Social science & medicine
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Social science & medicine · Jan 1987
ReviewPsychological research and chronic low back pain: a stand-still or breakthrough?
Some of the main psychological research topics concerning chronic low back pain (CLBP) are critically discussed. These topics include: 1. research aimed at describing a specific low back pain personality profile, 2. research into the predictability of therapy results on the basis of psychological assessment, and 3. outcome research of psychologically-oriented treatment for CLBP. It is concluded that these topics provide little insight into the role of psychological factors in the development and maintenance of CLBP. ⋯ Discussed are: 1. Risk factors in the transition from acute to chronic LBP, 2. the deviant sensitivity to acute, experimental pain stimuli of CLBP patients, 3. the relationship between CLBP behavior and psychophysiologic variables, 4. determinants of CLBP behavior, with special attention to endurance, 5. the deviant processing of proprioceptive stimuli, and 6. the implementation for chronic pain of the unpredictability and uncontrollability paradigms. The emphasis in the presentation of these new topics is more on raising questions than on answering them.
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Social science & medicine · Jan 1987
ReviewThe political abuse of medicine and the challenge of opposing it.
A fundamental aim of medicine is to protect and promote health. The practice of medicine has, however, been used to promote political aims which may be detrimental to health. The article attempts to isolate the ways in which political abuses may interfere with good medical practice: by allowing health policies to be influenced by undemocratic political considerations; by using health services to reward or punish political supporters or opponents; by direct medical involvement in political acts which contradict accepted medical ethics; and by the support which conventional medical practises give to perpetuating inequalities in health and social services. ⋯ The ways in which medical personnel have opposed the political abuse of medicine is explored by a brief review of the opposition of Chilean doctors to torture, the involvement of South African doctors in opposing the abuse of health services in perpetuating apartheid, and the growing medical movement in opposition to nuclear war. Some comments concerning the monitoring of a multitude of medical disciplines which are open to political abuse are made. The purpose of the paper is primarily to stimulate debate around this important issue and it does not attempt to provide a comprehensive review of the political abuse of medicine.
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Social science & medicine · Jan 1987
Historical ArticlePsychiatric emergency services: evolution, adaptation and proliferation.
This paper traces the dramatic rise of psychiatric emergency services (PES) and crisis intervention services over recent decades. It examines three processes--the evolution of such services, their adaptation to diverse settings, and the striking increase both in the number of programs and their utilization. PES first evolved along three disparate lines--makeshift psychiatric emergency care in the emergency room of the general hospital, ad hoc after-care services in the psychiatric hospital, and the community mental health movement. ⋯ Although PES were initially visualized as resources for acute mental health care and continue to serve as such, they have become increasingly chronicized, consequent on the deinstitutionalized abandonment of many chronically ill persons. Changes are also occurring in the social and demographic characteristics of persons utilizing PES and in the ways in which the services are perceived and utilized. The early development of unlabeled and makeshift psychiatric emergency care in the general hospital's emergency room and the psychiatric hospital were instances of 'evolutionary planning'.(ABSTRACT TRUNCATED AT 250 WORDS)
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Despite a warm sunny climate, rickets is extremely common in children living in an isolated mountainous area of North Yemen. In a small township the overall prevalence amongst children under five years attending for vaccination was 27%. The condition was most common at the end of the first year and had disappeared by the fifth year. ⋯ Several factors may contribute to the very high rates of rickets in rural Yemen. However, lack of exposure to sunlight as a consequence of particular cultural practices is likely to be the most important. The major social and behavioural factors which restrict the young child access to sunlight are outlined, and possible remedies discussed.
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Using the current controversy in breast cancer treatment as a model, this paper reports on physicians' attitudes and behavior in the use of informed consent. Findings are based on a survey of 170 oncologists from eight countries and representing three medical specialties. Physician responses indicate that they regarded informed consent as an intrusion into the doctor-patient relationship. ⋯ The constraints of obtaining informed consent reduced physicians' willingness to participate in scientific experiments. The consent form was seen to highlight their dual role as care-giver and scientific investigator, making them uncomfortable in dealing with patients. These findings demonstrate the ways in which legal restrictions associated with the introduction of new technologies critically affect the practice of medicine.