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PubMed2002

The core concepts of the 'four principles' of bioethics as found in Islamic tradition.

Ethics can be described as a sub-branch of applied philosophy that seeks 'what is the right and the wrong, the good and the bad set of behaviours in a given circumstance'. Bioethics, however, is a quasi-social science that offers solutions to the moral conflicts arising in medical and biological science practice. There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers, Beauchamp and Childress, formulated some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'Four Principles' which have almost always existed and govern the ethical behaviour of human societies, were presented by the authors as universal and applicable to any culture and society. These 'Four Principles' have been one of the most widely discussed issues in Biomedical Ethics with arguments for and against them. The authors' claim has been tested by research conducted in different cultures and societies. In this study we aim to explore the roots of the 'Four Principles' in Islamic tradition and culture, and show that this particular set of principles are not something new but only one of the latest formulations of age-old common sense principles. It is therefore concluded that these principles are already being applied in Islamic traditional and cultural societies.

Beneficence↗
PubMed2000

Environmental factors, situation of women and child mortality in southwestern Nigeria.

In an earlier paper, the author identified the role of maternal social characteristics on child mortality in Sub-Saharan Africa through statistical analysis (Iyun, 1992; GeoJournal, 26(1), 43-52). This follow-up analysis attempts to further analyze and determine the relative significance of environmental and maternal factors on childhood mortality in two contrasting towns in southwestern Nigeria. The research design takes advantage of the integration of the medical and social sciences. The results of the current analysis reveal interesting insights into child mortality and maternal factors on one hand and domestic environmental conditions on the other. They give credence to an ecological perspective as a way to understand the complexities behind child survival. Domestic environmental conditions were stronger predictors of child mortality in the more developed study town, Ota, than the more traditional town, Iseyin. However, in both sites maternal factors, in particular age of mother at marriage, age of mother at first childbirth and parity were statistically significant predictors of child mortality. Mother's education was only significant in the more urbanized center, and generally remains inconsistent in its relationship with child mortality. Furthermore, child mortality rates continued to be a function of an environmental factor, namely source of drinking water, and a child care behavior factor, where the child was kept when mother was at work, especially the market environment.

Adolescent↗
PubMed1997

Schistosomiasis in two Nile delta villages: an anthropological perspective.

In the rapidly changing Nile delta villages, applied research for schistosomiasis control requires a holistic view of the social and environmental setting of the disease. An interdisciplinary, participatory study of two delta villages studied human behaviour in relation to disease transmission, knowledge and treatment using the insights and methods of social science, especially anthropology. Through primarily qualitative techniques such as focus group discussions and participant observation, we found that most people who used the canals for domestic, recreational or agricultural activities thought that they had little alternative but to do so, even though they knew of the risk of exposure to schistosomiasis. The knowledge and behaviour of villagers with regard to schistosomiasis affected their utilization of the local provisions for schistosomiasis diagnosis and treatment. Our monitoring of diagnosis and testing for schistosomiasis at a local health centre identified areas which could be upgraded, and we trained health staff to improve their knowledge of schistosomiasis. Our findings reinforce the need for integrated research and implementation strategies, taking into account the knowledge and capabilities of all those involved in schistosomiasis control at the village level, and the fostering of effective communication between villagers, both women and men, and the local staff in rural health centres.

Adolescent↗
PubMed2003

"Typhoid Mary" and "HIV Jane": responsibility, agency and disease prevention.

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.

Carrier State↗
PubMed2002

[Fitness for work after vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVE: The evaluation of a vocational rehabilitation programme initiated by the State Social Security Institute in Iceland (SSSI) in 1999 with the aim of reducing disability. MATERIAL AND METHODS: New disability claimants who had been unable to work because of illness for a few months at least were referred by SSSI physicians to a multidisciplinary team for assessment of rehabilitation potentials and an advice on the appropriate type of rehabilitation. The study group included all the 109 individuals who were referred to the team in the year 2000. Data on marital status, number of children and level of education was compared with information about the Icelandic population obtained in a national survey. The outcome of the rehabilitation was assessed in a telephone survey, carried out by the Social Science Research Institute, University of Iceland, 1-2 years after the assessment and by information obtained from the disability register at SSSI. The effectiveness of the rehabilitation programme was evaluated by comparing the study group with a comparable group that had started to receive rehabilitation pension before the SSSI could offer vocational rehabilitation. Their progress was assessed a year and half after they had contacted the SSSI, the same length of time as the study group had been in the in the rehabilitation programme. RESULTS: In the study group there were about twice as many women as men. The mean age was 35 years (range 18-57 years). The main medical reasons for referral to the team were musculosceletal and psychiatric disorders. Those evaluated were more likely to be unmarried or divorced, had more children and a lower educational level than the general Icelandic population. After evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. In all, 46 individuals received other treatment or education. Almost three quarters (72%) of the participants in the telephone survey said that their fitness for work had increased after rehabilitation, but only 47% had returned to work. At the time of the reserach, 23% were students and it is likely that a part of them will return to work when their studies are completed. Between one and two years after the evaluation by the multidisciplinary team 44 out of 109 (40.4%) in the study group received disability pension and a equal number received no social insurance benefits at all. In the comparison group 97 out of 119 (81.5%) received disability pension and 21 (17.7%) received no social insurance benefits at all. CONCLUSIONS: This study shows that vocational rehabilitation organized by the SSSI is effective and can prevent disability. The results of this study are similar to the results of two Swedish studies on the same topic.

English Abstract↗
PubMed2006

Independent living programmes for improving outcomes for young people leaving the care system.

BACKGROUND: Independent living programmes (ILPs) are designed to provide young people leaving care with skills that will limit their disadvantage and aid in their successful transition into adulthood. Programmes focus on personal development, independent living skills, education, and vocational support. OBJECTIVES: To assess the effectiveness of independent living programmes for young people leaving the care system. SEARCH STRATEGY: The following electronic databases were searched: Cochrane Register of Controlled Trials (CENTRAL) (Issue 3, 2005); MEDLINE (1966 to June 2005); EMBASE (1980 to June 2005); CINAHL (1982 to June 2005); PsycINFO (1887 to June 2005); Sociological Abstracts (1952 - June 2005); Applied Social Science Index and Abstracts (ASSIA) (1987- June 2005) and Dissertation Abstracts (to June 2005). All bibliographies were cross-referenced, and experts were contacted for unpublished or ongoing studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing ILPs to standard care, another intervention, no intervention, or a wait-list control, for young people leaving care systems at their country's statutory age of discharge. DATA COLLECTION AND ANALYSIS: 2196 citations were identified and screened independently by two reviewers. Full text versions were obtained for 54 papers. None met the review's inclusion criteria. MAIN RESULTS: No study was found that met the inclusion criteria of the review. Eighteen studies using nonrandomised or noncomparative designs were found, which generally reported favourable outcomes for ILP participants; however, reliable inferences cannot be drawn from these studies due to their use of weak methodology. AUTHORS' CONCLUSIONS: Results from randomised controlled trials show no evidence of the effectiveness of ILPs in improving or impairing outcomes for young people discharged from care. Further research into ILPs using randomised controlled designs is needed.

Activities of Daily Living↗
PubMed1988

Alcohol control policy in Israel 1986-1987: recognizing the need for diverse primary prevention initiatives.

The purpose of this paper is to describe the recent integration of two different preventive models (the 'Distribution of Consumption Model' and the 'Social Science Model'), planned to support each other, in order to reduce per capita alcohol consumption and curb the rise in alcohol-related problems in Israel, to shed light on the Israeli laws regulating alcohol use and on the extent of their enforcement, to illustrate the causes for their enforcement and to discern some indications for future directions. Although the focus on attitudes and practices which lead to excessive drinking, and the efforts to change them through education remain the very core of the entire Israeli preventive program, alcohol itself has been considered to be a source of difficulties. The beginning of law-enforcement concerning its availability among youngsters and drivers has emerged, both as a result of several fatal events and intense pressures of the Israeli Alcoholism Prevention and Treatment Services. The present tasks are to reinforce the emerging trends of enforcement concerning the existing laws, to adopt some new regulations pertaining to alcohol advertising targeted at adolescents, and to continue with the educational messages based on Jewish-Israeli norms.

Alcohol Drinking↗
PubMedDate not supplied

Portuguese-speaking women voice their opinions: using their words to teach about wife abuse.

BACKGROUND: This study examined Portuguese-speaking women's definitions of wife abuse and beliefs about appropriate responses to abuse. The goals were to determine the breadth of definitions and to examine cultural stereotyping. This information was sought in an effort to design education strategies in the Portuguese-speaking community. METHODS: One-on-one semistructured interviews were conducted with 163 Portuguese-speaking women living in Toronto, Canada. The participants' open-ended answers were first coded using Qualitative Software Research NUDIST and then narrowed and grouped. Responses were then tagged by group label to generate descriptive statistics using Statistical Package for Social Sciences. RESULTS: Participants defined wife abuse broadly with respect to kind, prevalence, and severity. Six themes for abuse emerged: physical, psychological, sexual, financial, patriarchal, and infidelity. Participants provided various responses to what women should do and actually do in response to abuse. Most participants believed that Portuguese-speaking women should leave their husbands and/or seek help for the abuse, but that they actually remain quiet about the abuse and take very little action. Their responses and explanations demonstrate that they hold stereotypes about their culture. CONCLUSIONS: The range of definitions reported by participants suggests that a continuum of wife abuse, using Portuguese-speaking women's own words, can be created to educate them about how abusive acts are linked and used to maintain control over women. The differences that emerged with respect to appropriate responses to abuse suggest that it may be important to challenge Portuguese-speaking women about the cultural stereotypes that they hold to help them see patriarchy as widespread rather than particular to their culture.

Adult↗
PubMed2004

Capacity building in rural health research: a Canadian perspective.

INTRODUCTION: The need to build capacity in rural health research is recognized in Canada. During its formative stage, the Canadian Rural Health Research Society (established in 2002), performed a nation-wide survey of the research teaching and training opportunities available to students interested in rural and remote health issues. Intended as a cross-sectional 'snapshot,' and to provide base-line data, the survey involved a comprehensive list of educational programs in health and science disciplines at all Canadian Universities offering graduate-level programs. The present project report gives an overview of the results, documenting the current strengths, but also the noticeable gaps that exist. METHODS: Data were collected via an Internet survey, developed according to Dillman's email survey design principles. Although multiple contacts are recommended, due to time constraints only two were made. The instrument included both open- and closed-ended questions designed to determine institutional commitments to rural health research training generally, as well as specific information about course offerings, infrastructure supports for students, financial assistance for studying specific topics, and future plans. Health was defined broadly and included a number of disciplines beyond those usually considered under the health rubric. Individuals in administrative positions for 462 programs in 24 distinct disciplines at 56 institutions were sent the survey. Responses were received from 120 programs at 40 universities. Due to budget constraints the instrument was not translated into French. Descriptive statistics were used to analyse the data, combined with a thematic analysis of written comments. Ethical approval was obtained from the Lakehead University before the study was conducted. RESULTS: Despite the fact that one-third of Canadians live in rural, remote and northern areas, there is a paucity of research that addresses rural health issues. Moreover, Canadian universities have very limited rural health offerings in their curricula. There are few formal courses available on rural health topics generally or rural health research specifically. Although students can take rural-related independent studies or reading courses, very few actually take advantage of the option. Of all disciplines, nursing faculty are most likely to pursue rural health research and to offer rural health courses. Moreover, nursing faculty most often indicate an intention to expand their rural health offerings. In the social sciences, geography and environmental science programs, relatively few students choose to study rural health. Similarly, in medicine, the number of students exploring rural health issues is small. There is some specific financial assistance available to students who are interested in rural health research and, as well, they have access to general pools of funding. CONCLUSION: The survey results demonstrate the limitations of current educational programs. However, they also indicate areas of potential growth and show widespread interest in increasing the offerings available at universities across Canada. The article concludes by giving an overview of the mandate and initiatives being taken by the new research society to augment training, and to enhance student participation. In addition, it notes the positive developments linked to a new Strategic Plan by the Canadian Institutes of Health Research (CIHR) to enhance rural health research in Canada.

Journal Article↗
PubMed2005

Violence among peoples in the light of human frustration and aggression.

This article sets out to provide a general background to the study of aggression in the social sciences, with a particular focus on its link to collective violence. While the study of what happens in the human brain appears to be already highly complex, analysis of violent behavior appears to be even more intricate. A deductive system in the sense of a general and clear system of propositions logically connected to one another is not feasible, principally because contrary to the natural sciences there are no verities but merely "stylized facts." One of these concerns the setting of human aggression in the light of frustration, as argued in the frustration-aggression hypothesis developed by Dollard et al. in 1939. Apart from conceiving of aggression as a pure human instinct, it may also be seen as externally driven, while a third possibility concerns culturally "learned" aggression. Proof of the latter is that the strongest correlation appears to be that between current violence and previous manifestations thereof. Attention is paid to the way in which Gurr has rooted his relative deprivation theory on causes of collective violence among peoples in mechanisms of frustration and aggression. That theory is taken a bit further in terms of "perceived acquirement failure," which appears to be highly connected to the role of the state. Based on certain observations by Hannah Arendt, the argument then proceeds to violence as a manifestation of powerlessness. Finally, this leads to a discussion of justice as a crucial factor in what Durkheim used to call a "right to conflict." In this way, human aggression is placed in a broad socio-economic context.

Aggression↗
PubMed2003

Drift as a mechanism for cultural change: an example from baby names.

In the social sciences, there is currently no consensus on the mechanism by which cultural elements come and go in human society. For elements that are value-neutral, an appropriate null model may be one of random copying between individuals in the population. We show that the frequency distributions of baby names used in the United States in each decade of the twentieth century, for both males and females, obey a power law that is maintained over 100 years even though the population is growing, names are being introduced and lost every decade and large changes in the frequencies of specific names are common. We show that these distributions are satisfactorily explained by a simple process in which individuals randomly copy names from each other, a process that is analogous to the infinite-allele model of population genetics with random genetic drift. By its simplicity, this model provides a powerful null hypothesis for cultural change. It further explains why a few elements inevitably become highly popular, even if they have no intrinsic superiority over alternatives. Random copying could potentially explain power law distributions in other cultural realms, including the links on the World Wide Web.

Culture↗
PubMed2006

A study of knowledge and attitudes towards the use of evidence-based medicine among primary health care physicians in Bahrain.

OBJECTIVE: A study of perceptions and attitudes towards the use of evidence-based medicine (EBM) among family physicians in Bahrain. METHODS: A systematically developed, anonymous, self administered 13 item questionnaire was mailed to 124 Bahraini family physicians in the Ministry of Health, Bahrain between January and April 2004. The response rate was 65%. Data were analyzed using the Statistical Package for Social Sciences (Windows version 11.00). RESULTS: The respondents (n=81) were mainly female (65.4%) with a mean age of 40 (SD 7.7) years, with 12.7 (SD 8.3) years since graduation. Forty-two percent had attended EBM workshops and 61% claimed to use EBM in their practice. Those who had attended a workshop were more likely to assert that they were practicing EBM (82% versus 47%; p=0.001). Less than 10% selected patient s choice as a component of EBM. The 81.5% of respondents agreed their patients were willing to participate in decision making but 50% felt that only 10-25% of their patients were capable. No time (53.1%) and no ready access to resources (73.5%) were the most cited barriers, 32% of respondents agreed that EBM is not applicable to their culture. CONCLUSION: Most family physicians in Bahrain claimed to use EBM in their practice, particularly if they had attended an EBM workshop. However, most of them did not consider patients values as a component of EBM. A substantial minority considered that EBM is inapplicable to their culture.

Adult↗
PubMed1996

A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health.

OBJECTIVE: To review the available evidence in order to identify effective interventions which health services alone or in collaboration with other agencies could use to reduce inequalities in health. METHODS: A search of the literature was undertaken using a number of databases including Medline (from 1990), Applied Social Science Index and Abstracts (1987-1994), and the System for Information on Grey Literature in Europe (1984-1994), on a large range of key words. Studies were included if they assessed interventions designed to reduce inequalities in health or improve the health of a population group relevant to the review, and could be carried out by a health service alone or in collaboration with other agencies. Only studies evaluating interventions using an experimental design were included. Papers in any language were considered. In addition, systematic reviews of the research on the effectiveness of health promotion and the treatment of conditions where there are significant health inequalities were identified in order to illustrate the potential for reducing inequalities in health. RESULTS: 94 studies were identified which satisfied all the inclusion criteria and 21 reviews were included. A number of interventions have been shown to improve the health of groups who are disadvantaged by socio-economic class, ethnicity or age and, if properly targeted, could be expected to reduce health inequalities. If a health intervention is being used, there should be evidence that it has an impact on health status. Attention should then be given to the way in which the intervention is delivered and the characteristics of a programme to promote implementation. Characteristics of successful interventions specifically aimed at reducing health differentials include: systematic and intensive approaches to delivering effective health care; improvement in access and prompts to encourage the use of services; strategies employing a combination of interventions and those involving a multi-disciplinary approach; ensuring interventions address the expressed or identified needs of the target population; and the involvement of peers in the delivery of interventions. However, these characteristics alone are not sufficient for success, nor are they universally necessary. CONCLUSIONS: Although it is likely that the most significant contributions to reducing health inequalities will be in improving economic and social conditions and the physical environment, there are interventions which health services, either alone or in collaboration with other agencies, can use to reduce inequalities in health.

Age Factors↗
PubMed2006

Assessing the effects of human mixing patterns on human immunodeficiency virus-1 interhost phylogenetics through social network simulation.

Geneticists seeking to understand HIV-1 evolution among human hosts generally assume that hosts represent a panmictic population. Social science research demonstrates that the network patterns over which HIV-1 spreads are highly nonrandom, but the effect of these patterns on the genetic diversity of HIV-1 and other sexually transmitted pathogens has yet to be thoroughly examined. In addition, interhost phylogenetic models rarely account explicitly for genetic diversity arising from intrahost dynamics. This study outlines a graph-theoretic framework (exponential random graph modeling, ERGM) for the estimation, inference, and simulation of dynamic partnership networks. This approach is used to simulate HIV-1 transmission and evolution under eight mixing patterns resembling those observed in empirical human populations, while simultaneously incorporating intrahost viral diversity. Models of parametric growth fit panmictic populations well, yielding estimates of total viral effective population on the order of the product of infected host size and intrahost effective viral population size. Populations exhibiting patterns of nonrandom mixing differ more widely in estimates of effective population size they yield, however, and reconstructions of population dynamics can exhibit severe errors if panmixis is assumed. I discuss implications for HIV-1 phylogenetics and the potential for ERGM to provide a general framework for addressing these issues.

Evolution, Molecular↗
PubMed2002

Communication, information and support for adults with malignant cerebral glioma : a systematic literature review.

The goal of this work was a systematic review of communication, information and support for adults with malignant cerebral glioma. Medical, nursing and social science computerised databases up to spring 2000 were searched. Key organisations were contacted, and specialist journals were searched. Inclusion criteria were publication in English, inclusion of patients with malignant cerebral glioma, measurement of patients' and relatives' awareness of the prognosis, distress, satisfaction with information or care received, uptake of service or professional communication skills. Studies of patients with other cancers were excluded. Qualitative and quantitative studies were assessed, graded for methodological quality and combined. Twelve observational studies were found, although many were limited by sample selection, description and setting. Patient awareness of the prognosis varied, and relatives appeared more aware. There was no direct evidence about what patients and relatives wanted to know, but qualitative studies suggested that an individual approach to disclosure and maintaining hope were important. Most patients and relatives valued specialist nurse support highly. No specific studies of interventions to break bad news, giving information or training staff were found for these patients. Evidence from observational studies suggests that these patients need individually tailored communication and information, and specialist support. Existing intervention studies of patients with other cancers may suggest effective strategies.

Adult↗
PubMed2004

New understandings of parental grief: literature review.

BACKGROUND: Health professionals have a critical role in supporting bereaved parents and rely on models of grief to inform and guide their practice. However, different models, based on fundamentally different theoretical perspectives and research paradigms, do not necessarily reflect the experiences, or particular needs, of bereaved parents. AIM: The aim of this paper is to report a literature review exploring changing theoretical perspectives in relation to parental grief in the United Kingdom and United States of America. METHODS: A literature search was conducted of nursing, medical and social science data bases using the key words bereaved parents, models of grief and theories of grief. This revealed 266 publications, of which 32 were relevant. Contemporary literature has formed the focus of this review but older material has been included to trace how theoretical perspectives on parental grief have evolved over time. FINDINGS: Theoretical perspectives, on which models of grief are based, have evolved continuously over the last century. Also, traditional and new models differ because in that they are rooted in positivistic and non-positivistic research paradigms respectively. The main implications for health professionals are that new models can be applied in practice to support parents in their grief. The literature reflects an Anglo-American cultural perspective and further research is needed to reflect the multicultural diversity of today's multicultural societies. CONCLUSIONS: This review highlights fundamental differences between traditional and new models of grief. Traditional models, place emphasis on bereaved people letting go of their emotional relationships with those who have died. In contrast, new models, place emphasis on parents holding on to their relationship with their dead children, and identify therapeutic interventions that support parents in their grief.

Attitude to Death↗
PubMed2001

Monitoring health reform: a report card approach.

UNLABELLED: During the past several years, budget cuts have forced hospitals in several countries to change the way they deliver care. Gilson (Gilson, L. (1998). DISCUSSION: In defence and pursuit of equity. Social Science & Medicine, 47(12), 1891-1896) has argued that, while health reforms are designed to improve efficiency, they have considerable potential to harm equity in the delivery of health care services. It is essential to monitor the impact of health reforms, not only to ensure the balance between equity and efficiency, but also to determine the effect of reforms on such things as access to care and the quality of care delivered. This paper proposes a framework for monitoring these and other indicators that may be affected by health care reform. Application of this framework is illustrated with data from Winnipeg, Manitoba, Canada. Despite the closure of almost 24% of the hospital beds in Winnipeg between 1992 and 1996, access to care and quality of care remained generally unchanged. Improvements in efficiency occurred without harming the equitable delivery of health care services. Given our increasing understanding of the weak links between health care and health, improving efficiency within the health care system may actually be a prerequisite for addressing equity issues in health.

Adolescent↗
PubMed2005

Heroic frames: discursive constructions around the requested death movement in Australia in the late-1990s.

This paper focuses on a critical development in the life of the requested death movement [McInerney, F. (2000). "Requested Death": A new social movement. Social Science & Medicine, 50(1), 137-54.], that being the passage of the Northern Territory of Australia's Rights of the Terminally Ill (ROTI) Act 1995. This legislation, for the first time anywhere in the world, allowed for lawful euthanasia and physician-assisted suicide, thereby fulfilling key requirements of the movement. Taking a constructionist perspective, I analyzed discursive representations of dying, death and medicine in selected Australian print media during this time period (1995-1997). The media's predilection for reporting dramatic and unusual death coincided with the movement's construction of contemporary dying as horrific, intractable, and intolerable. Across all analyzed publications and genres, an heroic discourse was found to be a dominant influence, couched within a dramatic framing that served to reinforce many of the claims of the requested death movement. The framing of requested death activists as heroes, and of requested death itself as a redeeming and transforming act for those seeking it, were preeminent in press portrayals. The dominance of this heroic discourse suggests that such media and movement frames worked in tandem to both resonate with and reinforce popular Australian notions of terminal illness and dying in the late 20th century.

Attitude to Death↗