Social science & medicine
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Social science & medicine · Jan 1990
Review Comparative StudyInternational perspectives on treatment choice in neonatal intensive care units.
Over the past 25 years, neonatal intensive care units (NICUs) have been established throughout the industrialized world and in some Third World nations to provide sophisticated medical interventions for critically ill newborns. This paper discusses the four major factors affecting treatment choices for newborns with disabilities or at risk for disabilities: the availability of resources, societal attitudes toward medical interventions and life with disabilities, the roles of physicians, parents and other decision-makers, and the role of the law. Much has been written on the bioethical issues surrounding such treatment as it is practiced in the United States, including analysis by social scientists; however, little has been written on how those issues are perceived and dealt with in most other nations, and very little comparative research has been conducted. ⋯ S. practice, which has received much attention, with a generalized commentary on practices in other parts of the world, which have received less examination. The nations surveyed include Australia, Brazil, Britain, Canada, China, France, India, Israel, Japan, the Netherlands, Poland, Sweden, and West Germany. The value of further comparative research is discussed in order to encourage others to do such research.
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Social science & medicine · Jan 1990
Comparative Study Clinical TrialApplication of the verbal autopsy during a clinical trial.
During a community-based treatment trial of onchocerciasis with ivermectin, verbal autopsies were employed as one method to assess the safety of the drug. The verbal autopsy questionnaire was designed to determine causes of death and mortality differentials in the treated population. During the 8 months of surveillance here reported, 25 individuals died, yet only 9 of these deaths were certified. ⋯ We found that in 80% of the adult deaths, the verbal autopsy and death certificate diagnoses of underlying cause of death agreed. The verbal autopsy was less accurate in diagnosing child deaths which we attribute to the design of the verbal autopsy (being to detect potential drug related deaths in adults) and to the delay between death and interview. We conclude that verbal autopsies are an important addition to surveillance systems in remote areas where the absence or inadequacy of health information systems does not allow a thorough follow-up of all subjects in drug studies.
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Social science & medicine · Jan 1990
Referrals to physiotherapy: the relation between the number of referrals, the indication for referral and the inclination to refer.
This article studies the relation between the referral rate and the type of patients general practitioners refer for physiotherapy. The study population consists of GPs participating in the Netherlands' Sentinel Stations Network, who recorded data on all referrals to physiotherapy during one year and filled in a questionnaire. ⋯ High referring GPs were no more inclined to give in to their patients demands, had busier practices, closer relations with physiotherapists and viewed their knowledge of physiotherapy as more satisfactory than low referring GPs. Some policy implications are discussed in respect to these results.
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Social science & medicine · Jan 1989
Privacy between physicians and patients: more than a matter of confidentiality.
This study examined patients' perceptions (N = 427) of the meaning of privacy within the physician-patient dyad. The recognition of the importance of privacy, the norms that govern privacy, and the specific behaviors that may be considered to violate privacy in relationships has most often received only general attention by researchers. ⋯ Thus, in contrast to the usual conception of patient confidentiality as an issue focused on information, confidentiality is cast as a topic within both the informational and psychological realms of privacy. Implications for current medical interviewing practices, especially with regard to questions that concern patients' sexual behavior, are discussed.