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PubMed2006

Growing up with idiopathic short stature: psychosocial development and hormone treatment; a critical review.

To facilitate decisions on interventions in medically referred children with idiopathic short stature, the research on psychosocial functioning of these children, possible risk and protective factors influencing adaptation, and effects of hormone treatment were reviewed. Parents ranked the behaviour of their children on average between normal and below normal. The magnitude of these deviations varied from small to large. Little is known about the children's self-perceived psychosocial functioning. Some risk factors were found: being teased, being juvenilised, being a boy, having a younger but taller sibling, low intelligence, and low socioeconomic status. There have been few studies on the impact of protective factors including temperament, coping strategies, and social support. On average, hormone treatment did not improve psychosocial functioning. The research shows the advantages and disadvantages of hormone treatment that must be considered when choosing a suitable intervention. It is suggested that psychosocial adjustment can be improved by focusing on factors other than height alone.

Adaptation, Psychological↗
PubMed2004

Building community capacity for violence prevention.

The capacity of communities to prevent violence is examined from three perspectives: youth violence, child maltreatment, and intimate partner violence. The analysis suggests that community social control and collective efficacy are significant protective factors for all three types of violence, but these need to be further distinguished for their relationships to private, parochial, and state controls. It is argued that strong interpersonal ties are not the only contributor to collective efficacy and violence prevention. Weak ties, including those outside the community, and organizational ties are also seen as necessary. Violence prevention programs should be structured in ways that contribute to the communities' own capacity to prevent violence.

Adolescent↗
PubMed2003

Gender-related traumatic deaths in Transkei: incidence and causes.

This study is unique in that it strives to unfold, perhaps for the first time, the problem of female mortality due to trauma in the Transkei region of the Eastern Cape Province of South Africa. This study was carried out in the Umtata and Ngqeleni magisterial districts which have a combined population of about 400,000. Most of the people have very few resources and have historically relied on money repatriated by migrant workers. The objective was to establish the incidence and the causes of deaths due to gender-related trauma and to formulate recommendations which could probably help prevent or reduce these deaths. The study reviewed cases of female traumatic death during the period January 1993 to December 1999 that were brought to the mortuary in Umtata General Hospital (UGH). There were 1,054 (23%) traumatic deaths recorded in females between 1993 and 1999. Of these 486 (28%) were related to motor vehicle collisions, 219 (18%) due to gunshot injuries, 152 (19%) due to stab wounds and 139 (21%) as a result of blunt trauma. The male to female ratio was 3.3:1 in traumatic deaths. In homicides the male:female ratio was 4.4:1, gunshot 4.5:1, stab 4.2:1 and blunt injuries 3.7:1. In motor vehicle collisions (MVC's) the ratio was 2.5:1. There is an increasing incidence of traumatic deaths in women. Gun shot injuries are the commonest among traumatic deaths in females. This article recommends stricter measures to protect women in the form of legislation. Social uplifting and economic support should be carried out as part of the process of social change. In this case educating the entire community is necessary to safeguard women and their future survival.

Accidents, Traffic↗
PubMed1997

An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study.

OBJECTIVES: This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS: Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS: The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS: Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.

Age Distribution↗
PubMed2001

Prevalence and predictors of physical partner abuse among Mexican American women.

OBJECTIVES: This study determined the lifetime prevalence of physical abuse by a current partner among women of Mexican origin and assessed factors associated with abuse. METHODS: Data are for a subsample of 1155 women with current partners from a larger population-based cross-sectional survey of US residents of Mexican origin. RESULTS: The self-reported prevalence of physical abuse by a current partner was 10.7%. In multivariate analysis, factors associated with physical abuse included US birthplace (odds ratio = 2.1; 95% confidence interval = 1.24, 3.56), young age, urban residence, and having 4 or more children. Social support and regular church attendance were protective. CONCLUSIONS: The self-reported prevalence of physical abuse among Mexican American women is high. US birth is associated with increased risk of abuse. Community-based prevention efforts should be aimed at this population.

Adolescent↗
PubMed2002

Precaution, prediction, proof, and policy assessment.

The challenge of sustainable development--the ultimate goal of precaution-- demands that we shift our focus away from individual environmental problems and toward long-term integration of environmental, social, and economic policy. It also elevates protection of ecosystem processes and biodiversity to the status of significant policy goals. In this article, the author argues for a new use of the precautionary principle, as a means to assess broad policy decisions to target indirect or systemic rather than direct threats to sustainability. He draws on a case study of two Australian policies: the National Strategy for Ecologically Sustainable Development (ESD), and the National Competition Policy (NCP).1 While the proposals are ambitious and may not be achievable in the near future, nonetheless, it is in the nature of institutional and policy systems that it is difficult to predict when opportunities for policy change will arise. It is crucial to develop and articulate strategies now, to be promoted during brief windows of opportunity for policy change.

Journal Article↗
PubMedDate not supplied

The future of employment-based health insurance.

A transformation of employment-connected health insurance from a defined benefit to defined contribution arrangement is projected based on new economic realities affecting the competitiveness of the business environment. This article discusses those new realities along with the future of employment-based health insurance. The business of American business is profits, but, to the detriment of that goal, for the past half century business has also been in the business of providing health insurance for workers. However, in light of previously unencountered pressures on profits, employers are realizing they cannot afford to continue the practice of paying for and overseeing the provision of healthcare benefits to employees amid increasing premiums, state and federal mandates, the overbearing cost of managing healthcare benefits, and the threat of loss of protection under ERISA. Yet, the political and social pressures on businesses to continue to provide health insurance are formidable, perhaps impregnable, barriers to complete withdrawal of what has come to be thought of as a "right" of employees. Companies are anxious to find alternatives to the status quo, but any feasible alternative must cost less, require less administrative oversight, and ensure that employees still maintain a measure of choice. Two possible solutions for American businesses are adoption of (1) a "medical savings account" system, or (2) a "voucher" system. Either system would result in lower costs and greater fiscal stability for both employers and employees. They would also remove much of the responsibility for healthcare decisions from employers and place it in the hands of the employees. But, perhaps the greatest contribution of either system would be the reduction in moral hazard and its inflationary effect on medical costs.

Commerce↗
PubMed2003

[Torture as a medico-psychological and social problem].

AIM: To investigate and define the consequences of the torture in civilian survivors of state sponsored violence in Bosnia and Herzegovina and to point out that torture is not solely medical and psychological problem but also a social problem requiring various interventions of the society at large. METHODS: The study included 50 subjects who were survivors of torture. For registration of psychopathological symptoms, the Multidimensional Instrument for Symptoms Assessment SCL 90-R comprising 90 items divided in 9 subscales, (L.R. Derogates 1986) was used. The Mississippi Questionnaire containing 35 items, (Kean. et al. 1988) for the registration of the symptoms of the posttraumatic stress disorders, was used and Sociodemographic questionnaire for the registration of the sociodemographic characteristics of the subjects, was used. RESULTS: Our research indicates statistically significant decline in social position of the survivors of the torture compared with their life situation before surviving the atrocities of the war their economic position is weaker, unemployment rate in this population reaches 82% compared with the rate of 24% before the war. They also survived the loss of a great number of family members. The subjects also presented with a variety of somatic and psychological symptoms. CONCLUSIONS: Torture survivors comprise the most vulnerable group in the society after the war and they require multidisciplinary program for their psychosocial rehabilitation. This, comprehensive approach includes social and legal guarantees in order to protect their rights and interests.

Adolescent↗
PubMed2003

[The forms of postgraduate education of physicians in Poland in years (1918-1939)].

Postgraduate studies of the Polish physicians between World Wars was not obligatory, except the doctors, who occupied positions in Health Services Administration. They were trained in The State School of Hygiene, in which were performed systematically courses regarding social diseases (tuberculosis, trachoma), organization of health protection. This studies were founded by Department of Health in Ministry of Public Care. The other forms of training were courses of several weeks, regarding general practice or particularly specializations, organized by medical departments of Universities. The aim of this education was completion of the theoretical academic knowledge wish practical skills. The trainings were also organized by medical associations, departments, institutes, hospital wards and other public societies. The postgraduate studies were continued during the domain and foreign medical meetings, by reading medical journals and publications and by practicing in hospital wards. Until the II World War the postgraduate training was not obligatory and the idea of the state institution coordinating this area was not realized.

Education, Medical, Graduate↗
PubMed2004

Views on sexuality in croatian medieval sources.

We analyzed attitudes towards sexuality during the medieval period in Croatia. For that purpose we investigated numerous medical and literary texts, statutes, and specific natural philosophical work entitled "Lucidar". Contrary to medical books, which had a low impact on the broader community, literary texts were important in spreading messages on sexuality, as well as in shaping medieval mentality and creating sexual taboos. Consequently, a specific perspective and culture influenced rules and practices for community protection, as well as various levels of social systems. Within the three large groups of sources, we selected those typical both in their content (ideas) and forms, and representative in shaping attitudes toward sexuality on our territory. The first group of sources (examples from literary genres) were identified as an important vehicle in transferring messages of morality, moral obligation and sexuality in general. Deeply rooted in Christianity they became a pattern according to which the way of life and value were measured, a specific view toward sexuality was shaped, and notions of stigma and taboo articulated.

Attitude↗
PubMed2005

[Gene testing of hereditary cancer on comprehensive gene medical examination support system].

It has been estimated that genetic factors or a combination of genetic and environmental factors play a role in the development of 10-15% of all cancers. A genetic cause of hereditary cancer has been identified in more than 40 diseases till now. For preventing this cancer, gene testing is essential because it has no definite clinical marker as in hereditary non-polyposis colorectal cancer: HNPCC. Much more experience must be accumulated in this testing at the clinical base in order to increase specificity and sensitivity while safeguarding ethical, legal and social issues (ELSI). Recently, the Personal Information Protection Law was enforced. Gene inspection involving hereditary cancer should be carried out under a comprehensive gene medical examination organization. It is important for the family doctor, medical specialist, and gene inspection person in charge to cooperate closely with one another, and this will be a subject of future study.

Adenomatous Polyposis Coli↗
PubMed2005

Digital literacy in a landscape of data: a plea for a broader definition for citizens and patients.

The term 'digital literacy' is taking on a broader definition and greater urgency, as ubiquitous computing becomes a reality, and individuals and communities find their bodies and actions creating an exuberant wellspring of rich, complex data. These biological and sociological data can be ignored, used alone or shared with others for various reasons - for personal or social good or ill. Although strategies to protect our data from commercial, criminal, and governmental access are already being debated daily in the media, this paper is a brief plea for why we need to expand our concerns beyond the current financial and medical record security issues.

Biomedical Technology↗
PubMed1989

Protecting our children.

American society will face major economic and social difficulties in the years to come if we do not address the serious threat to our prosperity posed by the growing numbers of young people who lack the education to function in a highly technical world. The author identifies some of the circumstances and behaviors that place children at risk of academic failure, including poverty, teenage pregnancy, drug abuse, unstable families, and suicide. Failure of the education, health, and social service systems set up to deal with these risk factors is also identified as part of the problem. The author offers four proposals for restructuring failing systems to provide our youth with the support they need to mature, learn, and develop.

Adolescent↗
PubMedDate not supplied

The need for professional doctors of public health.

Planning, organizing, and operating today's complex health care systems or heading Federal, State, and city public health agencies in the United States and other countries require professionals broadly prepared in the meaning, philosophy, and strategies of public health. It is and has been recognized that the best trained clinical physician could not be expected to know the policies and practices of official public health programs. The chief health official of a State or other jurisdiction, for example, deals with the epidemiology of many diseases; with all aspects of the environment; with hospitals, drugs, health manpower, and nutrition; with issues of health economics, finance, and politics; and with administration. For these tasks, most of medical education is irrelevant. To produce the needed specialists, candidates with a BA degree would be educated as doctors of public health. The proposed 5-year postgraduate curriculum is as demanding as the training for the MD degree, but completely different. The 38 subjects or courses in the curriculum are grouped into four categories: basic tools of social analysis, health and disease in populations, protection of health and prevention of disease, and health care systems and management. At present, MPH degree holders take only a handful of core and elective courses and emerge with little systematic knowledge about the majority of problems they face. The DrPH candidates at schools of public health spend most of their time on research and dissertation writing--adequate preparation for university teachers, but academia is not the goal of most candidates, nor the greatest need of society. Recruits for the proposed new doctorate in public health may be found among the thousands of young people who want to do "community health work" but see no way to play a significant role without getting an MD degree first.

Curriculum↗
PubMed1995

[The deconstructions of schizophrenia (I)].

Standing in the midst of this great historical change, as sometimes it is called the switch to the "post-modern", we are now confronted with the demand of paradigm change in every field of scientific knowledge. So it is the case with psychiatry. Just about 100 years ago, the trend of "social defense" (society's need to be protected from harm) was going on covering the whole civilized countries. It brought about a situation that could be generalized as "institutionalism" which made mental hospitals huge and custodial, resulting in the prevalence of nihilism with regard to treatment. It was just at this time that Dementia praecox, the preconcept of Schizophrenia, was formed by Kraepelin, E. (1896) as a mental disease resulting in peculiar dementia. After some period, Dementia praecox was transformed into Schizophrenia (Gruppe der Schizophrenien) by Bleuler, E. (1908) with a new methodology: to grasp the disease from the symptomatic viewpoint. Jaspers, K. (1912) as well as Schneider, K. (1938) followed him in the way that was psychopathologically more strict; the latter reached the formulation of the . Despite this eventful metamorphosis of the concept of Schizophrenia, its fundamental traits have remained unchanged until the late 1960's. They could be summarized as follows: 1) What patients mention is incomprehensible; 2) The prognosis leads to peculiar dementia; 3) The real cause of the disease is the brain disorder. These three are the reflection of the custodialism, curative nihilism and materialism through the institutionalized mental hospitals in those days. Now, since the 1970's, the situation has been completely changed, or at least, faced with inevitable changes. The tide of "deinstitutionalization" is covering all over the civilized countries, demanding the normalization of mentally disordered persons. Thus, deprived of its motherland (i.e. institutionalism), the concept of Schizophrenia has got into confusion or even crisis. And in order to relieve this confusion, severe attempts are internationally being made to identify the diagnostic criteria of Schizophrenia by means of what they call "operational diagnosis". I believe, however, that what is truely necessary is not such a compromising modification, but a more radical change that is: the DECONSTRUCTION OF SCHIZOPHRENIA.

Community Psychiatry↗
PubMed1994

[Medical consequences of land mines: Red Cross experiences].

OBJECTIVE: To describe the medical consequences of land mine injuries. DESIGN: Retrospective study. METHOD: A total of 17,414 casualties of war, treated in five hospitals of the International Committee of the Red Cross (ICRC) over a three-year period were evaluated. 3264 of these casualties had anti-personnel mine injuries. RESULTS: Approximately one out of three land mine casualties underwent an amputation of the lower extremities (n = 1040). The number of operations and the blood requirements depended on the extent of the amputation. Hospital mortality was 3.8%. CONCLUSION: Amputees have a higher mortality and a longer hospital stay, need more blood and undergo more operations than non-amputated casualties. The social consequences are considerable, as well. Better protection against indiscriminate use of anti-personnel mines is urgently necessary on medical grounds.

Adult↗
PubMed1997

[Quality in public health. Deficits, concepts and political quality key issues from the ministerial viewpoint].

To preserve the quality of the German health care system as well as continuously optimize it towards the needs stated by ethics and law, an inter-professional and inter-institutional quality policy is required. It should be patient-centered, focus on process management and be based on EN ISO-Standards adapted to the specific needs of health care. The latter could provide internationally compatible models for quality management and quality improvement including economic efficiency. The 40 nation Council of Europe's 5th European Conference of Health Ministers in Warsaw as well as the 69th Conference of German Federal State Health Ministers (GMK) at Cottbus, who tackled the issue in November 1996, pointed out essential aspects. The GMK stated a lack of effective general concepts, quality control and patients' rights protection in Germany. Both conferences demanded equity, social justice and an active participation of patients in the setting of quality standards and the conception, functioning and control of health care. This includes rationalisations by using the limited funds in a most effective way.

Cost-Benefit Analysis↗
PubMed1990

A social stress model of substance abuse.

The social stress model provides a framework for detecting protective factors that may contribute to adolescents' resiliency when confronted with compelling influences to engage in substance abuse. Parameters of the model were tested in 2 urban high school samples (N = 124) of Black (78%), White (16%), and Hispanic (6%) adolescents aged 12-14 years. Pretest and posttest measures, designed to detect the relative influence of stress, social networks, social competencies, and community resources on levels of students' usage, were completed at the beginning and end of the school year. The parameters of the model, estimated using LISREL7, indicated that the pathway from family characteristics to usage and from assertion to usage were significant. The paths from the remaining hypothesized variables were not significant. Implications for the design of prevention programs that facilitate youths' resiliency are discussed.

Adolescent↗