A SOCIOLOGICAL STUDY OF AWARENESS OF SYMPTOMS AMONG PERSONS WITH PULMONARY TUBERCULOSIS.
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In 39 randomly selected villages and towns in Tumkur District, South India, approximately 2000 persons, tuberculosis cases and matched controls, were interviewed in order to determine how many had symptoms suggestive of tuberculosis. Approximately 70% of the bacteriologically confirmed cases and over half the radiologically active or probably active cases had at least one major symptom. The authors discuss these findings in the light of the results of certain other studies they have carried out-for example, on present action-taking among tuberculosis sufferers. They conclude that under present circumstances in India, it is epidemiologically and economically justified to base tuberculosis control programmes on the persons who seek assistance because of worry over symptoms. Only when services satisfying the needs of the already worried tuberculosis sufferers are well developed, may mass case-finding be considered as an additional measure. (+info)
A SOCIOLOGICAL INQUIRY INTO AN URBAN TUBERCULOSIS CONTROL PROGRAMME IN INDIA.
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Tuberculosis control by mass domiciliary chemotherapy is now being attempted on an increasingly large scale in the technically underdeveloped countries. The National Tuberculosis Institute in Bangalore, India, is an important centre for the development of such programmes, and the study reported in this paper is an inquiry into the working of an urban tuberculosis programme which is operated under the auspices of the Institute. The study reveals several fundamental weaknesses in the treatment organization in this particular programme, and the authors show that such weaknesses are in evidence in similar programmes elsewhere. However, the authors conclude that a great proportion of the problems of inadequate treatment can be dealt with by improved administration and organization. In the authors' opinion, such improvements merit a much higher priority than measures to perfect the technical aspects of the programmes. (+info)
MEDICINE AMONG NEW IMMIGRANTS AND ARAB MINORITIES IN ISRAEL.
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The reaction to modern medicine and the general health of the new immigrants and Arab populations of Israel are described. The material was gathered during a threemonth visit to Israel where the author participated in the medical care of these persons. While these peoples still share many of the traditional medical superstitions and practices, the new immigrants have progressed much more during the 16 years of Israel's existence. At present over 99% of Jewish women give birth in hospital, whereas only 65% of Israeli Arabs do. The infant mortality rate among the Jews in 1963 was about 21 deaths per 1000 live births, about one-half the rate for Arabs. The importance of understanding the cultural background and social conflicts of these people as a preliminary to the provision of proper medical care is stressed. (+info)
THE EMOTIONAL RESPONSES OF MARRIED WOMEN RECEIVING ORAL CONTRACEPTIVES.
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One hundred women taking oral contraceptives were questioned concerning their opinions about personal and sociological effects of this method of conception control. Fifty-three per cent reported improved coital satisfaction while 4% noted the opposite effect. Libido was increased in 22% and decreased in 13%. One woman in five believed that an increase in premarital and extramarital sexual activity would take place in the general population as a result of tablet-induced infertility. The problem of population control is discussed. It is paradoxical that the incidence of unplanned pregnancies continues to increase despite the availability of completely reliable conception control. This reflects present inability to communicate contraceptive knowledge to the appropriate people. (+info)
Mental health services use among school-aged children with disabilities: the role of sociodemographics, functional limitations, family burdens, and care coordination.
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OBJECTIVE: To examine the use of mental health services and correlates of receiving services among community-dwelling children with disabilities, ages 6 to 17 years. STUDY DESIGN: Data are from the 1994 and 1995 National Health Interview Survey Disability Supplements (NHIS-D), conducted by the National Center for Health Statistics. The study sample is 4,939 children with disabilities, representing an estimated eight million children with disabilities nationwide. Parents of children under 16 years of age reported (17-year-olds self-reported) on health, emotional and behavioral problems, mental health services use, and who, if anyone, coordinated the child's health care. PRINCIPAL FINDINGS: Among disabled children with poor psychosocial adjustment (11.5 percent), only 11.8 percent received mental health services in the past year. Multivariate logistic regression analysis showed service use was associated with poor psychosocial adjustment; communication, social, and learning-related functional impairments; public health insurance; and financial family burdens. Younger and black disabled children were less likely to receive mental health services. The odds of service use were greater with the involvement of a health professional in coordinating care, in contrast to no one or family only. Moreover, children with disabilities were more likely to use outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings. CONCLUSIONS: Findings indicate that only two in five disabled children with poor psychosocial adjustment receive mental health services. Differences by age, race, and insurance coverage suggest that inequalities to access exist. However, the school setting may be one in which some barriers to mental health services for disabled children are reduced. The study also shows that the involvement of health professionals in care coordination is associated with greater access to mental health care for disabled children. These findings underscore the importance of engaging both health care professionals and the family in the care process. (+info)
Measuring contextual characteristics for community health.
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OBJECTIVE: To conceptualize and measure community contextual influences on population health and health disparities. DATA SOURCES: We use traditional and nontraditional secondary sources of data comprising a comprehensive array of community characteristics. STUDY DESIGN: Using a consultative process, we identify 12 overarching dimensions of contextual characteristics that may affect community health, as well as specific subcomponents relating to each dimension. DATA COLLECTION: An extensive geocoded library of data indicators relating to each dimension and subcomponent for metropolitan areas in the United States is assembled. PRINCIPAL FINDINGS: We describe the development of community contextual health profiles, present the rationale supporting each of the profile dimensions, and provide examples of relevant data sources. CONCLUSIONS: Our conceptual framework for community contextual characteristics, including a specified set of dimensions and components, can provide practical ways to monitor health-related aspects of the economic, social, and physical environments in which people live. We suggest several guiding principles useful for understanding how aspects of contextual characteristics can affect health and health disparities. (+info)
Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center.
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Most studies of the impact of information systems in organizations tend to see the implementation process as a "rollout" of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing information systems is determined by organizational factors. However, it is less clear what these factors are. The authors propose to characterize the introduction of an information system as a process of mutual shaping. As a result, both the technology and the practice supported by the technology are transformed, and specific technical and social outcomes gradually emerge. The authors suggest that insights from social studies of science and technology can help to understand an implementation process. Focusing on three theoretical aspects, the authors argue first that the implementation process should be understood as a thoroughly social process in which both technology and practice are transformed. Second, following Orlikowski's concept of "emergent change," they suggest that implementing a system is, by its very nature, unpredictable. Third, they argue that success and failure are not dichotomous and static categories, but socially negotiated judgments. Using these insights, the authors have analyzed the implementation of a computerized physician order entry (CPOE) system in a large Dutch university medical center. During the course of this study, the full implementation of CPOE was halted, but the aborted implementation exposed issues on which the authors did not initially focus. (+info)
Qualitative and quantitative research in social epidemiology: is complementarity the only issue?
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Although in recent years there has been a growing acceptance of qualitative research in social epidemiology, the role and scope of its use remain a contested terrain. We sketch some of the issues that have been the focus of the debate between supporters and critics of qualitative research in social epidemiology and adjacent public health disciplines. They include epistemological problems, such as the limitations of survey research to uncover social mechanisms, lack of background among epidemiologists to generate sound hypotheses for specific populations, and ontological problems such the idealism inherent in some of the qualitative research coming from anthropology. Next we review the urban ethnographies of Elliot Liebow's and a decade of population based research in African American and low income neighborhoods in the United States to expose another role for qualitative research in social epidemiology. Thus, we argue that qualitative research has been used in scientific debates that confront egalitarian researchers with institutions or peers with opposing economic interests and ideologies. Qualitative research is often a powerful tool to fuel alternative theoretical frameworks and measures to be included in quantitative population based surveys. We confine this use of qualitative research to the academic world and do not necessarily imply that communities benefit from it as in action research. (+info)