Societal costs and morbidity of pertussis in adolescents and adults. (17/112)

BACKGROUND: Since the 1980s, the reported incidence of pertussis among adolescents and adults has been steadily increasing. To understand whether the benefits of an acellular pertussis vaccine formulated for adolescents and adults might offset its costs, policy makers will need information about morbidity and societal (medical and nonmedical) costs of pertussis. METHODS: Adolescents (age, 10-17 years) and adults (age, >or=18 years) with confirmed pertussis illness were identified by the Massachusetts enhanced pertussis surveillance system. We evaluated medical costs in a cohort of patients who had confirmed pertussis during the period of January 1998 through December 2000; nonmedical costs, by means of prospective interviews, in a cohort of patients who had confirmed pertussis during the period of December 2001 through January 2003; and morbidity in both cohorts. Our main outcome measures were mean costs per case, in 2002 US dollars. RESULTS: In the analysis of medical costs, 1679 adolescents and 936 adults were found to have mean costs of 242 dollars and 326 dollars, respectively (P<.05). In interviews with 314 adolescents and 203 adults, adults had significantly higher nonmedical costs (447 dollars) than those of adolescents (155 dollars). A total of 83% of adolescents missed a mean of 5.5 days from school (range, 0.4-32 days), and 61% of adults missed a mean of 9.8 days from work (range, 0.1-180 days) because of pertussis. Thirty-eight percent of adolescents and 61% of adults were still coughing at the time of the interview, which occurred an average of 106 days and 94 days, respectively, after cough onset. CONCLUSIONS: Pertussis causes significant morbidity in and costs for adolescents and adults, with time losses comprising the largest proportion of the cost. Societal costs should be considered when making decisions about potential vaccine use in the future.  (+info)

Social paediatrics. (18/112)

Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective.  (+info)

Childhood obesity - what we can learn from existing data on societal trends, part 1. (19/112)

The number of overweight and obese youth has increased in recent decades, and numerous theories on causes have been proposed. Yet almost no data are available to assess how the lives of children have changed during the "obesity epidemic." What are children and adolescents now doing with their time that they did not do before? Are they participating less in sports? Watching more television? Doing more homework? Without tracking these broader societal changes, it is difficult to identify the most (and least) promising areas for interventions. This two-part report compiles trend data for several areas. Part 1 discusses trends in time use, homework, and media use; part 2 discusses trends in transportation, physical education, and diet. The main findings of this article are the following: One, the free time of children has substantially declined because of increased time away from home, primarily in school, day care, and after-school programs. Two, participation in organized activities (including sports) has also increased. Three, unstructured playtime has decreased to make room for organized activities. Four, time spent in some sedentary activities like watching television, participating in conversations, or taking part in other passive leisure activities also declined just when obesity became a major concern. Five, increases in homework have not caused decreases in free time, contradicting a common belief in education circles.  (+info)

Psychological and sociological theories concerning adjustment to traumatic spinal cord injury: the implications for rehabilitation. (20/112)

During the past decades many healthcare professionals have turned their attention to describing the process of adjustment to traumatic spinal cord injury. Extensive review of the literature concerning adjustment is examined, together with an analysis of the effect which these theories have upon the healthcare provider who interacts with the client. Traditional rehabilitation has had the objective of teaching physical skills to such patients in order to achieve the highest possible level of independence. This paper challenges the rehabilitation team to broaden this concept of successful outcome. 'Living' requires more than physical survival.  (+info)

The social organization in constraint-induced movement therapy. (21/112)

Ethnographic data were collected at two rehabilitation facilities conducting ongoing research to evaluate functional and neurological outcomes of constraint-induced movement therapy (CIMT). Our findings indicate that several patterns of behavior occur during participant/therapist interaction in therapy sessions: coaching, cheerleading, reminding, changing, and contemplating. These interaction patterns indicate that learned nonuse of an affected limb does not exist in social isolation and that people who participate in CIMT routinely consider the balance of any improvement against the costs of using an affected limb that is still not fully functional. These patterns of social interaction that occur during therapy--which often influence a participant's hope for future physical progress--are an important part of CIMT that may not be fully acknowledged in the clinical training of therapists.  (+info)

Punishing and abstaining for public goods. (22/112)

The evolution of cooperation within sizable groups of nonrelated humans offers many challenges for our understanding. Current research has highlighted two factors boosting cooperation in public goods interactions, namely, costly punishment of defectors and the option to abstain from the joint enterprise. A recent modeling approach has suggested that the autarkic option acts as a catalyzer for the ultimate fixation of altruistic punishment. We present an alternative, more microeconomically based model that yields a bistable outcome instead. Evolutionary dynamics can lead either to a Nash equilibrium of punishing and nonpunishing cooperators or to an oscillating state without punishers.  (+info)

Experimental study of inequality and unpredictability in an artificial cultural market. (23/112)

Hit songs, books, and movies are many times more successful than average, suggesting that "the best" alternatives are qualitatively different from "the rest"; yet experts routinely fail to predict which products will succeed. We investigated this paradox experimentally, by creating an artificial "music market" in which 14,341 participants downloaded previously unknown songs either with or without knowledge of previous participants' choices. Increasing the strength of social influence increased both inequality and unpredictability of success. Success was also only partly determined by quality: The best songs rarely did poorly, and the worst rarely did well, but any other result was possible.  (+info)

Toward a conceptual reexamination of the patient-physician relationship in the healthcare institution for the new millennium. (24/112)

There is a crisis in the patient-physician relationship. Mass media, managed care and malpractice are just a few factors that contribute to a lack of trust, understanding and loyalty in the patient-physician relationship. We have experienced some select concepts within the Society, Culture and Personality (SCP) model. In it, we explore how social class, age, race, ethnicity and family background of the patient impact upon the patient-physician relationships. The analysis of the sick role is most prominent, and in this interactive process empathy must be given to each person who seeks medical help.  (+info)