Social Science & Medicine (1967)最新文献

A sero-epidemiological screening of several samples of the Liberian population revealed an overall prevalence of hepatitis-B antigen (HG-Ag) of 11.3% among 405 sera. The rates varied according to differences in sampling, geographical origin and age distribution, with a range of HB-Ag carriers from 9 to 25%. The respective samples of urban populations appeared to have less antigen carriers when compared to rural population samples. A group of about 90 students and teachers from an educational institution, representing immigrant subjects from the coastal and interior regions of Liberia, revealed no substantial differences in the respective rates (10–11%). Two rural populations were sampled and revealed carrier rates of about 12% after age adjustment. The hypothetical role of a vector-borne transmission is discussed as well as the significance of the persistance of the antigen under the influence of immune deficiency and tropical diseases.

Attention is given to the processes involved in the selection of drugs for prescribing by general practitioners. Two particular aspects are focussed upon. The first is innovation, whereby a new preparation is used by physicians. It is argued that this is an irrational process under certain systems of drug administration since general physicians do not possess sufficient knowledge to innovate with expectations of safety and effectiveness. Nevertheless, it is conceded that the process of diffusion of satisfactory innovations is a matter of critical importance.

The second aspect is relinquishment, whereby a physician responds to the advocacy of professional sources by ceasing to use a drug against which these sources warn. This part of the paper is supported by data on the prescribing of non-barbiturate hypnotics. It is seen that despite the most frequent and widespread warnings a drug may still be used. The consequences of the two processes is discussed.

Repressed Hostility, a psychological construct hypothesized to correlate with CHD in middle-aged men, was theoretically derived from Ibrahim's formulation of the relationship between three psychological dimensions: Repression, Anxiety, and Manifest Hostility. The Three dimensions, as measured by corresponding scales of the MMPI, were rank ordered for each subject (S), by the S's score on each scale, into six profiles, ranging on a continuum from the scale type for Repressed Hostility, Hostility < Anxiety < Repression (HAR) to the non-scale type, Repression < Anxiety < Hostility (RAH). Ss were drawn from two distinctly different study populations. Prior to classifying Ss into psychological profiles, the three MMPI scales were modified to more sensitively reflect the greater “psychological meaningfulness” of the sub-sampled items from each of the three scales. The criterion for assessing the efficacy of the modification procedure was the empirical relationship between Repressed Hostility and CHD. Repressed Hostility was measured by profile characterization and CHD was determined by presence or absence of CHD and, if absent, by graded categories of physiological risk (the average ranks of three indicators: systolic, diastolic blood pressure, and serum cholesterol.) The assessment was made by jointly classifying Ss by CHD or physiological risk (independent variable) and Repressed Hostility status—Original MMPI scales (dependent variable₁) and Modified MMPI scales (dependent variable₂.) Modifications of Ibrahim's original design were made having to do with profile designation, method of scoring S's scale responses, reclassification of physiological risk, social class and age. The data powerfully supported the hypothesis that scale modification was responsible for finding a well-defined, consistent and general relationship (across two studies and five social classes) between Repressed Hostility and the physiological risk of developing CHD in men below 60 years of age. Although the Original scale data revealed some association between the physiological and psychological variables, the extent of the association can be shown to be a result of the influence of Modified scale items on Original scale scores.

This paper addresses the question of whether objective sociopolitical differences in national health care system are reflected in the attitudes of physicians working in those systems. An approximation of a cross-national design is used: physicians in the United States who were raised and trained in foreign countries (“FMGs”) are compared with physicians raised and trained in the United States (“USMGs”) in their attitudes toward political and health care issues. The main hypothesis is that FMGs hold more “liberal” attitudes than USMGs because of the more progressive features of most foreign health care system relative to that of the United States.

Data were collected in the Spring of 1973 from nationally representative samples of physicians, including housestaff, in the United States. On three of the four attitude areas examined—economic-welfare liberalism, federal government involvement in health care, and national health insurance—the findings support the general hypothesis: FMGs are more liberal in their thinking than are USMGs. The differences are larger among housestaff than among “senior” physicians. On the fourth issue, support for peer reviews of physicians' work, there are no differences between FMGs and USMGs among senior physicians, but among housestaff, USMGs are slightly more favorable. This latter finding, a reversal in the dominant pattern of greater liberalism among FMGs, is interpreted in light of the debate over the competence of FMGs, especially housestaff, and their presumed sense of vulnerability to peer reviews.

Alternative explanations of the general findings, such as the operation of selective factors in the migration of FMGs to the United States, are examined and rejected.

Problems arising during interaction between professional helpers and their clients, especially between doctor and patient, are examined and one particular problem, that of the tendency to perceive another person's behaviour as caused by predispositional traits within that person rather than by situational events, is considered to be fundamental. Evidence is reviewed which suggests that professional training may exacerbate such a tendency and consideration is given to the way in which training regimes may help to overcome the bias and allow better relationships to develop during professional encounters.