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PubMed2005

Rethinking gender differences in health: why we need to integrate social and biological perspectives.

The complexity of gender differences in health (i.e., men's lower life expectancy and women's greater morbidity) extends beyond notions of either social or biological disadvantage. Gaps remain in understanding the antecedents of such differences and the issues this paradox raises regarding the connections between social and biological processes. Our goals in this analytic essay are to make the case that gender differences in health matter and that understanding these differences requires an explanation of why rational people are not effective in making health a priority in their everyday lives. We describe some salient gender health differences in cardiovascular disease, immune function and disorders, and depression and indicate why neither social nor biological perspectives alone are sufficient to account for them. We consider the limitations of current models of socioeconomic and racial/ethnic health disparities to explain the puzzling gender differences in health. Finally, we discuss constrained choice, a key issue that is missing in the current understanding of these gender differences, and call on the social science community to work with biomedical researchers on the interdisciplinary work required to address the paradoxical differences in men's and women's health.

Cardiovascular Diseases↗
PubMed1996

Depression following a spinal cord injury.

OBJECT: Depression is a common problem following a spinal cord injury (SCI) and can greatly interfere with the rehabilitation process because of reduced energy, negative expectations, and social withdrawal. Understanding various factors which influence a vulnerability to depression may improve the diagnosis and treatment of depressive disorders and can improve rehabilitation outcome. METHOD: A thorough literature search was conducted using Medline, PsychLit, Pyschinfo, and Social Science Citation Index to identify relevant articles published between 1967 and 1995. RESULTS: A diathesis-stress model is proposed to explain the increased risk of depressive symptoms after a SCI. Biological changes associated with SCI and pre-existing cognitive biases may influence the individual's vulnerability to stressful life events following the injury. The nature and frequency of stressful life events following the injury can tax the individual's coping resources. Furthermore, the perceived quality of social support and the severity of conflict within the family can influence the individual's adaptation. CONCLUSIONS: Social support and recent stressors should be assessed to identify patients at high risk for depression. Patients are less likely to become depressed if their independence is fostered and they are encouraged to develop new sources of self-esteem. Relatives can be counseled to help maintain supportive relationships within the family.

Adaptation, Psychological↗
PubMed2004

The psychosocial work environment and musculoskeletal disorders: design of a comprehensive interviewer-administered questionnaire.

BACKGROUND: Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorders (WRMSDs), but a lack of standardized measurement tools reflects both the theoretical and methodological limitations of current research. METHODS: An interdisciplinary team including biomedical, behavioral, and social science researchers used an iterative process to adapt existing instruments for an interviewer-administered questionnaire assessing psychosocial workplace exposure related to musculoskeletal disorders. RESULTS: The resulting questionnaire included measures of psychosocial workplace factors based on two theoretical models (the demand-control-support and the effort-reward imbalance models), supplemented by the additional constructs of "emotional demands," and "experiences of discrimination." Other psychosocial and physical measures selected for questionnaire inclusion address physical workload, sociodemographic and anthropometric characteristics, social relations and life events, health behaviors, and physical and psychological health. CONCLUSION: Using an interdisciplinary approach facilitated the development of a comprehensive questionnaire inclusive of key measures of psychosocial factors that may play a role in the complex mechanisms leading to WRMSDs.

Humans↗
PubMed1991

Talent, history, and the fulfillment of promise.

Life course studies are a flourishing enterprise across the social sciences and humanities, particularly since the 1960s, but the historical roots of this work extend back at least to the turn of the century (Elder 1985; Sorensen et al. 1986). The new era is distinguished by a rapidly growing number of longitudinal samples as well as by innovative techniques for collecting and analyzing life histories. Most distinctive of the new work is its consciousness of the interplay between lives and times. To understand life trajectories one must consider the social changes underway. The events, continuities, and transformations of a changing world shape the pathways of aging. This research explores the long-term consequences of one era of social change in particular (World War II and the preceding decade of hard times) for the life experiences and career achievements of men who lived through that period. Using the data archives of the oldest longitudinal study still active in the United States (Terman 1925), we assess the career achievements of the men (born 1904-1917) in relation to cohort membership, social origins, and wartime mobilization. Through different opportunities, resources, and support, the life stage of these men in the 1930s and 40s shaped the distinctive impact of historical circumstances on their accomplishments. All of the men are members of the Stanford-Terman study, which began in 1922 with more than 800 males and has continued across 11 additional data waves up to 1986.

Aged↗
PubMed2006

Conclusion: genetic diversity and science communication - some issues of 'translation' and language.

This commentary concerns some key themes from the symposium. While molecular genetics may provide new opportunities to articulate biological concepts of race, the ideological baggage associated with the term suggests that it is best dropped from discussions. In screening programmes and genetic practice, ethnic identity is likely to be an uncertain surrogate to identify individuals with particular genetic variants. Precise language and explanation will aid communication about genetic matters. Talking of genes for particular traits or diseases is unhelpful. School teaching of classic Mendelian genetics is ineffective and should be replaced with some teaching of elementary developmental biology based on matters of everyday salience and interest. Social science literature is replete with unfounded claims of geneticization.

Communication↗
PubMed1992

Learning to see: moral growth during medical training.

During medical training students and residents reconstruct their view of the world. Patients become bodies; both the faults and the virtues of the medical profession become exaggerated. This reconstruction has moral relevance: it is in part a moral blindness. The pain of medical training, together with its narrowness, contributes substantially to these faulty reconstructions. Possible improvements include teaching more social science, selecting chief residents and faculty for their attitudes, helping students acquire communication skills, and helping them deal with their own pain. Most importantly, clearer moral vision requires time and scope for reflection.

Attitude of Health Personnel↗
PubMed2005

Medical education and training: responding to community needs.

At its inception in 1987, the Aga Khan University introduced the idea of community-based medical education in Pakistan, at a time when this model was being introduced and adapted internationally. Human resource development has been a major objective in the Department of Community Health Sciences (CHS). CHS has contributed to developing a medical curriculum that addresses the health needs of the community at large. This paper narrates the department's experience in working directly with under-served communities, leading to the development of specialized courses and degree programs. CHS emphasizes operational research and development of managerial skills among front-line public health professionals, in both the public and private sectors. Training is provided by people from diverse backgrounds, such as public health, community development, social sciences, law, epidemiology, economy, biostatistics, demography, theater, and film. The lessons we have learned show that the mode of training depends on the overall objectives of the program, the clients and the setting. However, in the spirit of the participatory approach, the recipients of the training must be involved during all stages so as to ensure the sustainability of the training program. Training must focus on the communities at the grass roots level or community based organizations, where the communities identify their own capacity and needs. Wide dissemination of training materials, courses and manuals is also useful to replicate successful experience.

Community Health Services↗
PubMed1989

Residential mobility, social support and adolescent self-concept.

The effects of residential relocation on children has been a topic of interest to social science researchers for decades. Early research attributed school phobias, classroom behavior problems, lack of academic success, and poor peer relationships to residential mobility. Although most current literature has disputed many of these early findings, a question remains regarding the relationship between self-concept and residential relocation. Significant negative findings have been found in previous studies of this relationship. This study attempts to expand the research in two ways: first, by providing a theoretical framework and, second, by testing the role of social support from parents and peers as a mediator in the relationship. The investigation benefits from theory on life events and stress which guides the analysis of mobility and self-concept in a sample of 205 students in the sixth, seventh, and eighth grades. Findings indicate that social support attenuates a negative effect of mobility on specific measures of self-concept.

Adolescent↗
PubMed1984

Ethnohistory and alcohol studies.

This chapter briefly outlines the development of ethnohistory in the United States and Canada and then examines the contributions that ethnohistorical studies have made to our understanding of heavy drinking in situations of acculturation. Three major models used by anthropologists and ethnohistorians to account for heavy drinking in such contexts are identified: (1) drinking as a response to sociocultural disorganization, (2) drinking as a response to deprivation, and (3) drinking as an expression of traditional values and activities. These models are evaluated in light of recent theoretical and methodological developments within anthropology and other social sciences. The discussion draws on ethnohistorical case studies to exemplify these developments. It is argued that ethnohistory 's ongoing interaction between field and archival research offers a unique and essential approach to the study of alcohol use.

Acculturation↗
PubMed2005

Lesbian families and family functioning: an overview.

OBJECTIVES: In the last 30 years a growing body of studies on lesbian parents and the development of children has been published. METHODS: Four computerized databases were identified studies for inclusion in this review of research on lesbian families, namely PsychInfo, Educational Resources Information Centre (ERIC), Medline, and the Social Sciences Citation Index. RESULTS: Forty-four empirical studies on lesbian families published between 1978 and 2003 were reviewed. In the research on lesbian families two phases were identified. To begin with, systematic studies on lesbian families focused on lesbian families with children who were born in a previous heterosexual relationship. More recently, studies included lesbian families whose children were born to the lesbian couple (planned lesbian families). In both phases, articles reporting results on children's development (such as sexual identity, emotional/behavioral development, social relationships and cognitive functioning), and parental functioning (such as mental psychological health and parenting skills). This paper presents and discusses major finding of the reviewed articles. CONCLUSION: Studies in both phases have emphasized that lesbian and heterosexual families are very much alike. However, it is the stigma of lesbianism that makes the family situation of lesbian families different. PRACTICE IMPLICATIONS: Healthcare workers should be informed about the similarities and differences between lesbian families and heterosexual families, and about the non-traditional family situation of planned lesbian families.

Adaptation, Psychological↗
PubMed1999

The effects of respite care on informal carers' well-being: a systematic review.

PURPOSE: The provision of respite care is a common method employed to reduce the burden on those who care for individuals with a chronic illness or disability. The aim of the present review was to examine research on respite provision with a view to establishing what effect it has on carers. METHOD: A literature search was conducted for studies examining the effect of respite provision on carers, 'Psyclit', 'Medline' and Social Science Citation Index computerized databases were utilized, followed by a search of the reference sections of relevant studies. RESULTS: The search yielded 29 studies, from which there was little evidence that respite intervention has either a consistent or enduring beneficial effect on carers' well-being. This may be due in part to the fact that the majority of the work conducted has been methodologically poor. Also significant, however, might be that the findings suggest respite care often fails to facilitate the maintenance of socially supportive relationships, which may moderate strain after respite has ended. CONCLUSIONS: A more 'carer-centred' approach is required in both the provision and evaluation of respite care intervention. This approach would address the experiences of both caregiver and care-recipient during the respite period.

Caregivers↗
PubMed2002

[Stressors in the teacher's workplace].

Psychosocial stressors are common problem affecting social functioning and health in many social groups. A great variety of stressors affect people working in auxiliary professions. Those stressors may induce professional burnout. The article outlines differences and similarities between Maslach burnout construct and a few concepts of stress. It also gives the literature review concerning job stressors in teachers. A wider view on teaching profession from the perspective of social sciences aims at deepened diagnosis and therapy in the context of psychiatric disturbances and constitutes the basis for planing and implementing environmental programmes of health promotion for this profession. Such perspective is consistent with the latest decisions of European Union.

Adaptation, Psychological↗
PubMed1991

[Have early disorders increased?].

The author rejects the proposition, encountered in some parts of the psychoanalytic and social-science literature, that certain types of disturbances correspond to certain epochs or forms of society. Instead he reminds us of the core of the psychoanalytic theory of representation according to which every formation of inner structure is an individual creative innovation that eludes normative interpretation.

Humans↗
PubMed2004

Shifts in the philosophical foundations of psychiatry since Jaspers: implications for psychopathology and psychotherapy.

Jaspers' AllgemeinePsychopathologie, the General Psychopathology, published in 1923, had a profound influence on the development of psychiatry. Central to it was the attempt to give the new psychiatry a philosophical foundation, the key element in which was the dichotomy between meaningful and causal connections. This dichotomy was superimposed on the earlier mind-body distinction, and both converged on the conclusion that mind and meaning were problematic from the point of view of science. The inevitable splits came to a head in the 1960's, with attacks on the one side by the other: medical psychiatry was attacked for systematically stripping madness of its meaning and hence dehumanising it, while psychoanalysis, the champion of meaning, was rounded upon for being unscientific. At the same time however there was emerging a new paradigm that effectively deconstructed the problematic, namely, the cognitive or information-processing paradigm. This paradigm has made it possible to construct a unified bio-psycho-social science of psychopathology. In psychotherapy, the shift has been away from the view that meaning is non-causal, a matter only of existential significance or of hermeneutic interpretation, towards the working assumption that it is crucially involved in aetiology, as in the new cognitive behaviour therapy paradigm.

Cognitive Behavioral Therapy↗
PubMed2002

Human-computer interaction: psychological aspects of the human use of computing.

Human-computer interaction (HCI) is a multidisciplinary field in which psychology and other social sciences unite with computer science and related technical fields with the goal of making computing systems that are both useful and usable. It is a blend of applied and basic research, both drawing from psychological research and contributing new ideas to it. New technologies continuously challenge HCI researchers with new options, as do the demands of new audiences and uses. A variety of usability methods have been developed that draw upon psychological principles. HCI research has expanded beyond its roots in the cognitive processes of individual users to include social and organizational processes involved in computer usage in real environments as well as the use of computers in collaboration. HCI researchers need to be mindful of the longer-term changes brought about by the use of computing in a variety of venues.

Attitude to Computers↗
PubMed1993

[Public health: an interdisciplinary challenge].

Presented as an opening lecture of the new postgraduate education programme of both the Technical and the Free University of Berlin, sponsored by the German Federal Minister of Research and Technology, this lecture recalls the foundation of the first School of Public Health (The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md., USA) by William Henry Welch, 75 years ago. Already in this early experience, several central topics of Public Health can be traced back: for instance the exact description of health problems of total population groups, the aetiological understanding of health problems as well as the transfer of knowledge in public health programmes. After a definition of the Public Health concept both in- and outside Germany, the article reviews three examples of core topics of Public Health. Drawing on results from the first report "Health of Zurich", applications of descriptive epidemiology for both priority finding in Public Health as well as aetiological research are illustrated. The second example, with data from a recent representative survey of adults swiss germans on the issue of discrimination against persons infected with HIV draws attention to the central importance of social sciences within Public Health. Finally, the third example discusses recent advances in health services research, including issues of health economics, an other important part of an interdisciplinary Public Health understanding.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Reinventing mass communication: a World Health Organization tool for behavioral change to control disease.

Most of the WHO's vertical programs, because they were ill-conceived, ill-designed, and defectively implemented, have fallen far short of expectations. These limitations have been doggedly ignored by the WHO, although the authorities in India have now realized that such vertical programs are expensive and not sustainable. Launching of Communication for Behavioral Impact (COMBI) appears to mark a desperate effort to revive their performance. It represents yet another deviation from the mandate given to the WHO. In 1983, the then director general warned against motivational manipulation of people to sell health ideas, but the WHO has now brazenly come forward to look for help from the private sector. COMBI uses the jargon and language of the market place to "market" health programs; it calls this "cause-related marketing." The WHO has been most a historical in conceptualizing COMBI, as it has not learned from the failure of UNICEF's earlier venture to market child survival by employing experts in social marketing to bring about "community mobilization." The WHO should have reviewed the large body of literature on work in the health social sciences, health education, and the many programs based on the concept of "information, education, and communication." The pointed neglect of such key issues raises serious moral, ethical, and human rights questions. The COMBI approach amounts to be a breach of trust--a threat to human dignity.

Communication↗
PubMed2004

Urban bioethics: adapting bioethics to the urban context.

Urban bioethics is an area of inquiry within the discipline of bioethics that focuses on ethical issues, problems, and conflicts relating to medicine, science, health care, and the environment that typically arise in urban settings. Urban bioethics challenges traditional bioethics (1) to examine value concerns in a multicultural context, including issues related to equity and disparity, and public health concerns that may highlight conflict between individual rights and the public good, and (2) to broaden its primary focus on individual self-determination and respect for autonomy to include examination of the interests of family, community, and society. Three features associated with urban life-density, diversity, and disparity-affect the health of urban populations and provide the substrate for identifying ethical concerns and value conflicts and creating interventions to affect population health outcomes. The field of urban bioethics can be helpful in creating ethical foundations and principles for public health practice, developing strategies to respect diversity in health policy in a pluralistic society, and fostering collaborative work among educators, social scientists, and others to eliminate bias among health professionals and health care institutions to enhance patients' satisfaction with their care and ultimately affect health outcomes. Educational programs at all levels and encompassing all health professions are needed as a first step to address the perplexing and important problem of eliminating health disparities. Urban bioethics is both contributing to the social science literature in this area and helping educators to craft interventions to affect professional attitudes and behaviors.

Bioethics↗