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

Pre-scientific medicines are immensely widespread involving about 80% of the world's population. This is a consequence of the connection between many pre-scientific medicines and religion, whereby many people resort to personal, domestic and popular medicines initially, because of the lack of any suitably scientifically trained staff. The environment, soil and climate, diversifies the various systems of pre-scientific medicine so that it is necessary to distinguish between those in arid zones, equatorial forests, cold climates and at great heights.

The study of pre-scientific medicines has great implications for scientific research. Vast areas of research are available just in drugs, whether of animal, vegetable or mineral origin. Then there are the physical treatments, attention to the five sense-organs (melotherapy, coreotherapy, chromatotherapy, osmatictherapy, gustative and tactile sensations) which involve provocation of reflexes and releases of hormones, which can explain the success of many pre-scientific medicines. Then there are interesting therapies based on the psychic factors such as occurs in possession worship, trances, dreams, stress and emotional shocks. Certainly pre-scientific therapies have their own curative efficacy that stems from the phenomena described above.

Pre-scientific medicines are no less important in the social field: the possibilities for information exchange between traditional and scientific medicine and the attempts to introduce pre-scientific medicines to other peoples who lack suitable scientific health assistance, because of the absence of enough technically trained personnel, make pre-scientific medicines extremely valuable.

Villages and the health services available to rural dwellers in a northern region of Nigeria are described. The villages were visited as part of a social study of gynaecological patients attending A.B.U. Teaching Hospital, Zaria, to determine the availability and utilization of health care facilities. It was found that the majority of villagers had no ready access to orthodox health care facilities and, where such services existed, villagers used both orthodox and traditional systems. In the case of obstetric services, socio-cultural traditions and lack of education appear to affect adversely women's propensity to utilise obstetric care. It is demonstrated that an efficient obstetric service can gain people's trust so that they come to hospital more readily and so avoid complications in childbirth. The general picture presented, however, is one of deprivation. There is a lack of health services and those that exist are undermanned and ill equipped. Locally initiated cooperative enterprise indicates that an integrated approach to health care delivery would achieve good results in making health care facilities more readily available to the people. It was seen that it will be necessary to ensure a pure water supply, a good road system, educational and economic development, as well as more comprehensive health care coverage, if the general health status of rural dwellers in this region is to be raised.

A distinction is made between the types of problems posed in preventing sickness and those faced in maintaining health. Preventing sickness has been based on analytic modes of inquiry, but concern with health requires integrative methods. A study of the investigations of a disease. Kuru, and a method of synthesising six types of evidence are used to illustrate the two approaches to knowledge. The conclusion is drawn that research findings would be more immediately applicable to the work of health development if the challenge of the integrative approach were accepted.

The dominance of the medical model and the categories that derive from it have inhibited the development of more independently sociological perspectives on illness. Using the case of epilepsy, this paper compares the standard medical typology of characteristic seizure patterns (grand mal, petit mal, psychomotor, etc.) to a sociological typology that emerges from our depth interviews with 80 people who have epilepsy. Our preliminary analysis yields a typology of characteristic ways of dealing with epilepsy based on how the condition is experienced by those who have it. Grounded types of adaptation are presented in terms of “adjusted” (including “pragmatic”, “secret” and “quasi-liberated”) and “unadjusted” (including “debilitated”) reactions. Comparison allows us to examine toward what ends typologies are constructed and highlights the different insights of medical and sociological perspectives on epilepsy. A sociological typology constructed independent of and complementary to the medical one illuminates the social experience of illness in a new way.

Health services research has critically reviewed health care practice administration, planning and financing. Principles for setting priorities have been scrutinized, as have many details that add up to broad programs of action.

Naturally, the question of reviewing the reviewers is relevant. Many conclude pessimistically that health services research has had little or no effect. We argue that one should not so much look for immediate and direct effects on policy and practice, but consider the long-term and often indirect effect on the concepts, ideas and methods which shape the health service. Then, there is evidence that health service research does make a difference.

To improve its effects, we suggest that one should: (1) plan the research so carefully that one is able to report on the issues that come up for debate, (2) co-operate closely with service planners and provide assistance—they are to be helped, not antagonized, (3) avoid drowning oneself in methodological refinements and scientific jargon, and (4) not consider the job finished when the report is published, but repeat the message through seminars, teaching and other ways of selling ideas.

The discipline of geriatrics derives its knowledge base from gerontology and clinical medicine. The former supports a belief in biological life and natural death while the latter presents the notions of pathological life and pathological death. These theories are incompatible and the continuing debate on the status of geriatrics as well as a coherent policy towards health care for the elderly rests on this cognitive contradiction.

While families tend to report similar initial reactions to a diagnosis of severe childhood illness, study data suggests that longterm familial responses are more varied. Based upon the perceptions of parents representing 100 families managing childhood cystic fibrosis for several years, the present study revealed that coping strategies utilized to minimize the illness related hardships were statistically significantly associated with longterm adequacy of family functioning. It is suggested that professionals providing support to families facing chronic hardships could strengthen continuous familial interaction by encouraging familial sharing of the burdens of the stressful situation and promoting familial ability to endow the illness situation with a personally significant meaning.

Two contemporary movements in nursing, nurse management and primary nursing, are described as strategies for increasing nurses' professional autonomy. The two strategies are viewed in terms of the individual nurse's experience of work in the context of the increasing managerial control of hospital organizations. Two determinants of the structure of professional work experience are considered: “personal rationality” and “organizational rationality”. The nurse management and primary nursing strategies are viewed as increasing the personal rationality of nursing work while simultaneously serving the potentially destructive requirements of increased organizational rationality.

The handicapped, the chronic sick and the elderly are described by the author as ‘dependency groups’ to emphasise, despite their different diagnostic labels, their common status as citizens and patients. They share several crucial characteristics—they are not amenable to curative treatment and not being susceptible to professional skills are professionally uninteresting; they are potentially costly as long-term users of medical and social services; having multiple needs, they are not the clear responsibility of any one service; they are economically unproductive and hence economically and socially dependent. They pose the policy question : who should accept what degrees of responsibility for clients/ patients in these dependency groups and what form should support take? Public, political, professional and organisational responses to this question are reviewed and questions raised about the implementation of formal policies in the face of professional and organisational autonomy and separatism.