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PubMed2001

Theory and practice in epidemiology.

Scientific and ethical theories are examined in terms of the practice of epidemiology, the study of the determinants and distributions of disease, and the application of the knowledge gained to prevent disease and improve the health of populations. Scientific theories provide explanations and predictions for epidemiologic studies of disease etiology and prevention. Causal theory is the key example for epidemiologic science, although theories of selection processes, theories of health, and theories of probability and statistics are also core. Theories of ethics provide principles, warrants, and methods for acting upon the knowledge gained in the scientific pursuits of epidemiology and for obtaining that knowledge appropriately. Ethical theories guide practitioners in making justified decisions about when and under what conditions public health interventions should be undertaken and how research participants should be treated. Theories of midlevel bioethical principles have received the most attention in epidemiology, but other theories, such as virtue theory and communitarian theory, are also relevant. Many theories matter to the practice of epidemiology: theories of biology, aging, evolution, and medicine; theories of history, religion, law, economics, and politics, as well as the theories of the physical, behavioral, and social sciences. These theories matter because epidemiologists study many different biological and social phenomena, and preventive interventions occur at many different levels of explanation. Development of theory is not a high priority in contemporary epidemiology. Identifying the responsibilities of the discipline to be public health intervention and rigorous science is a first step toward developing and applying theory in epidemiology.

Causality↗
PubMed1991

Factors associated with success among southern Cheyenne and Arapaho Indians.

Researchers in applied social science are seeking ways of approaching the facilitation of community-based development at the grass-roots level. Much research to date has focused on negative social aspects in communities, such as substance abuse and high numbers of school drop-outs. An innovative approach was developed that involved looking instead at successful individuals in communities. Individuals identified as successful were interviewed about the factors they associated with their own success. The experience of supportive parenting during their childhoods and moderation in alcohol and other substance use as adults were strongly correlated with success in life. The interview process provided an effective springboard for discussions and the development of intervention strategies at the community level.

Achievement↗
PubMed1986

Sociological concepts in the etiology of chronic disease: the case of ischemic heart disease.

This paper first gives a selective and critical review of conventional sociological variables included into epidemiologic and clinical studies of ischemic heart disease (IHD). In a second section, links between social and biological processes are discussed, and a conceptual sociological approach is developed which relates critical experiences of active distress to impaired long-term control of social status. This approach is elaborated to some extent in order to illustrate possible avenues of future research which strengthen cross-fertilization between medical and social sciences.

Adaptation, Psychological↗
PubMed1997

Race and health: basic questions, emerging directions.

PURPOSE: This paper examines the scientific consensus on the conceptualization of race, identifies why health researchers should analyze racial differences in morbidity and mortality and provides guidelines for future health research that includes race. METHODS: Examines scientific dictionaries and reviews the social science, public health and medical literature on the role of race in health. RESULTS: First, this paper reviews the evidence suggesting that race is more of a social category than a biological one. Variation in genotypic characteristics exists, but race does not capture it. Second, since racial categories have historically represented and continue to reflect the creation of social, economic, and political disadvantage that is consequential for well-being, it is important to continue to study racial differences in health. Finally, the paper outlines directions for a more deliberate and thoughtful examination of the role of race in health. CONCLUSIONS: Race is typically used in a mechanical and uncritical manner as a proxy for unmeasured biological, socioeconomic, and/or sociocultural factors. Future research should explore how clearly delineated environmental demands combine with genetic susceptibilities as well as with specified behavioral and physiological responses to increase the risk of illness for groups differentially exposed to psychosocial adversity.

Culture↗
PubMed1980

The medical model-why psychiatry is a branch of medicine.

With a perspective from evolutionary biology and a view of the philosophy of science as described by Popper, various models of psychiatry are discussed. It is concluded that any satisfactory model must be a synthesis of the biological, psychological and social. It is argued that the concept of diagnosis is the core of the medical model, and that psychiatry is a branch of medicine, and not a social science, because the biological aspect is very important.

Autistic Disorder↗
PubMed1998

Major medical explanations for high infant mortality in nineteenth-century Europe.

Statistics initially developed as a recognized field in the social sciences in the middle of the nineteenth century. The European medical profession first made use of mounting statistical evidence to dramatize infant mortality, one of the great social problems of the century. Those telling statistics amply demonstrated the general proportions of the problem as well as pinpointing the fact that a large percentage of the dying was neonatal in character. The medical profession also insisted that these infants were passing away from a series of ailments. Number one on their list was what they called debility, followed by respiratory disorders, gastro-intestinal problems, and convulsions. While nineteenth-century European medicine did not necessarily solve this social problem, it did evidently convince the larger society that these high tolls were morally unacceptable.

Cause of Death↗
PubMed2003

Social work and the law: a therapeutic jurisprudence perspective.

Social workers in all practice areas are affected by interactions with the law and legal systems. Unfortunately, the profession has paid inadequate attention to education, scholarship, and practice in legal environments. This article introduces a new perspective for examining social work and the law called "therapeutic jurisprudence," which emanates from psychology/mental health law. Therapeutic jurisprudence focuses on the therapeutic and antitherapeutic consequences of laws, legal rules, and legal actions. It provides a framework for assessing legal issues, applying social science research to legal questions, and structuring interventions in the legal environment. The authors argue that this perspective has the potential to serve as a lens through which social workers can view the law and, ultimately, use the knowledge gained to achieve better outcomes for clients.

Consumer Advocacy↗
PubMed1989

Sibling relationships in old age: a typology.

Sibling interactions in old age have received limited attention in social science literature. This article examines the different kinds of relationships which exist between siblings in old age and the ways in which each type meets or ignores the social and psychological needs of older people. Five types of sibling relationships emerged from data collected in open-ended, exploratory interviews with thirty men and thirty women over the age of sixty-five who had at least one living sibling. Each type reflects a discrete pattern of instrumental support, emotional support, and contact, as well as a different degree of closeness, envy, resentment, approval, and involvement with the sibling. The distribution of same-sex and cross-sex dyads among the types suggests gender differences in sibling interactions based on the gender composition of the sibling dyad rather than on the gender of the respondent.

Aged↗
PubMed1981

Critical issues and experiences in drug treatment and prevention evaluation.

The present paper considers major perspectives on behavior that are prevalent in the social sciences and shows how these relate to divergent conceptions of the people who use various substances and the ways in which drug taking is associated with individuals' personal, social, and cultural experiences. This discussion will enable us to develop an ethnographically informed, social context model of drug use which sees substance use as motivated, adaptive behavior that is pursued in the consummation of valued experiences. Discussion next turns to reviewing relevant drug treatment and drug education/prevention literature, as well as the experiences of the author, that have informed the development of the frame of reference the paper emphasizes. In this process a coherent way of approaching the relationships individuals may establish with drugs and strategies for drug treatment and education/prevention efforts are set out.

Goals↗
PubMed1997

Disclosures and refutations: clinical psychoanalysis as a logic of enquiry.

The author argues that the empirical status of psychoanalysis has been distorted by the controversy surrounding Aristotelian and Galilean-Newtonian schemes of science, whose core ideas, respectively, are scientific concepts or forms and scientific laws. Bound by the Euclidian axiomatic tradition, Newtonian-style 'laws' do not obtain in the social sciences, and in biology they apply only at near-molecular levels, not at the level of mind. Continuing the traditional Aristotelian reliance on 'exemplars', neither Freud's nor Darwin's work fits the deductivist, infallibilistic scientific criteria used by philosophers such as Tarski, Popper or Grünbaum. Rebutting the charge that the workings of psychoanalysis are not explicit enough, this paper unfolds the logic of enquiry it utilises. In contrast to Newtonian inductivism, Popper's method of conjectures and refutations and Lakatos's method of proofs and refutations, clinical psychoanalysis employs a 'practical logic' of disclosures and refutations, a constantly evolving enquiry of multi-layered and tentative evidence of discordance and analogy. Such epistemic fallibilism, relying on a build-up of ostensive evidences rather than on 'certainties', is illustrated in the text by Moore's famous 'two-hands' argument, is held to fit in with the workings of everyday discernment and, arguably, with Darwinian evolution.

Humans↗
PubMed2004

Integrating the social and behavioral sciences in an undergraduate medical curriculum: the UCSF essential core.

Dramatic global-migration patterns over recent decades have forever changed the racial, ethnic, social, and cultural makeup of the people of the United States. Simultaneously, the patterns of disease and risk factor distribution within the U.S. population are changing in ways that accentuate the role of lifestyle, behavior, and social and economic differences in the onset and outcomes of disease. Medical school curricula must prepare students to address these demographic realities. The University of California, San Francisco's (UCSF's) redesigned curriculum, launched in September 2001, integrates social, behavioral, and biomedical science education in an early and sustained way. The traditional undergraduate medical structure of two years of basic science plus two years of clinical rotations was replaced with a model divided into three stages spanning four years: the Essential Core, the Clinical Core, and Advanced Studies. The authors summarize the role of the social and behavioral sciences in the UCSF Essential Core-the first 16 months of instruction divided into integrated blocks, each centered on clinical cases. Basic thematic areas (e.g., behavior change, health disparities), content illustrations (e.g., Introduction to the Biopsychosocial Model, The Culture of Medicine), and process considerations (e.g., integration, content order, evaluations) are presented. Special challenges and limitations are also discussed.

Behavioral Sciences↗
PubMed1993

Toward a social theory of psychiatric phenomena.

This essay relies on a positivistic/scientific perspective to define psychiatric phenomena. However, it draws a distinction between a biomedical versus a social science approach. The aim is to review some of the theoretical and empirical considerations that pertain to psychiatric phenomena that need to be addressed in order to develop a social theory about them. The object of the theory is to explain how psychiatric phenomena are labeled, interpreted, and handled across societies that differ in terms of social structure and culture. Some of the kinds of variables and questions that would allow for cross-cultural analyses are identified. In addition, two topics that a social theory could address--that of the medicalization and stigmatization of psychiatric phenomena--are introduced. These topics are elaborated by developing propositions that substantively illustrate the questions/hypotheses of a social theory of psychiatric phenomena. The essay illustrates that a social theory constitutes a complex enterprise that requires dealing with philosophical, methodological and empirical issues.

Attitude↗
PubMed2004

[The possibilities of scientific education through the scientific articles of Budapest papers in the second half of the 19th century].

Enlightenment in health issues has always been a structural part of the generally meant healing activities. The ways of addressing the people changed along with the centuries: the press was the right medium to inform wide masses of different classes of people in the 19th century. The feuilleton was one of the popular styles used by the press, nevertheless it grew out of it's classical frames, and gained the most various themes during the second half of the century. So the feuilletons on natural sciences written by medical doctors about health issues appeared as well. These writings represent the natural sciences' knowledge of the comfortable and popular sort of positivism and national program spanning from Zsigmond Kemény to Eötvös, where the reader has to feel it's practical use in the everyday life. It is the scientific knowledge that is interpreted through these feuilletons on the first place, but on the other hand a specific way of reception of natural sciences can be traced by them. Their particularity lies at the intersection of the most possible subjective description of the objective facts: possible historical readings of medical, literary and social sciences. This paper tries to catch these moments through the feuilletons of István Apáthy, Tihamér Balogh and Miklós Dubay.

Health Education↗
PubMed1994

Categories of social relationship.

The study of social relationships lies at the heart of the social sciences, but our understanding of the cognitive structures that support them has received little attention. This paper develops an account of the form and content of these structures, arguing that social relationships are represented by a small number of categories, rather than by dimensions as proposed by others. Taxometric analyses demonstrated that categories proposed by Fiske (1991) are truly discrete, controverting dimensional representation and one possible form of prototype structure. The categories appear to combine in the specification of actually existing social relationships, and are more informative, or "basic", then colloquial relationship categories.

Adult↗
PubMed1989

Conceptual and methodological problems in research on the quality of life in clinical medicine.

This introductory paper discusses three issues: theory, validity of measurement and benefits of assessment. It is argued that the conceptual entity 'quality of life' remains ill-defined, although researchers commonly agree on its multi-dimensional nature. The selectivity of dimensions under study is illustrated by referring to recent work on the quality of life in cancer and in cardiovascular disease. Despite conceptual weaknesses, promising developments are apparent in research methodology. The issue is discussed with special reference to the convergent and discriminant validity of some widely used research methods. Improvements in therapy and patient-physician relationships are considered among the major benefits of assessing the quality of life in clinical practice. In conclusion, this field of research, if based on appropriate theory, opens important opportunities for cross-fertilization between advanced medicine and the social sciences.

Behavioral Research↗
PubMed2002

The death of "Till death us do part": the transformation of pair-bonding in the 20th century.

During the last half of the 20th century within Western civilization, for the first time in human history, divorce replaced death as the most common endpoint of marriage. In this article I explore the history of this death-to-divorce transition, the forces associated with the transition, and what the transition may have revealed about the human capacity for monogamous, lifelong pair-bonding. The impact and consequences of the transition for the generations that came of age during it and immediately afterwards are examined, with particular attention to the emergence of new, alternative pair-bonding structures such as cohabitation and nonmarital co-parenting. The article highlights the inability of the dichotomous marriage-versus-being-single paradigm to encompass the new pair-bonding structures and the normalizing of divorce. Precepts for a new, more encompassing, veridical and humane pair-bonding paradigm are presented, and some of their implications for social policy, family law, social science, and couple and family therapy are elaborated.

Divorce↗