights issue; risk reduction is not.

Journal Article↗
PubMed2007

Political-economic values and the relationship between socioeconomic status and self-esteem.

Values concerning the distribution of wealth are an important aspect of identity for many Americans, and such values may therefore influence how Americans experience their own socioeconomic status (SES). Based on this proposition, the present research examines political-economic values as a moderator of the relationship between SES and self-esteem. Results supported the hypothesis that there is a stronger relationship between SES and self-esteem among individuals who report relatively inegalitarian values than among individuals who report relatively egalitarian values. This result was replicated using both objective and subjective measures of SES. Implications of the present findings for the study of values and well-being, psychological conflict, and the influence of economic factors on self-esteem are discussed.

Adult↗
PubMed2006

Tactful or doubtful? Expectations of politeness explain the severity bias in the interpretation of probability phrases.

When a statement about the occurrence of a medical condition is qualified by an expression of probability, such as the word possible, listeners interpret the probability of the condition as being higher the more severe the condition. This severity bias can have serious consequences for the well-being of patients. We argue that the bias is due to a misconception of the pragmatic function served by the expression of probability. The more severe the condition, the greater the chance that the listener construes the expression as a politeness marker rather than as an uncertainty marker. When this misconception does not occur, neither should the severity bias. An analysis of interpretations of probability expressions using a membership-function approach validates this account. We discuss the consequences of this bias for the communication of risk within and outside the medical domain.

Adult↗
PubMed1997

The social, economic and political impact of the global HIV/AIDS epidemic.

OBJECTIVES: This paper reviews the themes emerging from reports of the many social, economic and political effects of the HIV/AIDS epidemic on individuals, nations and the world. The impact of the global HIV/AIDS epidemic has been felt in every facet of society. APPROACH: The impact of the epidemic is described in five areas: (1) challenges and changes to traditional public health approaches to infectious diseases and sexually transmitted diseases; (2) adjustments to 'standard' clinical research and drug regulatory practices; (3) emphasis on the importance of personal behaviors and behavioral approaches in controlling the epidemic; (4) revealing the complexity of and recognizing the need to monitor the impacts of HIV/AIDS; and (5) highlighting the difficulties of, and need for, the international responsiveness to address HIV/AIDS. The oral health community's response to the epidemic is briefly described. CONCLUSIONS: Although in its second decade, the epidemic is still in its early stages of evolution. The challenges lie in the development and perpetual evolution of strategies to respond to the epidemic locally while thinking and acting globally. The international oral health community is one of many that has played and must continue to play an active role in a multi-disciplinary effort needed to curb this epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Chiropractic and the politics of health care.

Musculoskeletal disorders remain a common disability suffered by Australians, but the question of who should treat them remains a contentious issue as the first centenary of the original chiropractic adjustment approaches. This paper, part of a longitudinal study of the role of chiropractic in the Australian health system, analyses this ongoing debate. Recent events are analysed here in this commentary on the politics of health care in this field. These include meta-analysis to evaluate the effectiveness of spinal manipulation for the treatment of lower back pain, recent legal action in the United States, and the recent epistle against Australian chiropractors published by the Australian Medical Association.

American Medical Association↗
PubMed1996

DWARF BUNT: politics, identification, and biology.

Dwarf bunt is a disease of wheat caused by the smut fungus Tilletia controversa Kuhn. Winter wheat (Triticum aestivum L.) is the primary host of economic significance. Although the total acreage affected by dwarf bunt is small relative to total wheat production worldwide, the disease has assumed attention disproportionate to its economic impact because it has become a matter of contention in world trade in cereals. This review describes the political and economic issues underlying the study and identification of T. controversa.

Journal Article↗
PubMed2005

Clinician/patient connections in ethnoculturally nonconcordant encounters with political-asylum seekers: a comparison of physicians and nurses.

The article compares the ability of nurses and physicians to connect with patients in ethnoculturally nonconcordant clinical encounters with 41 randomly selected political-asylum seekers (PAS) residing at five Finnish reception centers in summer 2002. Doctors and nurses were equally unlikely to draw congruent assessments of the patient's past and present health condition, mixed use of biomedical/ethnocultural practices, adherence with medication and eat/drink instructions, (dis)satisfaction, and future confidence in recommended biomedical and ethnocultural approaches. Nurses were considerably more likely to hold views that were congruent with the patient's reported health care effectiveness in Finland. The findings suggest that doctors should request and place special weight on the insights of the principal attending nurse when assessing the potential contributions of personal, family, and host-society health care assets and inhibitors to a migrant patient's overall health plan. The results also suggest that culturally sensitive health care training offers specific advantages to nurses who attend to PAS.

Adolescent↗
PubMed2003

Health promotion policy and politics: lessons from childhood injury prevention.

Health promotion policies--including laws that regulate safe products, environments, and behaviors--are among the most effective mechanisms for reducing childhood injuries for large segments of the population. In this article, five examples of safety legislation and regulation to reduce childhood injury are described. Two such efforts are aimed at preventing injury-producing events from occurring: child-resistant packaging for medications and hazardous substances, and graduated licensing for teen drivers. Three other examples illustrate the value and complexities of policies designed to prevent an injury once a hazardous event has occurred: bicycle helmet legislation, children's sleepwear standards, and child safety seat laws. One important role of health promotion is to tackle not only how health promotion policies and politics can improve child health, but also how to educate legislators and policy makers in the process.

Accidents, Traffic↗
PubMed2005

Striving for congruence: the interconnection between values, practice, and political action.

In the current U.S. health care system, both good health and a higher quality of health care are more likely to be experienced by those who have access to money, power, and privilege. Consequently, serious health disparities exist between the rich and poor, White people and people of color, and men and women. The American Association of Colleges of Nursing (AACN) has made explicit the values that form the cornerstone of professional nursing: altruism, autonomy, human dignity, integrity, and social justice. In this article, the authors explore the interconnections between values explicated by the AACN and nursing practices and policies. The authors draw on work in the field of pain management, cultural competency, and harm reduction as exemplars of this interconnection. The authors propose that through political action, nurses can strive for congruence between their professional values, practice, and policies and subsequently effect change and improve health outcomes.

Education, Nursing↗
PubMed1989

The politics of organ transplantation: a parable of our time.

This paper reviews the historical development of federal government policy for kidney, heart, and liver transplantation. It examines several political dimensions of whole organ transplantation: the role of the print and broadcast media; the management of organ procurement; the certification of transplant centers; the evaluation of new surgical procedures; and the issues of financing, distributive justice, and rationing of scarce medical resources. The author finds that the media, though powerful in affecting transplant policy, have not been subjected to critical analysis. Organ procurement modifications, driven by a need orientation toward closing the gap between actual and desired levels of performance, may have adversely affected performance. The case of liver transplantation suggests the need for improved institutions and mechanisms for evaluating new surgical procedures. Finally, states that confront the need to meet a binding budget-balancing requirement may allocate funds away from expensive medical procedures that benefit the few toward basic services that benefit the many; the Oregon and Virginia Medicaid programs exemplify this point.

Certification↗
PubMed1990

The politics of universal access: the Massachusetts Health Security Act of 1988.

This article analyzes the passage of an unprecedented state law, promising every resident access to affordable health insurance. The Massachusetts Health Security Act of 1988 was the product of a set of political and financial pressures that had been developing for nearly a decade. Hospital, insurance, and business interests were unable to reach a new accommodation on hospital payment. This logjam created the opportunity for a policy breakthrough, but did not inherently lend itself to progressive reform. It was consumer activism that forced the traditional powers in health policy to address the interests of the uninsured. By imposing a more public-interest agenda on the process, consumers were able to change the configuration of the stalemate, but could not resolve it. The particular terms of the stalemate, however, made possible a new, more aggressive role for state government in health policy. Unable to satisfy their competing interests within a policy framework that had universal access as a goal, traditionally powerful interest groups found themselves increasingly dependent on the state to broker a new agreement. While the many concessions made to these groups are likely to prove to be the bill's undoing, the unraveling of the agreement will not end the story. The same pressures which led to passage of the Massachusetts law and which are now causing other states to act will continue to exert their effect until a more durable solution is found.

Health Services Accessibility↗