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Byline: Sunil. Pandya Wherever the art of medicine is lived, there is also a love of humanity.' Hippocrates (460-370 B.C.) Some definitions The word 'human' is derived from the Latin [...]

Among the common mechanisms for understanding human bodies, in sickness and in health, proliferating among professionals and laypeople alike during the transatlantic long eighteenth century was the nonhuman animal. Often [...]

INTRODUCTION In a 1997 edition of al-Suyuti's (1) treatise on the plague, which was composed in the fifteenth century, the actual treatise occupies only one-third of the volume; the rest [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.08.010 Byline: Gavin J. Andrews (a), David Shaw (b) Abstract: Needle phobia is a relatively common condition that, because it involves fear of a clinical procedure, often deals a 'double blow' to sufferers. Not only can it affect their general health care seeking behaviors (with avoidance potentially having serious health implications), if and when they present for health care, it often causes them significant physical and mental distress. This paper reports on a specific type of therapeutic practice that health professionals use when injecting their clients who have (undiagnosed) needle phobia, aimed at preventing, or momentarily relieving, their negative experiences. In-depth interviews with ten nurses and two doctors explore their often spontaneous use of visualization techniques which, involving a strong and varied emphasis on place, are highly geographical. Three emerging themes provide focused insights into visualization; breadth and forms, techniques and approaches, instinct and intuition. The paper concludes with considerations of practice advancement and future research. Author Affiliation: (a) McMaster University, Canada (b) Bucks New University, UK

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jdeveco.2009.11.001 Byline: Kenneth L. Leonard (a), Melkiory C. Masatu (b) Keywords: Motivation; Practice quality; Health care; Tanzania; Hawthorne effect Abstract: Many doctors in developing countries provide considerably lower quality care to their patients than they have been trained to provide. The gap between best possible practice and actual performance (often referred to as the know-do gap) is difficult to measure among doctors who differ in levels of training and experience and who face very different types of patients. We exploit the Hawthorne effect-in which doctors change their behavior when a researcher comes to observe their practices-to measure the gap between best and actual performance. We analyze this gap for a sample of doctors and also examine the impact of the organization for which doctors work on their performance. We find that some organizations succeed in motivating doctors to work at levels of performance that are close to their best possible practice. This paper adds to recent evidence that motivation can be as important to health care quality as training and knowledge. Author Affiliation: (a) 2200 Symons Hall, University of Maryland College Park, MD 20742, United States (b) Centre for Educational Development in Health, Arusha (CEDHA), P.O. Box 1162, Arusha, Tanzania Article History: Received 30 April 2007; Revised 2 November 2009; Accepted 3 November 2009

In this paper, I explore the links between liberal political theory and the evaluative nature of medical classification, arguing for stronger recognition of those links in a liberal model of medical practice. All judgments of medical or psychiatric 'dysfunction,' I argue, are fundamentally evaluative, reflecting our collective willingness or reluctance to tolerate and/or accommodate the conditions in question. Illness, then, is 'socially constructed.' But the relativist worries that this loaded phrase evokes are unfounded; patients, doctors, and communities will agree in the vast majority of cases about what counts as illness. Where they cannot come to agreement, however, we are faced with precisely the sort of dispute about values and ways of life that the institutions of the liberal state are designed to accommodate. I accordingly sketch a model of medical practice, based loosely on Jurgen Habermas's political theories, designed to maximize both our awareness and our understanding of these disputes. Keywords: constructivism, Habermas, liberal, Szasz, value doi: 10.1093/jmp/jhq035

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.10.016 Byline: Judith D. de Jong (a), Peter P. Groenewegen (a)(b), Peter Spreeuwenberg (a), Francois Schellevis (a)(c), Gert P. Westert (d)(e) Abstract: This article aimed to test the general hypothesis that guidelines create uniformity, or reduce variation, in medical practice. Medical practice variation has policy interest and is one of the reasons for developing guidelines. The development and implementation of guidelines was considered in the broader context of processes of rationalization. We focused on the influence of voluntary guidelines developed by the professional organization for family physicians in the Netherlands on variation in drug prescription. Data were used from the First and Second Dutch National Survey of General Practice (DNSGP1 and DNSGP2), collected in 1987 and 2001 respectively. DNSGP1 consisted of 103 practices and 161 GPs serving 335.000 patients. DNSGP2 consisted of 104 practices and 195 GPs serving 390.000 patients. Two groups of diagnoses were created, one containing all diagnoses for which guidelines were introduced and one containing all other diagnoses. For both groups a measure of concentration, Herfindahl-Hirschman Index (HHI), was used to represent variation. This measure of concentration was compared between both groups using multilevel analysis. Results showed that although there was an overall increase in variation (a significantly lower HHI) in prescription, the increase was less in the cases of diagnoses for which guidelines were introduced. Guidelines, primarily, had an effect on variations in single-handed practices. The overall conclusion is that the introduction of guidelines, although it probably tempered the increase in variation, did not reduce variation. Author Affiliation: (a) NIVEL, Utrecht University, Netherlands (b) Utrecht University, Utrecht, Netherlands (c) Vrije Universiteit Medical Centre, Amsterdam, Netherlands (d) RIVM, Bilthoven, Netherlands (e) Tilburg University, Tilburg, Netherlands

Strength-based assessment can enhance clinical clarity, improve the range of information, and provide a more complete picture of clients and their circumstances. Deficit-oriented assessment has improved the assessment and treatment of a number of disorders but, at the same time, has created a negative bias, considered strengths as clinical peripheries or by-products, tended to reduce clients to diagnostic categories, and created a power differential, which could be counterproductive to clinical efficacy. Strength-based assessment explores weaknesses as well as strengths to effectively deal with problems. We present a number of strength-based strategies for use in clinical practice. These strategies, we hope, will help clinicians to operationalize how strengths and weaknesses reverberate and contribute to a client's psychological status, which is comprehensive and guards against negative bias. Keywords: strengths; clinical assessment; positive psychology; psychopathology; deficits; well-being

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.01.042 Byline: Ruth McDonald, Kath Checkland, Stephen Harrison, Anna Coleman Abstract: For Freidson [(1985). The reorganisation of the medical profession. Medical Care Review, 42(1), 11-35], collegiality, or ostensible equal status amongst members of the medical profession, serves a dual purpose. It socialises members into an attitude of loyalty to colleagues and presents an image to those outside the profession that all its members are competent and trustworthy. However, Freidson saw the use of formal standards developed by one (knowledge) elite within medicine and enforced by another (administrative) elite as threatening collegiality and professional unity. Drawing on two studies in English primary medical care this paper reports the emergence of new strata or elites, with groups of doctors involved in surveillance of others and action to improve compliance in deficient individuals and organizations. Early indications are that these developments have not led to the consequences which Freidson predicted. The increasing acceptance of the legitimacy of professional scrutiny and accountability that we identify suggests that new norms are emerging in English primary medical care, the possibility of which Freidson's analysis fails to take account. Author Affiliation: National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, United Kingdom

Objectives. We examined whether stress related to negative body image perception and the desire to lose weight explained some of the body mass index-health gradient. Methods. We used 2003 Behavioral Risk Factor Surveillance System data to examine the impact of desired body weight, independent of actual body mass index, on the amount of physically and mentally unhealthy days by race, ethnicity, and gender. Results. The difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health. When we controlled for BMI and age, men who wished to lose 1%, 10%, and 20% of their body weight respectively suffered a net increase of 0.1,0.9, and 2.7 unhealthy days per month relative to those who were happy with their weight. For women, the corresponding numbers were 0.1, 1.6, and 4.3 unhealthy days per month. The desire to lose weight was more predictive of unhealthy days among women than among men and among Whites than among Blacks or Hispanics. Conclusions. Our results raise the possibility that some of the health effects of the obesity epidemic are related to the way we see our bodies. (doi:10.2105/AJPH.2007.114769)

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1468-0009.2007.00514.x Byline: PETER J. CUNNINGHAM (1), JACK HADLEY (1) Keywords: Charity care; uninsured; Medicaid; access; physicians; safety net Abstract: Context: The decline over the past decade in the percentage of physicians providing care to charity and Medicaid patients has been attributed to both financial pressure and the changing practice environment. Policymakers should be concerned about these trends, since private physicians are a major source of medical care for low-income persons. This study examines how changes in physicians' practice income, ownership, and size affect their decisions to stop or start treating charity care and Medicaid patients. Methods: This study uses panel data from four rounds of the Community Tracking Study Physician Survey. The dependent variables are the likelihood of physicians' (1) dropping charity care, (2) starting to provide charity care, (3) no longer accepting new Medicaid patients, and (4) starting to accept new Medicaid patients. The primary independent variables are changes in physicians' practice income, ownership, and practice type/size. Multivariate analysis controls for the effects of other physician practice characteristics, health policies, and health care market factors. Findings: A decline in physicians' income increased the likelihood that a physician would stop accepting new Medicaid patients but had no effect on his or her decision to provide charity care. Those physicians who switched from being owners to employees or from small to larger practices were more likely to drop charity care and to start accepting Medicaid patients, and physicians who made the opposite practice changes did the reverse. Conclusions: Changes in their income and practice arrangements make physicians less willing to accept Medicaid and uninsured patients. Moreover, physicians moving into different practice arrangements treat charity and Medicaid patients as substitutes rather than as similar types of patients. To reverse these trends, policymakers should consider raising Medicaid reimbursement rates and subsidizing organizations that encourage private physicians to provide charity care. Author Affiliation: (1)Center for Studying Health System Change; George Mason University Article note: Address correspondence to: Peter J. Cunningham, Center for Studying Health System Change, 600 Maryland Ave., S.W., Suite 550, Washington, DC, 20024 (email: pcunningham@hschange.org).

As a framework for presenting ideas on developing ways to make sociology more applicable, we focus on the recent state of medical sociology research. Data for this paper were generated through a content analysis of a twelve-year period (1993-2004) of the Journal of Health and Social Behavior (JHSB) and Social Science & Medicine (SSM). The analysis aims to determine if the content of JHSB and SSM reflect the breadth of the sub-discipline of medical sociology as well as the stated goals of the journals. The selected issues of JHSB and SSM were coded on the basis of the following attributes: (1) Primary Substantive Topic, (2) Methodology, (3) Data Type and Analytic Technique, and (4) Research and Policy Recommendations. We found that the orientation of JHSB articles was towards generating research and theory that shy away from policy, interdisciplinary approaches, and applied issues. SSM content tends to display more interdisciplinary breadth and variety, but also reflects a dearth of applied recommendations. Our discussion focuses on what JHSB and SSM could be. We present ideas on how the sociological discipline in general--and JHSB and SSM in particular--can help generate and nourish new forms of inquiry that can impact the way research questions are framed. We conclude that such a shift is needed in order to maximize the applicability of social scientific evidence to everyday life, and we share examples situated within a socio-medical context, where there is a particular need for the application of social evidence to practice. Keywords: Medical sociology: Content analysis; Practice; Interdisciplinary; Policy; Social science & medicine; Journal of health and social behavior

OBJECTIVE. Our aim was to quantify contemporary infant mortality risks and to evaluate the change by plurality, gestation, and race during the most recent decade. PATIENTS AND METHODS. The study population included live births of 20 to 43 weeks' gestation from the 1989-1991 and 1999-2001 US Birth Cohort Linked Birth/ Infant Death Data Sets, including 11 317 895 and 11 181 095 live births and 89 823 and 67 129 infant deaths, respectively. Adjusted odds ratios and 95% confidence intervals were calculated to evaluate the change in risk by plurality and gestation and to compare the change with that for singletons. RESULTS. Overall, the infant mortality risk decreased significantly for singletons, twins, and triplets but nonsignificantly for quadruplets and quintuplets. Compared with singletons, significantly greater reductions were experienced by twins overall and at CONCLUSIONS. The improvements in survival were greater for multiples versus singletons and for white versus black infants. Within each plurality, at each gestation the racial disparity in mortality has widened. Key Words infant mortality, birth weight, gestation, plurality, racial disparities, DURING THE 1990S, a series of major changes in medical practice, clinical guidelines, and national recommendations occurred in the United States and other industrialized nations, paralleling the rise in multiple [...]

Objectives: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. Methods: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys. Results: There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care. Conclusions: In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy. Keywords Preconception care * Preconception counseling * Preconception surveys * Practice patterns * Pregnancy outcomes * Prepregnancy planning * Prepregnancy surveys

Summary Recent regulatory warnings about adverse behavioural effects of antidepressants in susceptible individuals have raised the profile of these issues with clinicians, patients, and the public. We review available clinical [...]

Ferguson Medical Group and Missouri Delta Medical Center are virtually next-door neighbors in the small town of Sikeston, MO, about 140 miles south of St. Louis. In between them stands [...]

Summary This information on best practice is based on a systematic review of research, published by Blackwell Publishing Asia and conducted by the Centre for Evidence-based Nursing South Australia, a [...]

The role of diagnostic labels in medicine is usually that of labelling an illness as a means of communication. Control over labelling processes in medicine is ordinarily imposed via medical schools, textbooks, education or by diagnostic manuals. Diagnostic labels often change following new discoveries in underlying pathology such as 'consumption' being relabelled as 'TB' or 'cancer'. Sub-types of broad diagnostic labels also often emerge from such discoveries e.g. 'lung cancer' or 'throat cancer'. In mental health, underlying pathology is the subject of ongoing debate spanning ideas including the brain as a faulty organ, faulty genetics and environmental problems. With controversy over pathology comes controversy over labels and the idea that labels may be used not just for communication, but as devices of social and professional control, arising out of a social process. This study explores the codification of the diagnostic label 'depression' which emerged in the twentieth-century and has proliferated with numerous sub-types over the last 40 years. The aim is to examine its social determinants and context. Medline is used as a data source for professional label usage. A range of depression sub-type labels in professional use was identified. This exercise revealed many official and 'unofficial' terms in professional use. Citation rate plots by year were then generated for these depression sub-type labels. The rise and fall of different labels are examined in relation to social determinants and context, including publication of diagnostic manuals DSM and ICD, power shifts in psychiatry, the discovery of psychiatric drugs and the shift from inpatient to community care. Exploring the changing use of official and unofficial labels over time in this way provides a novel historical perspective on the concept of depression in the late twentieth-century. Keywords: Depression; History of medicine; Diagnostic labels; DSM; Community care

A study examining the informed therapeutic decisions made by dentists, by assimilation of evidence is presented. This assimilation requires, knowledge of the quality of the evidence and its translation into clinical practice.

Medicine is no longer a straight-line career path. Some doctors take time out to start a family; others try working in industry for a while; still others find themselves coming [...]

The field of spirituality and medicine has seen explosive growth in recent years, due in part to significant private support for the development of curricula in more than half of all U.S. medical schools, and for related residency training programs and research centers. While there is no single definition of 'spirituality' in use across these initiatives, this article examines the definitions and learning objectives relevant to spirituality that are addressed in a 1999 report of the Medical School Objectives Project (MSOP), with special attention to their ethical implications. It concludes with several 'diagnostic' case studies of religious consciousness from the medical literature and in literary texts, again with attention to ethical concerns. Keywords: bioethics, literature and medicine, medical education, religion and medicine, spirituality and medicine

Understanding the dynamics of dissent and heresy in medicine can be aided by the use of suitable frameworks. The dynamics of the search for truth vary considerably depending on whether the search is competitive or cooperative and on whether truth is assumed to be unitary or plural. Insights about dissent and heresy in medicine can be gained by making comparisons to politics and religion. To explain adherence to either orthodoxy or a challenging view, partisans use a standard set of explanations; social scientists use these plus others, especially symmetrical analyses. There is a wide array of methods by which orthodoxy maintains its domination and marginalises challengers. Finally, challengers can adopt various strategies in order to gain a hearing. Keywords: Dissent; Heresy; Orthodoxy; Medical knowledge; Medical

After the dissolution of the Soviet Union, Estonia quickly adopted a market economy. In medicine this has included the uptake of western-style health care and drug promotion aimed at practising physicians. Using post-menopausal hormone therapy (HT) as an example, we studied the consequences of this natural experiment on prescribing and on physicians' opinions of HT and drug promotion. Data were obtained from a cross-sectional questionnaire survey sent to gynaecologists and family practitioners (FPs) in 2000 compared to an earlier Finnish survey, and from drug sales figures (based on defined daily doses), local medical journals and observations. The survey focussed on physicians' opinions of HT, HT information and HT education, and was sent to a random sample of 500 physicians, of whom 68% responded. The sales of HT drugs in the 1990s in Estonia were much lower than in Finland, but rapidly rose during that decade. Physicians considered drug advertising to be a factor contributing to the increased HT use. Most gynaecologists but fewer FPs reported that they had had enough continuing education on menopause and HT. For 39% of the gynaecologists and 20% of the FPs, (part of) the costs to attend their last education activity was paid by a drug firm. Respondents who wished for further education considered drug firms to be potential organisers. Gynaecologists had had more communication on HT with the drug industry, and their attitudes towards HT were more positive than those of FPs. Fears about cancer in the 1980s were not found in 2000. The study suggests that the drug industry contributed to the change in physicians' views of HT. Keywords: Drug advertising; Prescribing; Physicians; Menopause; Hormone therapy; Estonia

Byline: Stale Fredriksen (1) Keywords: colonisation; instrumental action; Jurgen Habermas; modern medicine; technology Abstract: Stethoscopes, x-rays and other medical technologies are two-edged swords. They make medical treatment and diagnosis more accurate and effective, but do at the same time reveal our perceptual inadequacy. By transcending our senses, these technologies reveal that we can be seriously diseased without experiencing any symptoms at all. This situation has changed our attitude towards our relations and ourselves. The situation can be analysed using Jurgen Habermas' conception of 'systems colonisation of the lifeworld.' Medical technologies colonise our life world. They change the way we think and act. They make us all accept that we can become patients almost any minute, even if we feel perfectly healthy. Sense transcending technologies turn us all into proto-patient. Author Affiliation: (1) Centre for Medical Ethics, University of Oslo, Fredrik Holsts hus, 1130 Blindern, 0318, Oslo, Norway Article History: Registration Date: 07/10/2004 Article note: This revised version was published online in October 2005 with corrections to the Cover Date.

The objective of this article is to investigate whether the concept of techne is fruitful as a framework to analyze some of the pressing challenges in modern medicine. To do this, the concept of techne is scrutinized, and it is argued that it is a concept that integrates theoretical, practical and evaluative aspects, and that this makes it particularly suitable to analyze the complex activity of modern medicine. After applying this technical framework in relation to modern medicine, some of its general consequences are elaborated. In particular, it is argued that the concept of techne is appropriate to address the constitutive role of technology in medicine. Techne thus appears to be as fruitful a philosophical concept today as it was in antiquity. Keywords: ethics, practice, techne, technology, theory

This essay reads Mary Shelley's narrative of a plague-ravaged world in terms of contemporaneous medical theories of disease transmission. It argues that disease functions both literally and metaphorically in The [...]

Byline: William E. Stempsey (1) Keywords: determinism; epistemology; Hume; laws of nature; metaphysics; miracle; Peirce; Whitehead Abstract: In considering whether medical miracles occur, thelimits of epistemology bring us to confront ourmetaphysical worldview of medicine and nature ingeneral. This raises epistemological questions of ahigher order. David Hume's understanding of miraclesas violations of the laws of nature assumes thatnature is completely regular, whereas doctrines suchas C. S. Peirce's ``tychism'' hold that there is anelement of absolute chance in the workings of theuniverse. Process philosophy gives yet another viewof the working of nature. Physicians have noepistemological grounds for declaring any cure to bemiraculous. Miracles are theological (orphilosophical) entities, and not medical entities. All physicians can do is to determine whether or nota cure is scientifically inexplicable according to thecurrent epistemological standards of medical science. As these standards change, what is currentlyunexplainable may become explainable. However, we canalso come to realize that our current explanations arein fact unsatisfactory. Our justifications ofknowledge claims about miracles will depend on ourviews about determinism and indeterminism. If theuniverse is not a deterministic one, we should be opento the possibility of encountering what appear to usas sui generis events. These would not beviolations of immutable laws of nature, butmanifestations of the true workings of nature, andcertainly causes for wonder. Author Affiliation: (1) Department of Philosophy, College of the Holy Cross, One College Street, Worcester, MA, 01610-2395, USA Article History: Registration Date: 09/10/2004

Certain parallels can be drawn between evangelical religion and biomedicine, including the conviction of each that it provides access to vital knowledge, the perceived need to change human behavior without regard to race or culture, and a tendency toward cultural intolerance. These parallels are illustrated in the history of missionary and medical activity among the Cree of the James Bay region in northern Quebec. Three distinct phases of medical evangelism, defined by the activities of missions, the federal government, and an autonomous Cree health board, show a movement toward the redefinition of local healing practices and greater medical pluralism.

Means perturb matter and matter, means in James Merrill's poetry -- as in The Changing Light at Sandover, where the goofy medium of a Ouija board is elevated by and [...]