Free the dinosaurs into butterfly gardens: in a search for changing the profile of the academic professional.
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In the present debate about academic medicine in crisis, I argue that the problem is partly the consequence of a global process of alienation and depersonalization. Technology-based medicine is one of the key players which creates unsuitable role models. In its wake and as a consequence, the profile of the academic professional must be redesigned. Academic professionals should influence more strongly not only the quality of health care but the whole mentality in our socialized world. Academia itself should also become an arena for advanced ideas, and creative power pervaded by the humanities -- a facet which has been lost. (+info)
Exploring the organizational culture of exemplary community health center practices.
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BACKGROUND AND OBJECTIVES: A 1999 precursor to this study, published in Family Medicine, suggested that the organizational culture of practices was potentially important to health care providers and patients. In this research, we examined the experiences of people working in exemplary community health center practices to explore the components and maintaining factors of positive medical organizational culture. METHODS: Two exemplary practices were identified through a process of nominations and selection with respect to a presumptive definition of positive organizational culture. Interpretive categories and themes were developed through qualitative content analysis of semi-structured interviews, along with field observation. RESULTS: Categories of culture in these practices included Community Mission and Values, Leadership and Organizational Dynamics, Relationships, and Physical Space. Cultural qualities were nurtured by leadership approaches, collaborative staff meetings, and shared values about mission and workplace relationships. Staff consistently indicated that the spirit or culture in their practices was beneficial for employees, patients, and the process of clinical care. CONCLUSIONS: The positive organizational culture in these practices was substantially characterized and cultivated by specific values, attitudes, behaviors, and relationships of employees. Further work is indicated in approaches to assessment and intervention with organizational culture in medical settings and in evaluating associations with medical outcomes. (+info)
Making research matter: a civil society perspective on health research.
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Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research. Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. Civil society organizations (CSOs) are already at the forefront of such research. We suggest that there are at least three ways in which the participation of CSOs in research can be increased: namely, influencing commissioning and priority-setting; becoming involved in the review process and in conducting research; and through formal partnerships between communities and universities that link CSOs with academic researchers. (+info)
Metropolitan income inequality and working-age mortality: a cross-sectional analysis using comparable data from five countries.
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The relationship between income inequality and mortality has come into question as of late from many within-country studies. This article examines the relationship between income inequality and working-age mortality for metropolitan areas (MAs) in Australia, Canada, Great Britain, Sweden, and the United States to provide a fuller understanding of national contexts that produce associations between inequality and mortality. An ecological cross-sectional analysis of income inequality (as measured by median share of income) and working-age (25-64) mortality by using census and vital statistics data for 528 MAs (population >50,000) from five countries in 1990-1991 was used. When data from all countries were pooled, there was a significant relationship between income inequality and mortality in the 528 MAs studied. A hypothetical increase in the share of income to the poorest half of households of 1% was associated with a decline in working-age mortality of over 21 deaths per 100,000. Within each country, however, a significant relationship between inequality and mortality was evident only for MAs in the United States and Great Britain. These two countries had the highest average levels of income inequality and the largest populations of the five countries studied. Although a strong ecological association was found between income inequality and mortality across the 528 MAs, an association between income inequality and mortality was evident only in within-country analyses for the two most unequal countries: the United States and Great Britain. The absence of an effect of metropolitan-scale income inequality on mortality in the more egalitarian countries of Canada, Australia, and Sweden is suggestive of national-scale policies in these countries that buffer hypothetical effects of income inequality as a determinant of population health in industrialized economies. (+info)
'He found me very well; for me, I was still feeling sick': the strange worlds of physicians and patients in the 18th and 21st centuries.
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It is commonplace today to deplore the dissatisfaction of patients with the physician-patient relationship. Furthermore, historical investigation shows that this problem is not really new. We investigated an important source of patients' views in the 18th century, namely the letters of patients received by the famous Swiss physician, Samuel Tissot, and noted remarkably similar feelings of frustration. Yet the medical paradigms of today and of Tissot's times are considerably different. We propose that the persisting problems in the physician-patient relationship are due to a basic dissonance between the patient's ordinary modes of perception and the systematic way of perceiving reality characteristic of the physician. In addition, they reflect the unavoidable chasm between the ultimately private and singular nature of the illness experience, and the general and anonymous stance of medical theory. This chasm is therefore a permanent feature of the patient-physician relationship, predating the advent of scientific medicine, even if the latter reinforced it. In line with the current medical humanities movement, we believe that the engagement of physicians and medical students with literature and the arts helps them explore, and to some extent overcome, the existential divide between the patient's experiential self knowledge and the systematic, impersonal knowledge that plays a central role in medicine. We suggest a few examples of contemporary fiction that may be relevant and useful in this respect. (+info)
Social inequalities in perinatal and infant mortality in the northern region of Belgium (the Flanders).
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BACKGROUND: The study was intended to analyse the independent effect of some facets of the socio-economic status of both parents on perinatal, neonatal and post-neonatal mortality in the northern region of Belgium (the Flanders). METHOD: Perinatal data collected by the Study Centre for Perinatal Epidemiology were linked with socio-economic data collected by the district council. Mothers aged > or =25 years are included in the study. RESULTS: 50796 births were analysed. 452 infants died either before birth or during the first year of life. 52% of the foeto-infantile mortality occurred before birth and 57% of the infant mortality in the first week of life. The educational level was strongly related to foetal (p<0.001) and, to a lesser degree, to early-neonatal mortality (p=0.001). Employment did not correlate with any mortality item. Except for foetal mortality, the strongest correlation was always observed for maternal rather than paternal social items. In a logistic regression model, foetal mortality, perinatal mortality and infantile mortality remained strongly correlated with the educational level of the mother. Infant mortality beyond the first week of life was not correlated with any aspect of the social status of the parents. CONCLUSIONS: The educational level of the mother is the single most important determinant of infantile mortality in the Flanders representing the totality of hospital births by mothers aged > or =25 years in 1999 in the Flanders. KEY POINTS: STUDY QUESTION: Does education, profession and actual employment of both parents, independently operates discrimination in the outcome of pregnancy up to one year? Results: Maternal education is the only significant and independent determinant of foetal as well as neonatal and foeto-infantile mortality. Results: The status of the mother is by far more important than that of the father in determining the outcome of pregnancy. (+info)
Childhood adversities and health variations among middle-aged men: a retrospective lifecourse study.
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BACKGROUND: Using a lifecourse approach, this study examines whether childhood adversities act on adult health as latent or pathway effects, and whether not only childhood ill health and material deprivation, but also an adverse psychosocial environment in terms of stressful relations with parents contribute to later ill health. METHODS: Lifecourse interviews with 380 men born in 1946 were conducted. Outcome variables were perceived health, number of medical conditions, and activity limitations. Ordinal scales indicating levels of exposures as regards childhood health/growth, childhood material deprivation, stressful relations with parents, educational level, and unhealthy adult behaviours were made. Statistical analyses were performed by non-parametric correlation, logistic regression and OLS regression with dummy variables. RESULTS: Simple regression analyses showed a consistent pattern of more negative health outcomes with higher exposures on each of the lifecourse health determinants, but associations were relatively often not statistically significant. In multivariate analyses, the overall pattern remained with few alterations. The lifecourse determinants differed somewhat in their effects on the three health outcomes. Stressful relations with parents were significantly associated with perceived health and activity limitations. CONCLUSIONS: Childhood adversities influence later health to a large extent as latent effects. Stressful relations with parents were relatively important for two of the health outcomes, suggesting that not only ill health and material deprivation during childhood, but also an adverse psychosocial environment contributes to ill health among middle-aged men. KEY POINTS: The study asks whether childhood adversities influence middle-aged men's health through latent or pathway effects. Adjusted for adult circumstances, childhood health problems were associated with activity limitations and medical problems among men aged 55. Stressful relations to parents during childhood had direct negative effects on perceived overall health and activity limitations. Results indicate that childhood adversities often affect adult health as latent effects. Health promotion policies should consider that childhood psychosocial difficulties may have longterm negative health consequences. (+info)
Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice.
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BACKGROUND: For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. METHODS: Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12,000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. RESULTS: The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). CONCLUSION: Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP. (+info)