Social science & medicine. Part A, Medical sociology最新文献

Self-care is the basic level of health care in all societies. Yet, little is known about the range of lay reactions to illness and the forces shaping those reactions. This paper reviews literature concerned with self-care responses to illness. Questions arising from the data are discussed and future research needs are identified.

While limited, the literature illustrates the basic role and importance of self-evaluation of symptoms and self-decisions regarding reactions to illness. However, more studies of general populations are needed to chart the dimensions of self-care and to determine the forces which shape reactions to illness in various subgroups of society. It is particularly important at this time to design studies with uniform definitions of variables, especially definitions of self-care and self-medication.

Fiction has an important contribution to make to our insight into the social background of the period in which it was written. Novelists often make use of contemporary habits and social mores to provide context for events or to delineate characters. This paper takes as its examples, the novelist, John Galsworthy, his novels the first two Forsyte trilogies, and the social habit of smoking. Galsworthy frequently uses the smoking image, not only in creating his characters but also for atmosphere. In these novels we are able to follow the progress of smoking from the occasional cigar smoked for pleasure at certain specific times by men only in the 1880's, through to the 1920's when the smoking of cigarettes had become ubiquitous for men and women—so much so that it was almost a social necessity in the middle class. Although the main subject of this paper is John Galsworthy, works of several of his contemporary novelists are introduced for comparison. Events of the period, including two wars, the General Strike, the emancipation of women and changes in the tobacco industry are related to the progress of smoking habits as depicted by Galsworthy. Galsworthy was himself a smoker, but his contemporary, Thomas Hardy, who rarely mentions smoking did not smoke and Conan Doyle, who often mentions it, was a smoker.

Community-based health care programmes are being increasingly used to increase health care coverage, especially in developing countries. If such Primary Health Care (PHC) programmes are to effectively benefit communities for which they are designed, simple but effective evaluative procedures using readily available epidemiological data must be designed and used.

In this article tracer conditions (cough, diarrhoea and fever) are used to evaluate the quality of care provided by Community Clinic Attendants in rural districts served by the Brong-Ahafo Rural Integrated Development Programme (BARIDEP). 15 out of 30 Community Clinics of one attendant each were surveyed with 290 tracer observations among 200 patients of whom 95% “came for consultation with a new condition which had not been treated before by a CCA”.

In all the evaluation procedure was thought to be feasible and should provide an immediate and useful feedback which might be used to improve health provider performance through training programmes and general management of community clinics

The need to improve the design and application of tropical disease control measures has led to the establishment of a Social and Economic Research Scientific Working Group in the UNDP/World Bank WHO Special Programme for Research and Training in Tropical Diseases. This group will support research to increase the effectiveness of disease control activities and to improve the bases for research resource allocation decisions.

Specific projects will be sought to identify human attitudes and behaviour affecting disease transmission, analyze social and economic factors of disease causation, to estimate costs and effectiveness of disease control measures, and. based on these prior studies, to develop management strategies for disease control programmes. The development of management methods to minimize the adverse health consequences of economic development projects is also of interest. Guidelines to assess the social and economic consequences of the tropical diseases are being developed as the first phase of providing a more objective basis for allocating resources to tropical disease control.

Special effort is given to developing collaborative research projects among medical and social scientists from countries where tropical diseases are present.

Three distinct stages in the relationship between osteopathic medicine and allopathic medicine are discussed. Although it has often been predicted that osteopathy would be absorbed by ‘organized medicine’, it will be argued that its recent organizational rejuvenation must be viewed within the context of the political economy of medical care in the United States. Various ‘strategic elites’ in the past decade have turned to osteopathic medicine as one of several strategies for dealing with the contradictions inherent in capital-intensive medicine, particularly those which contribute to a shortage and geographical maldistribution of primary physicians.

The purpose of nutrition education is to promote better food habits in a community. In other words: behavioral change is the goal of nutrition education. On the basis of a Behaviour Modification Model by Van Beugen and data from case-studies on food habits proposals are formulated for the use of social data in planning a nutrition education programme.

Official policy, professional ideology and manifestos concerning geriatric care reflect Activity Theory assumptions about what constitutes ‘successful’ ageing. Three prescriptions for hospital geriatric care can be synthesised from these sources. Research data suggests there is often a reasonable ‘fit’ between these prescriptions and the careers of acutely ill geriatric patients who do not die. But for long stay patients, there is a wide discrepancy. Two distinct sub-types of long stay career can be identified, one of which is less discrepant from the care prescriptions than the other. It can be argued that contrasts in the structure of social relationships amongst doctor, nurse and patient are the key to understanding how the two types of long stay career are created. Moving on from this analysis, it is possible to suggest an alternative organizational arrangement for delivery of long stay geriatric care, within which the nursing profession or other non-medical carers, are explicitly accorded prime authority and responsibility. Potential problems, and the requirement for safeguards to prevent deterioration of standards must be considered, but there exist real possibilities for future development of positive alternatives.

In August–September 1978, a survey was undertaken of all non-government health practitioners residing in an area containing a study population of 263,000 in rural Bangladesh. The aim of the survey was to elucidate the type, pattern, distribution, characteristics of practice of non-government practitioners in one rural area of Bangladesh. The quality of data on this study population is considered unique because of 15 years of longitudinal demographic surveillance undertaken by the International Centre for Diarrhoeal Disease Research, Bangladesh.

Altogether, 1292 practitioners were identified, giving a practitioner density of 4.7 per 1000 population. Allopathic and homeopathic practitioners constituted 14.9 and 3.3%, respectively, of the total. Very few of these two practitioner categories were officially registered (1.8% of total). Kobiraj, totka (an indigenous healer), and other categories comprised 15.3, 60.5, and 6.0, respectively. Allopaths and homeopaths were younger, better educated, and predominately male in comparison to the more numerous kobiraj, totka, and other practitioners, who tended to be older, less educated, and more often women. Most of the latter group of practitioners learned their skills by apprenticeship while the former group more frequently attended schools.

The geographic distribution of allopaths and homeopaths was thinner than the more numerous kobiraj, totka, and other groups. Most practitioners reported unrestricted, full-time availability to clients in homes and offices without time limitations. Although most non-allopathic practitioners denied the use of allopathic drugs, indepth interviews suggested that this response was biased due to fear of regulatory violations. Allopaths and homeopaths averaged 18 patients daily, while kobiraj, totkas, and others averaged fewer than 10 patients daily.

When practitioners and clients were asked about specialization, a disease-specific utilization pattern emerged. For some diseases, all types of practitioners were employed; but for others, specific practitioner types were utilized. In general, there appeared to be good correspondence between the reported specialization of practitioners and the reported utilization pattern of clients. An attempt was also made to estimate the financial resources involved in non-government health systems. Crude estimations of reported income by practitioners was ten-fold lower than income estimated by client reports of cost and frequency of consultations.

The paper concludes by hypothesizing that, despite high financial costs, the non-government systems are utilized heavily because of availability, social access, and social perceptions of illness causation. Government services are not yet competitive because of poor availability, access, quality, and cost. Although information was not obtained on the biomedical effectiveness of native pharmacopoeias, perceived effectiveness was suffi