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PubMed2005

Evidence-informed education in the health care science professions.

The use of evidence to inform the practice and policy of professional education in the health care sciences is taking on an increasingly important role alongside the use of more traditional types of knowledge. It is an addition to the repertoire in this and many professions that draw on social-science discipline knowledge. In the field of health care science professional education, the Best Evidence Medical Education Collaboration (BEME) leads the movement toward evidence-informed practice. It is a movement not without controversy, and lively debate on epistemological and practical issues is in progress. With publication of the first BEME Reviews in 2005, this debate will be extended. We can expect energetic and healthy commentaries on both the review process and the substantive findings. All this will make a valuable contribution to an important aspect of professional education practice and policy that is here to stay.

Animals↗
PubMed1999

Socioeconomic aspects.

Most surgeons conceptualize "surgical advance" as the introduction of a new operative technique or the presentation of a technologic breakthrough. However, the true landmark innovations of the past decade, with regard to effecting surgical health care delivery, have been the impact of economics and sociology in determining the profession's future. In the past, the surgeon's primary interests revolved around the art and science of surgery, and socioeconomic issues were deemed of secondary importance. Consequently, few of the investigations into "surgical socioeconomics" were conducted by surgeons, and the surgical establishment was more than mildly apathetic toward such social science research. All of this has changed, and it is now evident that there is an overwhelming need for surgeons to incorporate an understanding of sociologic and economic conditions into their clinical thinking. Basic tenets of surgical socioeconomics are presented, and their impact on various clinical situations is discussed.

Cholecystectomy, Laparoscopic↗
PubMed1996

Shared understandings for informed consent: the relevance of psychological research on the provision of information.

The achievement of informed consent from patients and potential research participants is considered a basic requirement in clinical care and clinical research, but ethicists have paid little attention to the psychological processes and social factors involved in sharing information between individuals. Although many studies on consent have provided useful results, they are rarely informed by basic research in the social sciences. As a result, there are a large number of methodological and conceptual issues which have not been adequately addressed. The purpose of this paper is to illustrate how the work of cognitive and social psychologists can provide insights that are both relevant and valuable to the process of attaining consent. Research in these areas within psychology has indicated that there are important individual differences in how much information people require and that patients' current state of mind can affect estimates of probability, thus making analogue studies misleading. Collaboration between psychologists and ethicists would be of great value in identifying likely areas of mutual interest, particularly the choice of language in consent forms and information sheets, the design of consent forms, the amount of information provided, and the specification of risks and benefits.

Data Display↗
PubMed2002

Total internal reflection: an essay on paradigms.

INTRODUCTION: This paper presents a personal view of the relationship between science and the humanities within medical education, arguing for a more even balance between the two. This view stems from the author's recent experience of exploring the literature of learning theory and the social sciences. BACKGROUND: For historical reasons, medical education is dominated by a positivistic paradigm which assumes the existence of a single objective external reality. This can seduce us into believing that positivism is not a paradigm at all, but simply how the universe really is. Clinical practice, however, takes place in a much less certain world, where reconciling different interpretations of truth is an everyday necessity. This paper outlines the perils of uncritical adherence to a traditionally 'scientific' mode of thinking. TOTAL INTERNAL REFLECTION: In physics, total internal reflection is a phenomenon whereby light is reflected from the surface of a liquid without penetrating it, thereby making it impossible for anyone within a pool of water to see outside it. The author uses this concept as a metaphor to describe a limitation of perspective which characterises orthodox medical training, cutting students off from valuable sources of insight and understanding. CONCLUSIONS: Medical education often fails to provide learners with the tools they need to interpret the literature of other disciplines. In particular, it ignores the importance of recognising different perspectives. The paper ends by pleading for a more inclusive approach to alternative paradigms within our educational system.

Cultural Diversity↗
PubMed1997

Theory, explanation, and a third generation of theoretical development in social gerontology.

Efforts at cumulative knowledge building in social gerontology have been lax, judging from research articles published in journals between 1990 and 1994. Too little attention has been paid to the cumulative development of theory; readers are left with many empirical generalizations but underdeveloped explanations by which to interpret findings and build upon them in subsequent research. To assist future theory development in social gerontology, we review seven theoretical perspectives referenced most frequently in recent journals: (1) social constructionist, (2) social exchange, (3) life course, (4) feminist, (5) age stratification (age and society), (6) political economy of aging, and (7) critical theory. We suggest that, taken together, these represent a "third generation" of explanation in social gerontology, noting their debt to older and more established traditions in social science theory. We argue that authors and journal reviewers should place more emphasis on theory development - which means, most simply, the construction of explicit explanations in accounting for empirical findings - if knowledge development about social aspects of aging is to be cumulative, systematic, and incremental.

Aging↗
PubMed2002

What do we know about socioeconomic status and congestive heart failure? A review of the literature.

OBJECTIVE: To examine and assess the available literature concerning the effects of socioeconomic status (SES) and congestive heart failure (CHF). STUDY DESIGN: We examined electronic databases, including: MEDLINE, EMBASE, Social Science Citation Index, Science citation index, the Cochrane Database, and Bandolier. We hand searched recent copies of appropriate journals and scrutinized lists of identified papers. The search terms we used included "heart failure," "cardiac failure," "ventricular dysfunction," "social class," "socioeconomic," "poverty," and "deprivation." Two reviewers independently examined and selected papers for inclusion. A standardized data collection form was used for data extraction. OUTCOMES MEASURED: We measured (1) prevalence; (2) differences in care (eg, use of diagnostic tests); (3) morbidity (eg, health care use); and (4) mortality. DATA SOURCES: We examined all English-language abstracts or papers concerning human research related to the subject of SES and CHF, including all clinical trials, reviews, discussion papers, and editorials. RESULTS: Only 8 clinical studies were identified that specifically examined aspects of the relationship between socioeconomic status and CHF. Key themes included increased hospitalization rates with increasing social deprivation; lower income inversely associated with being placed on a waiting list for transplantation; and that those of lower socioeconomic status had a greater severity of illness on admission. CONCLUSIONS: There is a paucity of generalizable high-quality research in this subject area. Crucial issues not addressed include the effects, if any, of socioeconomic status on the behaviors of health care providers. Further investigation, with a more holistic approach, is necessary to inform future intervention strategies aimed at reducing excess mortality from CHF.

Health Services↗
PubMed1993

Life in the hospital: a review.

The ethnographic study of hospitalized patients' social worlds and individual experience, a once flourishing research tradition, has now largely vanished from the literature of social science. The disappearance of this tradition is accounted for by changes in the character of hospitals--decreasing lengths of stay, expansion of specialized units, and medicine's increased technical sophistication--that have weakened patients' social worlds and, perhaps, made patients' experience less consequential for health outcomes. If the ethnographic study of hospital patients is revitalized, it will take shape around a view of the patient as a newly empowered participant in decision-making processes.

Anthropology, Cultural↗
PubMed1985

The interrelationship of tropical disease and mental disorder: conceptual framework and literature review (Part I--Malaria).

Substantial interactions between tropical diseases and psychiatric illness have long been recognized, but the impact of biological factors in the field of cross-cultural psychiatry has been less well studied than psychosocial factors. In reviewing the literature at the intersection of tropical medicine and psychiatry in order to summarize the existing data base in this field, a generalized interactive model informed by the theoretical contributions of George Engel, the WHO Scientific Working Group on Social and Economic Research, Arthur Kleinman, P. M. Yap, Edward Sapir and others has been developed to serve as a conceptual framework for this analysis of the literature and to guide further research. The clinical literature of tropical medicine and psychiatry which recognizes the significance of concurrent tropical disease and mental disorders is reviewed along with the more specific literature on malaria and concomitant psychiatric illness. Many authors have focused on the role of organic mental disorders, especially in connection with cerebral malaria, but several have also addressed psychosocial parameters through which the interrelationship between malaria and a full range of mental disorders is also mediated. The effects of malaria may serve as biological, psychological or social stressors operating in a cultural context which precipitate or shape features of psychiatric symptomatology. Psychiatric illness may likewise precipitate an episode of malaria with typical symptoms in a patient with a previously subclinical infection. Implications of the literature and this generalized interactive model are considered as they apply to clinical practice, public health and the application of social science theory in medicine.

Cross-Cultural Comparison↗
PubMed2002

Manufacturing individual opinions: market research focus groups and the discursive psychology of evaluation.

This article addresses a paradox. On the one hand, discourse and rhetorical studies have provided evidence that evaluative talk is both variable and rhetorically organized. On the other hand, a wide range of social psychological research is produced that both presupposes and finds evidence of enduring underlying attitudes. One explanation for this may be that, on some occasions at least, the results of attitude research are a consequence of procedures that restrict and refine from everyday evaluative practices in a way that ensures the 'discovery' of underlying attitudes. The article explores this explanation in one domain where there is a major practical concern with attitudes and opinions, namely market research focus groups. Detailed analysis of transcripts of eight market research focus groups identifies three procedures that moderators use to produce freestanding opinion packages: (a). they display rhetorically embedded evaluations as inconsequential; (b). they provide formal guidance for participants to produce freestanding opinions; and (c). they formulate participants' talk as freestanding opinions, stripping off rhetorical elements. The findings are supported by considering deviant cases. This illustrates one way in which evaluations are transformed into freestanding attitudes. More broadly, it contributes to a body of work that studies how social science methods work in practice.

Adult↗
PubMed1998

General Electric Co. v. Joiner: lighting up the post-Daubert landscape?

The U.S. Supreme Court considered an appeal by the defendant, General Electric Co., in a products liability action. The appeal resulted from the ruling by the Court of Appeals for the Eleventh Circuit that overturned the district court's exclusion of evidence of cancer causation. The Supreme Court held that questions of the admissibility of such evidence are reviewable under the same standard--abuse of discretion--as are other decisions regarding evidentiary issues and are not subject to a more stringent standard of review. The Court further held that whether or not the evidence is excluded or is dispositive of the case does not change this standard of review. The Court then examined and upheld the decision by the trial court rather than remanding the action to the circuit court for reconsideration in light of the decision. Coupled with a series of recent circuit court of appeals decisions, the case establishes some guidance for the basis and methodology to be used to admit social science evidence in future cases.

Biphenyl Compounds↗
PubMed2000

Understanding and using the history of social psychology.

Authors in this collection offer both critique and contextualist counterpoint to the standard, "official" histories of the field-successive editions of the Handbook of Social Psychology in 1954, 1968, 1985, and 1998. Unlike mainstream histories, the collected studies do not together constitute a seamless chronicle of continual progress for practitioners in a research area seeking social science status, viability, and legitimacy. Rather the authors focus on choice points, crises, and debates (some still ongoing), pay special heed to non-mainstream branches and voices, question numerous assumptions concerning the interrelationships among social psychological methodology, ontology (Danziger; MacMartin & Winston; Stam, Radtke, & Lubek), boundaries (Good), and individualisms (moral, political, and/or methodological). The specific contributions of Floyd and Gordon Allport are discussed from several perspectives as they helped define and shape and write the history of the field (Lubek & Apfelbaum; Parkovnick; Greenwood; Chung), and bridge it to neighboring areas (personality) and disciplines (psychology and sociology) (Nicholson; Barenbaum; Cherry). The constraints, origin myths, insensitivities, and omissions of standard histories are pointed out (Samelson), some partial correctives are advanced, and a more generative role for future historical studies is suggested.

Historiography↗
PubMed2001

[Social urban development and poverty control as health promotion].

The Salomon Neumann Medal of the German Society for Social Medicine and Prevention bears the inscription. "Medicine is a Social Science". This provocative statement is most topical. It compels us to actively promote health by healthier living and environmental conditions apart from medical prevention. A core of this sphere of action is the reduction of social inequalities. Several recent congresses and publications have clearly shown that this subject remains one of the biggest challenges facing health promotion. German law has set the signs for reducing socially rooted inequalities for chances of health. This article postulates the thesis that health promotion can find allies for a healthy public policy in programmes planning for healthy urban development and for combatting poverty. The specific approaches for combatting social inequalities in the health sphere are reported and examples are given how such a health promotion policy may be translated into reality on a communal level. Finally, spotlight is on the dilemma of combatting inequality of chance due to differences in social status.

Germany↗
PubMed2006

The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents.

The need to provide quality mental health care for elders in nursing home settings has been a critical issue, as the aging population grows rapidly and institutional care becomes a necessity for some elders. The purpose of this quasi-experimental study was to describe the effect of participation in reminiscence group therapy on older nursing home residents' depression, self-esteem, and life satisfaction. Purposive sampling was used to recruit participants who met the study criteria. Residents of one ward were assigned to the reminiscence therapy group intervention, while residents of the other ward served as controls. Nine weekly one-hour sessions were designed to elicit reminiscence as group therapy for 12 elders in the experimental group. Another 12 elders were recruited for a control group matched to experimental subjects on relevant criteria. Depression, self-esteem, and life satisfaction were measured one week before and after the therapy. The Statistical Package for the Social Sciences (SPSS, Version 10.0) was used to analyze data. Results indicated that group reminiscence therapy significantly improved self-esteem, although effects on depression and life satisfaction were not significant. Reminiscence groups could enhance elders' social interaction with one another in nursing home settings and become support groups for participants. The model we created here can serve as a reference for future application in institutional care.

Aged↗
PubMed2005

Healthy country: healthy people? Exploring the health benefits of indigenous natural resource management.

OBJECTIVE: Decades of health-related research have produced a large body of knowledge describing alarming rates of morbidity, mortality and social/cultural disruption among Indigenous Australians, but have failed to deliver sustainable interventions to arrest the deepening spiral of ill-health. This paper explores the potential of Indigenous natural resource management (NRM) activities to promote and preserve Indigenous health in remote areas of northern Australia. METHOD: A literature review of the health, social science and ecology peer-reviewed journals and secondary literature. CONCLUSIONS AND IMPLICATIONS: Effective interventions in Indigenous health will require trans-disciplinary, holistic approaches that explicitly incorporate Indigenous health beliefs and engage with the social and cultural drivers of health. Aboriginal peoples maintain a strong belief that continued association with and caring for ancestral lands is a key determinant of health. Individual engagement with 'country' provides opportunities for physical activity and improved diet as well as boosting individual autonomy and self-esteem. Internationally, such culturally congruent health promotion activities have been successful in programs targeting substance abuse and chronic diseases. NRM is fundamental to the maintenance of biodiversity of northern Australia. Increased support for Indigenous involvement in land and sea NRM programs would also deliver concrete social benefits for communities including opportunities for sustainable and culturally apt regional employment, applied education and economic development. NRM may also reinvigorate societal/cultural constructs, increasing collective esteem and social cohesion.

Anthropology, Cultural↗
PubMed2001

Genetic studies of the Roma (Gypsies): a review.

BACKGROUND: Data provided by the social sciences as well as genetic research suggest that the 8-10 million Roma (Gypsies) who live in Europe today are best described as a conglomerate of genetically isolated founder populations. The relationship between the traditional social structure observed by the Roma, where the Group is the primary unit, and the boundaries, demographic history and biological relatedness of the diverse founder populations appears complex and has not been addressed by population genetic studies. RESULTS: Recent medical genetic research has identified a number of novel, or previously known but rare conditions, caused by private founder mutations. A summary of the findings, provided in this review, should assist diagnosis and counselling in affected families, and promote future collaborative research. The available incomplete epidemiological data suggest a non-random distribution of disease-causing mutations among Romani groups. CONCLUSION: Although far from systematic, the published information indicates that medical genetics has an important role to play in improving the health of this underprivileged and forgotten people of Europe. Reported carrier rates for some Mendelian disorders are in the range of 5-15%, sufficient to justify newborn screening and early treatment, or community-based education and carrier testing programs for disorders where no therapy is currently available. To be most productive, future studies of the epidemiology of single gene disorders should take social organisation and cultural anthropology into consideration, thus allowing the targeting of public health programs and contributing to the understanding of population structure and demographic history of the Roma.

Journal Article↗
PubMed2004

Technology-dependent children and their families: a review.

BACKGROUND: Advances in medical technology and nursing care have enabled children who rely on long-term medical and technical support to reunite with their families and community. The impact of discharging these children into the community involves a number of unprecedented social implications that warrant policy consideration. To begin with, an effort must be made to understand the phenomenon of caring for technology-dependent children living at home. AIM: The aim of this paper is to provide a comprehensive literature review on caring for technology-dependent children living at home. METHODS: The review was conducted via keyword searches using various electronic databases. These included CINAHL, MEDLINE, Social Science Index, Sociological Abstracts, Australian Family and Society Abstracts, and the Australian Bureau of Statistics. The articles and books found were examined for commonality and difference, significant themes were extracted, and the strength of the research methods and subsequent evidence were critiqued. FINDINGS: In this paper, themes relating to home care for technology-dependent children and their families are elucidated and summarized. These are: chronic illness and children; the impact of paediatric home care on children; the uniqueness of technology-dependent children and their families; and parents' experience of paediatric home care. DISCUSSION: Contentious issues, relevant to the social life of these children and their families, are raised and are discussed with the intention of extending awareness and provoking further debate among key stakeholders. These issues include: the changed meaning of home; family dynamics; social isolation; saving costs for whom?; shifts in responsibility; and parent-professional relationships. CONCLUSION: More research is needed in the arena of paediatric home care, to facilitate relevant policy formation and implementation.

Attitude to Health↗
PubMed1989

Social factors and trachoma: a review of the literature.

Although great advances have been made in the clinical understanding of trachoma, the disease remains endemic in many parts of the world. Economic, environmental, cultural and behavioral factors continue to play an important role in trachoma transmission and progression. The trachoma literature however, contains relatively few studies which rigorously assess the importance of social factors. A critical review of the trachoma literature implicates individual and community hygiene as important risk factors for disease. Specific risk behaviors remain to be identified and validated as independent predictors of infection in different settings. Collaboration between biomedical and social science professionals is needed to design and carry out further research.

Attitude to Health↗
PubMed1985

Handicap research in Denmark.

In connection with recent social developments in Denmark increasing interest has been shown in research in the area of handicaps. Three Danish Research Councils (for Medicine, the Humanities and the Social Sciences) appointed a Committee to investigate this area of research. A survey conducted in the relevant fields gave evidence of much activity in this area. Very few research projects, however, integrated educational, psychological, medical, technical and social aspects. The need for more cooperation, information and training was therefore stressed as a prerequisite for better interdisciplinary handicap research in Denmark. Research seminars and workshops held in 1982-83 supported the results of the survey, especially as regards the need for training in the methods of interdisciplinary research and understanding among professionals (nurses, teachers, social workers, therapists, etc.). A formal coordination agency is recommended in order to establish the necessary cooperation among researchers, planners and users in Danish handicap research.

Denmark↗