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Tesser CD. [A conceptual framework for good preventive practices (or for quaternary prevention)]. CAD SAUDE PUBLICA 2024; 40:e00068123. [PMID: 39292133 PMCID: PMC11405023 DOI: 10.1590/0102-311xpt068123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/03/2024] [Indexed: 09/19/2024] Open
Abstract
Prevention is universally advocated, especially in the case of noncommunicable diseases. However, given the proliferation of preventive technologies, it does not seem defensible to generically encourage preventive behaviors and tests for healthcare professionals and users. In this essay, we articulate concepts, ideas and criteria for considering preventive measures, providing a minimum guide to be used by professionals (especially in primary healthcare) and managers. The concepts of primary, secondary and quaternary prevention are explored, as well as those of reductive and additive prevention, high-risk and population-based preventive strategies; evidence-based medicine and its contemporary crisis; the precautionary principle; health promotion, an expanded, person-centered approach and shared decision-making. This discussion was designed to improve competence in the evaluation of preventive measures, making clinical and health decisions more judicious and less iatrogenic regarding primary and secondary prevention.
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2
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Herrick C, Bell K. The social life of natural experiments in epidemiology and public health. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:276-294. [PMID: 37596959 DOI: 10.1111/1467-9566.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
Over the twentieth century, the concept of the natural experiment has become increasingly prominent across a variety of disciplines, albeit most consequentially in epidemiology and public health. Drawing on an analysis of the scientific and medical literature, we explore the social life of the natural experiment, tracing its changing use, meaning and uptake to better understand the work done by the concept. We demonstrate how the natural experiment became central to the identity of post-war epidemiology as the discipline professionalised, turned its attention to the prevention of chronic disease and took centre stage in the field of public health. We then turn to its growing significance amid the rise of evidence-based medicine, and the new meanings natural experiments came to take on in the context of concerns about policy and evidence. Finally, we turn to the newest iteration of the natural experiment in the COVID-19 era, which saw an explosion of studies drawing on the term, albeit in ways that reveal more about the underlying politics of health than the method itself. Throughout, we illustrate that the concept of the natural experiment has always been fundamentally social and political and tied to disciplinary claims-making about evidence and what should count as such.
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Affiliation(s)
- Clare Herrick
- Department of Geography, King's College London, London, UK
| | - Kirsten Bell
- Department of Global Health and Social Medicine, King's College London, London, UK
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3
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Bruun MK. 'A factory of therapy': accountability and the monitoring of psychological therapy in IAPT. Anthropol Med 2023; 30:313-329. [PMID: 37466372 DOI: 10.1080/13648470.2023.2217773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/21/2023] [Accepted: 04/26/2023] [Indexed: 07/20/2023]
Abstract
Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded.
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Affiliation(s)
- Mikkel Kenni Bruun
- Department of Digital Humanities, King's College London, United Kingdom of Great Britain and Northern Ireland, London
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4
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Geampana A, Perrotta M. Accounting for complexity in healthcare innovation debates: Professional views on the use of new IVF treatments. Health (London) 2023; 27:907-923. [PMID: 35105230 PMCID: PMC10588277 DOI: 10.1177/13634593221074874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Social scientists have long been interested in the forces and values driving healthcare innovation. The simultaneous rise of 20th century healthcare reforms, increased importance of evidence and upsurge in lay health activism have shaped modern medicine. On this backdrop, fertility care emerged in the 1970s. Recent developments reveal a contentious relationship between new fertility treatments and clinical evidence, with emerging technologies being used without conclusive evidence of effectiveness despite being sold to patients. Initial critiques of this phenomenon emphasise commercial interests as the culprit, suggesting that the problematic use of unproven treatments is mainly driven by the private sector. Here, we challenge this over-simplified view of IVF care. Drawing on a qualitative analysis of key documents and 43 in-depth professional interviews, this article identifies three main stakeholder approaches to new treatment adoption. We argue that viewpoints are anchored within three critical overarching 'modes of coordination' or core values in modern healthcare: efficiency, effectiveness and patient-centeredness. This analysis encourages a more contextualised overview of fertility care than previous literatures have afforded. The IVF case shows that an emphasis on private versus public clinic practices obscure similarities between the two along with the values motivating healthcare professionals' approaches to new treatments.
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Andrade HSD, Carvalho SR. Genealogical analysis of Quaternary Prevention: between the use of Evidence-Based Medicine and care reformulation in Primary Health Care. CIENCIA & SAUDE COLETIVA 2023; 28:2109-2117. [PMID: 37436323 DOI: 10.1590/1413-81232023287.13292022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2022] [Indexed: 07/13/2023] Open
Abstract
We conducted a genealogical analysis of quaternary prevention, an instrument of primary health care to address overmedicalization and iatrogenesis, based on related statements and interviews with the creators of this concept. This tool has been used in the reformulation of care and the doctor-patient relationship, but limited to the risk-benefit assessment by using current scientific evidence. In this study, we analyze the paradoxes of evidence-based medicine (EBM) and discuss the relationship of EBM and quaternary prevention and primary health care (PHC). Finally, we suggest questioning the truth of the evidence for the development of other health paradigms.
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Affiliation(s)
- Henrique Sater de Andrade
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Sergio Resende Carvalho
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
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6
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Borozdina E. Evidence-based medicine and physicians’ institutional agency in Russian clinical settings. CRITICAL PUBLIC HEALTH 2023. [DOI: 10.1080/09581596.2023.2180608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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7
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A History of Heat Health Management Policies in the Singapore Military. Healthcare (Basel) 2023; 11:healthcare11020211. [PMID: 36673577 PMCID: PMC9858648 DOI: 10.3390/healthcare11020211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023] Open
Abstract
Our paper, which is the first historical study about heat injuries in Singapore, seeks to situate the Singapore Armed Forces' (SAF) history of heat stress management policies within the national context. Firstly, we observe that since the late 1970s, a research-driven approach has been adopted by the SAF's military medical leaders to formulate a range of policies to address the Forces' high incidence of heat injuries. This has resulted in the introduction of SAF-wide training measures, and the assembling of local scientific research expertise, which has led to a sharp reduction in heat injury incidence from the 1980s to 2000s. Through this, the SAF sought to demonstrate that its heat stress mitigation measures made the Singapore military 'heat proof'. Secondly, the state shaped a soldier safety agenda in the late 2000s on the back of an increasing emphasis on safety and the transformation of the SAF into a highly-educated and technologically-sophisticated force. This meant a shift towards concern about the welfare of every soldier, particularly through the state's drive to eradicate all training-related deaths. Accordingly, the SAF medical military leaders responded to the state's safety agenda by introducing heat stress management research and policies that were oriented towards the target of eradicating deaths due to heat stress. This policy and research direction, as such, has been strongly guided by the state's safety agenda and utilised to demonstrate to the public that all efforts have been taken to comprehensively mitigate the risks of heat.
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8
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Prussing E. Ethnography and quantification: Insights from epidemiology for Indigenous health equity. AMERICAN ANTHROPOLOGIST 2022. [DOI: 10.1111/aman.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erica Prussing
- Department of Anthropology and Department of Community & Behavioral Health University of Iowa
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9
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Clinical Animal Behaviour: Paradigms, Problems and Practice. Animals (Basel) 2022; 12:ani12223103. [PMID: 36428330 PMCID: PMC9687072 DOI: 10.3390/ani12223103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Both the public and clinicians are interested in the application of scientific knowledge concerning problem animal behaviour and its treatment. However, in order to do this effectively it is essential that individuals have not only scientific literacy but also an appreciation of philosophical concepts underpinning a particular approach and their practical implications on the knowledge generated as a result. This paper highlights several common misunderstandings and biases associated with different scientific perspectives relevant to clinical animal behaviour and their consequences for how we determine what may be a useful treatment for a given patient. In addition to more reflective evaluation of results, there is a need for researchers to report more information of value to clinicians; such as relevant treatment outcomes, effect sizes, population characteristics. Clinicians must also appreciate the limitations of population level study results to a given case. These challenges can however be overcome with the careful critical reflection using the scientific principles and caveats described.
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10
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Tian X, Zhang S. Expert or experiential knowledge? How knowledge informs situated action in childcare practices. Soc Sci Med 2022; 307:115195. [PMID: 35810691 DOI: 10.1016/j.socscimed.2022.115195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
The study examines how alternative health information affects the professional authority of doctors. Drawing on in-depth interviews with mothers in Hong Kong and focusing on child-rearing practices, we find that mothers glean expert knowledge from doctors and experiential knowledge from online resources, social networks, and direct observations. Despite the prevalence of information online and traditional Chinese remedies, mothers do not use experiential knowledge to challenge doctors. Instead, they self-interpret medical advice and set self-determined courses of action based on their own practical situations. Generally, they dichotomize child-rearing and caring issues into medical versus non-medical domains to which they apply expert and experiential knowledge, respectively. How a condition is categorized depends on whether their individualized experiential knowledge is adequate to allow them to manage the health of their child. This study concludes that mothers with alternative health information still respect professional authorities in clinical interactions, which accords with previous sociological studies, but mothers often consider expert knowledge overly generic, so they take initiative to translate generic health-related knowledge into individualized knowledge for their child and determine their own course of action. Our theoretical contribution is to bring situational concerns into the debate of professional authority by revealing how the accumulation of experiential knowledge informs situated action.
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Affiliation(s)
- Xiaoli Tian
- Department of Sociology, The University of Hong Kong, China.
| | - Sai Zhang
- Department of Sociology, The University of Hong Kong, China
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11
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Green S, Carusi A, Hoeyer K. Plastic diagnostics: The remaking of disease and evidence in personalized medicine. Soc Sci Med 2022; 304:112318. [PMID: 31130237 PMCID: PMC9218799 DOI: 10.1016/j.socscimed.2019.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
Abstract
Politically authorized reports on personalized and precision medicine stress an urgent need for finer-grained disease categories and faster taxonomic revision, through integration of genomic and phenotypic data. Developing a data-driven taxonomy is, however, not as simple as it sounds. It is often assumed that an integrated data infrastructure is relatively easy to implement in countries that already have highly centralized and digitalized health care systems. Our analysis of initiatives associated with the Danish National Genome Center, recently launched to bring Denmark to the forefront of personalized medicine, tells a different story. Through a "meta-taxonomy" of taxonomic revisions, we discuss what a genomics-based disease taxonomy entails, epistemically as well as organizationally. Whereas policy reports promote a vision of seamless data integration and standardization, we highlight how the envisioned strategy imposes significant changes on the organization of health care systems. Our analysis shows how persistent tensions in medicine between variation and standardization, and between change and continuity, remain obstacles for the production as well as the evaluation of genomics-based taxonomies of difference. We identify inherent conflicts between the ideal of dynamic revision and existing regulatory functions of disease categories in, for example, the organization and management of health care systems. Moreover, we raise concerns about shifts in the regulatory regime of evidence standards, where clinical care increasingly becomes a vehicle for biomedical research.
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Affiliation(s)
- Sara Green
- Section for History and Philosophy of Science, Department of Science Education, University of Copenhagen, Øster Voldgade 3, 1350, Copenhagen, Denmark; Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen K, Denmark.
| | - Annamaria Carusi
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Medical School, Beech Hill Road Sheffield, S10 2RX, United Kingdom.
| | - Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen K, Denmark.
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12
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Facilitators and barriers for clinical implementation of a 30-minute point-of-care test for Neisseria gonorrhoeae and Chlamydia trachomatis into clinical care: A qualitative study within sexual health services in England. PLoS One 2022; 17:e0265173. [PMID: 35271658 PMCID: PMC8912210 DOI: 10.1371/journal.pone.0265173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Point-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as “change champions” for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff.
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13
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Making epistemic goods compatible: knowledge-making practices in a lifestyle intervention RCT on mindfulness and compassion meditation. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Gutin I. Not 'putting a name to it': Managing uncertainty in the diagnosis of childhood obesity. Soc Sci Med 2022; 294:114714. [PMID: 35032744 PMCID: PMC8821372 DOI: 10.1016/j.socscimed.2022.114714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 02/03/2023]
Abstract
Childhood obesity is a challenging diagnosis. Children's body mass index (BMI) is an imprecise diagnostic of health, leading clinicians' interactions with patients and families to focus on the potential of future harm rather than the presence of infirmity or disease. This is complicated by emphasis on certainty in medical care; clinical diagnoses like childhood obesity are intended to help delineate good and bad health among patients. However, healthiness and wellbeing take on many meanings among individual children and families, especially in relation to weight. To better understand different forms of uncertainty and challenges in providing care, this study draws on 28 semi-structured interviews with U.S. health practitioners working with pediatric patients to examine strategies for communicating risk and defining success in the diagnosis and treatment of childhood obesity. Rather than focusing on patients' current BMIs or making the explicit diagnosis of obesity, clinicians turn to more optimistic prognoses emphasizing the gradual development of beliefs and behaviors that promote long-term physical, mental, and social health. This prognostic framework privileges the doctor-patient relationship over medical guidelines and protocols dictated by diagnoses, encouraging greater consideration of non-clinical factors shaping patients' health and weight. Clinicians expand their diagnostic framework and criteria to include information on the totality of patients' present and future lives, allowing for cognitively, emotionally, and socially attuned understanding of health and weight that is not focused on BMI. Critically, clinicians' awareness of the social etiology childhood obesity heightens their sense of futility about addressing it through clinical interventions, demonstrating the need for a diagnostic and treatment model that empowers doctors to look beyond the more proximate, biophysiological determinants of health.
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Affiliation(s)
- Iliya Gutin
- Population Research Center, University of Texas at Austin, 305 E. 23rd Street, Austin, TX, 78712-1699, USA.
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15
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Snell-Rood C, Jaramillo E, Gunderson L, Hagadone S, Fettes D, Aarons G, Willging C. Enacting competition, capacity, and collaboration: performing neoliberalism in the U.S. in the era of evidence-based interventions. CRITICAL PUBLIC HEALTH 2022; 32:283-294. [PMID: 35602887 PMCID: PMC9119579 DOI: 10.1080/09581596.2020.1834075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and perform influence how CBOs represent and accomplish their work. We draw on qualitative interviews conducted with government administrators (N=16) overseeing contracts for one child welfare EBI, SafeCare® and the leaders (N=25) of organizations contracted to implement this program. Participants endorsed competition, capacity, and collaboration as ideals within marketized contracting. Yet they expressed doubt about marketplace meritocracy and described the costs incurred in building the necessary organizational infrastructure to deliver EBIs and compete for contracts. We discuss the implications of marketized EBI contracting for CBOs and the limitations it poses for evidence-based public health, especially in socially marginalized communities.
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Affiliation(s)
- Claire Snell-Rood
- University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720 USA
| | - Elise Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA
| | | | - Danielle Fettes
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA 92093-0812, USA, Child and Adolescent Services Research Center, University of California, San Diego, 3665 Kearny Villa Rd., San Diego, CA 92123, USA
| | - Gregory Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA 92093-0812, USA, Child and Adolescent Services Research Center, University of California, San Diego, 3665 Kearny Villa Rd., San Diego, CA 92123, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA
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Colvin CJ. Understanding global health policy engagements with qualitative research: Qualitative evidence syntheses and the OptimizeMNH guidelines. Soc Sci Med 2021; 300:114678. [PMID: 34980487 DOI: 10.1016/j.socscimed.2021.114678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
Systematic reviews of qualitative evidence-or 'qualitative evidence syntheses' (QES)-have recently become an important form of knowledge production within the broader projects of 'evidence-based medicine' (EBM) and 'evidence-informed policymaking' in global health. Proponents of QES argue that these reviews offer a way to promote 'health systems thinking' and build a better understanding of local process and context in global health policy- and decision-making. EBM's detailed technical procedures for evidence synthesis, however, do not necessarily fit well with conventional qualitative research paradigms and there are concerns that subjecting qualitative research to EBM's logics and practices might fatally compromise both its epistemological integrity and political impact. This article addresses these concerns via a reflective case study of the use of qualitative evidence in the World Health Organization's (WHO) OptimizeMNH guidelines for task shifting in maternal and newborn health programs. When I first joined the team developing the evidence base for these health systems-oriented guidelines, I wondered whether the inclusion of qualitative research would result in a broadening of the forms of reason, experience and judgment that informed global health policy, or instead, be another disheartening example of how modern bureaucratic systems coopt, standardize, and complexity-reduce the alternative logics they encounter. While the integration of qualitative evidence did come at some cost to the depth and critical insights of the evidence we were reviewing, there were also important ways in which the technical procedures of evidence-based medicine were open to adaptation and transformation. The formal inclusion of qualitative evidence syntheses in these global guidelines did not represent-or produce-a dramatic about-turn in global health policy's hegemonic discourses and practices. It did reveal, however, that powerful systems of health governance like the WHO and evidence-based medicine are not inevitably closed, but in fact open to change, in often unpredictable ways.
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17
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Zhu M. Evidence-Based Medicine and Healthcare Quality in the Context of Information Failure: The Case of the UK Fertility Sector. PHARMACOECONOMICS - OPEN 2021; 5:561-576. [PMID: 34390482 PMCID: PMC8611149 DOI: 10.1007/s41669-021-00285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Economic incentives in the context of a particular type of market failure-asymmetric information (which takes place when quality information relating to treatment is not available to patients before purchasing the treatment)-are highly relevant to the understanding of the lack of clinics' incentives to disclose reliable evidence (relating to treatment quality) in the practice of evidence-based medicine. Based on the case study of the UK in vitro fertilisation (IVF) sector, I show that inadequate quality provision (relating to treatment effectiveness and safety) can be associated with a lack of voluntary disclosure of reliable evidence in the practice of evidence-based medicine. In the absence of sufficient economic incentives on clinics to voluntarily acquire and disclose evidence, I discuss the rationale for legislation requiring mandatory evidence disclosure as a possible mechanism to facilitate the acquisition and revelation of evidence. I do so by drawing evidence from the economic literature relating to the impact of such legislation on firms' quality improvement. Practical implications for implementation are discussed (and illustrated with examples in the context of the UK IVF sector) with the purpose to facilitate the role of regulators in setting the standards for evidence disclosure to improve interpretability of such evidence, together with the role of patients in engaging with clinics and verifying such evidence to improve its reliability and, ultimately, quality of care.
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Affiliation(s)
- Minyan Zhu
- Department of Economics, University of Reading, Whiteknights Campus, Reading, RG6 6EL, UK.
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18
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Fuller SS, Clarke E, Harding-Esch EM. Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development. PLoS One 2021; 16:e0259593. [PMID: 34748579 PMCID: PMC8575247 DOI: 10.1371/journal.pone.0259593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sexually Transmitted Infections, including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), continue to be a global health problem. Increased access to point-of-care-tests (POCTs) could help detect infection and lead to appropriate management of cases and contacts, reducing transmission and development of reproductive health sequelae. Yet diagnostics with good clinical effectiveness evidence can fail to be implemented into routine care. Here we assess values beyond clinical effectiveness for molecular CT/NG POCTs implemented across diverse routine practice settings. METHODS We conducted a systematic review of peer-reviewed primary research and conference abstract publications in Medline and Embase reporting on molecular CT/NG POCT implementation in routine clinical practice until 16th February 2021. Results were extracted into EndNote software and initially screened by title and abstract by one author according to the inclusion and exclusion criteria. Articles that met the criteria, or were unclear, were included for full-text assessment by all authors. Results were synthesised to assess the tests against guidance criteria and develop a CT/NG POCT value proposition for multiple stakeholders and settings. FINDINGS The systematic review search returned 440 articles; 28 were included overall. The Cepheid CT/NG GeneXpert was the only molecular CT/NG POCT implemented and evaluated in routine practice. It did not fulfil all test guidance criteria, however, studies of test implementation showed multiple values for test use across various healthcare settings and locations. Our value proposition highlights that the majority of values are setting-specific. Sexual health services and outreach services have the least overlap, with General Practice and other non-sexual health specialist services serving as a "bridge" between the two. CONCLUSIONS Those wishing to improve CT/NG diagnosis should be supported to identify the values most relevant to their settings and context, and prioritise implementation of tests that are most closely aligned with those values.
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Affiliation(s)
- Sebastian S. Fuller
- Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Headington, Oxford, United Kingdom
| | - Eleanor Clarke
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emma M. Harding-Esch
- Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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19
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Andri M. Clinical guidelines and clinical autonomy: exploring the missing link. J Health Organ Manag 2021. [DOI: 10.1108/jhom-11-2020-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.Design/methodology/approachDrawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.FindingsThe analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.Originality/valueAdvancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.
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Mugerauer R. Professional judgement in clinical practice (part 3): A better alternative to strong evidence-based medicine. J Eval Clin Pract 2021; 27:612-623. [PMID: 33274580 DOI: 10.1111/jep.13512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 01/10/2023]
Abstract
Parts 1 and 2 in this series of three articles have shown that and how strong evidence-based medicine has neither a coherent theoretical foundation nor creditable application to clinical practice. Because of its core commitment to the discredited positivist tradition it holds both a false concept of scientific knowledge and misunderstandings concerning clinical decision-making. Strong EBM continues attempts to use flawed adjustments to recover from the unsalvageable base view. Paper three argues that a promising solution is at hand if we can manage several modes of inclusion. A modified original, moderate version of EBM continues though usually overshadowed. As definitively laid out by Sackett in the 1990s, clinical decision making is intended to be person-centered, recognizing and integrating multiple modes of evidence and knowledge that have been marginalized: professional experience, illness narratives, and individual patients' values and preferences. Complementary resources are at hand: interpretative understanding and practice, such as philosophical anthropology, hermeneutical phenomenology, complexity theory, and phronetic practices respond to the major problems and open new possibilities. Phronesis is especially important in regard to public decision making. Within part 3 an additional tone necessarily occurs. While most of papers 1, 2, and 3 are written in the classical mode of contrasting the theoretical-logical and empirical evidence offered by contending positions bearing on the decision making and judgement in clinical practice, a shift occurs when considerations move beyond what is possible for clinical practitioners to accomplish. A different, discontinuous level of power operates in the trans-personal realm of instrumental policy, insurance, and hospital management practices. In this social-economic-political-ethical realm what happens in clinical practice today increasingly becomes a matter of what is "done unto" clinical practitioners, of what hampers their professional action and thus care of individual patients and clients.
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Affiliation(s)
- Robert Mugerauer
- College of Built Environments, University of Washington, Seattle, Washington, USA
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21
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Mugerauer R. Professional judgement in clinical practice (part 2): knowledge into practice. J Eval Clin Pract 2021; 27:603-611. [PMID: 33241613 DOI: 10.1111/jep.13514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Though strong evidence-based medicine is assertive in its claims, an insufficient theoretical basis and patchwork of arguments provide a good case that rather than introducing a new paradigm, EBM is resisting a shift to actually revolutionary complexity theory and other emergent approaches. This refusal to pass beyond discredited positivism is manifest in strong EBM's unsuccessful attempts to continually modify its already inadequate previous modifications, as did the defenders of the Ptolemaic astronomical model who increased the number of circular epicycles until the entire epicycle-deferent system proved untenable. METHODS Narrative Review. RESULTS The analysis in Part 1 of this three part series showed epistemological confusion as strong EBM plays the discredited positivistic tradition out to the end, thus repeating in a medical sphere and vocabulary the major assumptions and inadequacies that have appeared in the trajectory of modern science. Paper 2 in this series examines application, attending to strong EBM's claim of direct transferability of EBM research findings to clinical settings and its assertion of epistemological normativity. EBM's contention that it provides the "only valid" approach to knowledge and action is questioned by analyzing the troubled story of proposed hierarchies of the quality of research findings (especially of RCTs, with other factors marginalized), which falsely identifies evaluating findings with operationally utilizing them in clinical recommendations and decision-making. Further, its claim of carrying over its normative guidelines to cover the ethical responsibilities of researchers and clinicians is questioned.
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Affiliation(s)
- Robert Mugerauer
- College of Built Environments, University of Washington, Seattle, Washington, USA
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22
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Mugerauer R. Professional judgement in clinical practice (part 1): Recovering original, moderate evidence-based health care. J Eval Clin Pract 2021; 27:592-602. [PMID: 33241623 DOI: 10.1111/jep.13513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Evidence-based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three-article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings-all of which raises more questions regarding its application to provider-patient decision making, pedagogy, and policy.
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Affiliation(s)
- Robert Mugerauer
- College of Built Environments, University of Washington, Seattle, Washington, USA
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23
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Taipale J, Hautamäki L. Clinical practice guidelines in courts' representation of medical evidence and testimony. Soc Sci Med 2021; 275:113805. [PMID: 33721744 DOI: 10.1016/j.socscimed.2021.113805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
This article examines clinical practice guidelines (CPG) in the courtroom. The guidelines in question are Finnish national current care guidelines for brain injuries, and the case context is traffic insurance compensation cases contested in the Helsinki district court. We analyse 11 case verdicts qualitatively, drawing from earlier sociological and theoretical accounts of clinical practice guidelines and evidence-based medicine. What makes the case-type relevant for studying clinical practice guidelines is the fact that the cases, which feature a medical dispute concerning traumatic brain injury, involve highly specialized expertise and contradictory expert claims, but the cases are decided in a generalist court by non-expert judges. What we show in the article is how the guidelines structure, sequence and initiate temporal reworking in the judges' representation of medical evidence and testimony, and how the plaintiffs' delayed diagnoses complicate the application of the CPG in the evaluation. We further discuss the guidelines' epistemic authority in the verdicts and finish by comparing the 2008 and 2017 editions of Finnish CPGs for brain injuries, suggesting a multifaceted, courtroom-mediated feedback loop between the patient-plaintiffs and the clinical practice guidelines.
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24
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Wilson RJI, Vergélys C, Ward J, Peretti-Watel P, Verger P. Vaccine hesitancy among general practitioners in Southern France and their reluctant trust in the health authorities. Int J Qual Stud Health Well-being 2021; 15:1757336. [PMID: 32400299 PMCID: PMC7269038 DOI: 10.1080/17482631.2020.1757336] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: Vaccine hesitancy is common in France, including among general practitioners (GPs). We aimed to understand vaccine hesitant GPs’ views towards vaccines. Method: We conducted in-depth interviews that were thematically analysed. Result: We found that, facilitated by health scandals and vaccine controversies—that according to participants were not effectively handled by health authorities—the implicit contract existing between health authorities and GPs has been ruptured. This contract implies that health authorities support GPs in making vaccine recommendations by addressing GPs’ own concerns, providing them with adequate and up-to-date information and advice, and involving them in vaccine decision-making. In turn, GPs encourage vaccination to reach vaccine coverage targets. Conclusion: The rupture of this implicit contract has led to a breach in trust in the health authorities and the vaccines that they recommend.
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Affiliation(s)
- Rose Jane Isobel Wilson
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Chantal Vergélys
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Jeremy Ward
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,UMR 8236 (LIED), Université Paris Diderot, Paris, France
| | - Patrick Peretti-Watel
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Pierre Verger
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
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25
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Norman AH, Tesser CD. Medicina de família e prevenção quaternária. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2021. [DOI: 10.5712/rbmfc16(43)2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Este artigo revisita a constituição da medicina de família e comunidade (MFC) como especialidade médica e as suas raízes que favoreceram o nascimento do conceito de prevenção quaternária (P4). Evidencia que a tradição da medicina à beira de leito, a função-filtro dos MFCs - fortalecida por sistemas nacionais de saúde organizados a partir da atenção primária à saúde (APS) – e, a abordagem biográfica de Balint, favoreceram o processo de proteção da saúde dos pacientes. Desde seus primórdios, a MFC esteve vinculada a uma abordagem holística, humanista e integral da pessoa, coerente com a P4. Entretanto, dois momentos históricos tensionaram a abordagem da MFC. O primeiro foi a estruturação da biomedicina especializada nos hospitais, que centrou a abordagem nas doenças vistas como lesões corporais. O segundo foi o nascimento da medicina baseada em evidências (MBE), na década de 1990, que refinou o modelo biomédico amplificando o grau de abstração das intervenções biomédicas, vinculando-as às medidas de impacto no coletivo dos doentes. A medicina hospitalar e a MBE trouxeram avanços importantes ao cuidado, mas ampliaram seu potencial iatrogênico. A MBE construiu uma hierarquia de evidências de tamanha valorização na comunidade médico-científica que vem sendo aplicada acriticamente de forma protocolar. Esse processo vem afastando a abordagem holística e individualizada dos MFC, multiplicando o potencial de danos iatrogênicos e a medicalização. Existe uma necessidade redobrada da P4, a ser informada pela MBE e simultaneamente aplicada à própria MBE. A P4 implica um olhar crítico do MFC sobre o modus operandi da biomedicina, de maneira a viabilizar uma prática humanizada e desmedicalizante na APS.
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Lancaster K, Rhodes T. What prevents health policy being 'evidence-based'? New ways to think about evidence, policy and interventions in health. Br Med Bull 2020; 135:38-49. [PMID: 32897357 DOI: 10.1093/bmb/ldaa026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 07/06/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evidence-based policy decision-making is a dominant paradigm in health but realizing this ideal has proven challenging. SOURCES OF DATA This paper conceptually maps health policy, policy studies and social science literature critically engaged with evidence and decision-making. No new data were generated or analysed in support of this review. AREAS OF AGREEMENT Barriers to evidence-based policy have been documented, with efforts made to increase the uptake of evidence. AREAS OF CONTROVERSY Evident complexities have been regarded as a problem of translation. However, this assumes that policy-making is a process of authoritative choice, and that 'evidence' is inherently valuable policy knowledge, which has been critiqued. GROWING POINTS Alternative accounts urge consideration of how evidence comes to bear on decisions made within complex systems, and what counts as evidence. AREAS TIMELY FOR DEVELOPING RESEARCH An 'evidence-making intervention' approach offers a framework for conceptualizing how evidence and interventions are made relationally in practices, thus working with the politics and contingencies of implementation and policy-making.
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Affiliation(s)
- Kari Lancaster
- Centre for Social Research in Health, University of New South Wales, NSW 2052, Sydney, Australia
| | - Tim Rhodes
- Centre for Social Research in Health, University of New South Wales, NSW 2052, Sydney, Australia.,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
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27
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Rau Steuernagel C, Engebretsen E, Kristiansen HW, Moen K. Ethnography of texts: a literature review of health and female homosexuality in Brazil. MEDICAL HUMANITIES 2020; 46:204-213. [PMID: 31611283 PMCID: PMC7476287 DOI: 10.1136/medhum-2018-011544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 06/10/2023]
Abstract
This paper reviews the literature on health and female homosexuality in Brazil and, along the way, outlines an alternative approach to reviewing academic literature. Rather than summarising the contents of previously published papers, we relate to these publications primarily as partakers in the creation of knowledge. Inspired by Actor-Network Theory (ANT), we apply ethnographic methods to understand the papers as study participants endowed with action. We also draw on the notions of inscription and intertextuality to trace the complex relationship between the findings in the articles and the realities outside of them. We claim that 'evidence' is the product of translational processes in which original events, such as experiments, blood tests and interviews, are changed into textual entities. In addition, text production is seen as an absorption of everything else surrounding its creation. When events are turned into articles, the text incorporates the political environment to which original events once belonged. We thus observe a political text inscribed into the written evidence of sexually transmitted infections, and the practice of publishing about scientific vulnerabilities emerges as political action. In contrast with traditional ways of reviewing literature in medical scholarship, this article offers a reminder that although there is a connection between textual evidence and the reality outside publications, these dimensions are not neutrally interchangeable.
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Affiliation(s)
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | | | - Kåre Moen
- Department of Community Medicine and Global Health, Universtiy of Oslo, Oslo, Norway
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28
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Perrotta M, Geampana A. The trouble with IVF and randomised control trials: Professional legitimation narratives on time-lapse imaging and evidence-informed care. Soc Sci Med 2020; 258:113115. [PMID: 32593117 PMCID: PMC7369645 DOI: 10.1016/j.socscimed.2020.113115] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/09/2020] [Accepted: 06/04/2020] [Indexed: 01/28/2023]
Abstract
Focusing on the case of time-lapse imaging (TLI), this paper analyses how medical professionals negotiate the use of new 'add-on' fertility treatments in light of the limited evidence available. The data produced by TLI technologies is meant to help professionals identify the best embryo to be implanted. Embryo selection is essential in IVF practice for increasing pregnancy rates and reducing the negative effects of repeated failures. More than 5 years after the introduction of TLI in IVF labs, however, there has been no conclusive randomised control trial (RCT) evidence to show that the tools do indeed have a significant impact on pregnancy rates. Nonetheless, many public clinics in the UK have adopted such technologies. Consequently, our research asks: How is the use of TLI tools legitimised by professionals, in light of contradictory evidence? Focusing on 25 semi-structured staff interviews, we argue that professionals use several strategies to legitimise the use of TLI in the clinic without, however, challenging the tenets of evidence-based medicine (EBM) and the value it places on RCTs. Rather, professionals emphasise various advantages that TLI offers, including its use as a lab tool, its potential for knowledge production in embryology, and the role it plays in the management of patient expectations and course of treatment. This paper contributes to debates on the role of EBM in modern medicine and fertility care specifically - an area where this inter-relationship has been underexplored. We conclude by suggesting avenues towards a more nuanced understanding of EBM as it relates to IVF treatment and a rapidly changing biotechnology context.
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Affiliation(s)
- Manuela Perrotta
- Department of People and Organisations, School of Business and Management, Queen Mary University of London, United Kingdom.
| | - Alina Geampana
- Department of People and Organisations, School of Business and Management, Queen Mary University of London, United Kingdom
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29
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Hernantes N, Pumar-Méndez MJ, López-Dicastillo O, Iriarte A, Mujika A. Volunteerism as adolescent health promotion asset: a scoping review. Health Promot Int 2020; 35:610-623. [PMID: 31006021 DOI: 10.1093/heapro/daz026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Aim of this scoping review was to explore the available literature on volunteerism in adolescence and the benefits that this activity may report in their healthy development, from a salutogenic perspective. Searches were conducted in Pubmed, Cinahl, PsycINFO and Cochrane Library home databases; 15 articles were selected. Almost all of the studies were conducted in the United States between 1990 and 2000, primarily developed by psychologists and sociologists. The impact of volunteering was reflected in aspects that can be classified based on Lerner's dimensions of the PYD model. Volunteer activities promote an Improved academic, social, cognitive, and vocational competence in adolescents. An increase in conflict resolution capacity, leadership and personal agency, as well as improved pro-social attitudes and relationships with adults and peers, all of which contributed to their self-identification with the community. Moreover, increased positive development of adolescents reduces the rates of risky behaviors. Volunteerism may represent an opportunity for health promotion in adolescence. The concept of volunteering as an asset for health promotion during adolescence evokes the need to adopt and favor this view with regard to key areas of study associated with this stage such as education and health. Teams that work in community health, especially those in primary care, should recognize and value existing volunteer groups as an asset to promote the healthy development of adolescents. Friendlier health services should be encouraged that include comprehensive services from within educational institutions to community actions.
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Affiliation(s)
- Naia Hernantes
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing. Campus Universitario, 31008 Pamplona, Spain.,ImPuLS Research Group, University of Navarra.,DYA Gipuzkoa, Voluntary Association, Donostia-San Sebastián, Spain
| | - María J Pumar-Méndez
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing. Campus Universitario, 31008 Pamplona, Spain.,ImPuLS Research Group, University of Navarra.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Olga López-Dicastillo
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing. Campus Universitario, 31008 Pamplona, Spain.,ImPuLS Research Group, University of Navarra.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Andrea Iriarte
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing. Campus Universitario, 31008 Pamplona, Spain.,ImPuLS Research Group, University of Navarra.,Primary Care Emergency Service, Navarra Health Service - Osasunbidea, Pamplona, Spain
| | - Agurtzane Mujika
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing. Campus Universitario, 31008 Pamplona, Spain.,ImPuLS Research Group, University of Navarra.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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30
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Bloor K, Hale V, Faulkner A. Knowledge and uncertainty in Lyme disease detection: an evidence-based activism research study in the UK. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2019.1704688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Alex Faulkner
- Centre for Global Health Policy, School of Global Studies, University of Sussex, Brighton, UK
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31
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Questions regarding ‘epistemic injustice’ in knowledge-intensive policymaking: Two examples from Dutch health insurance policy. Soc Sci Med 2020; 245:112674. [DOI: 10.1016/j.socscimed.2019.112674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 11/19/2022]
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32
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Vere J, Gibson B. Evidence-based medicine as science. J Eval Clin Pract 2019; 25:997-1002. [PMID: 30575209 DOI: 10.1111/jep.13090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/08/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
Evidence-based medicine has claimed to be science on a number of occasions, but it is not clear that this status is deserved. Within the philosophy of science, four main theories about the nature of science are historically recognized: inductivism, falsificationism, Kuhnian paradigms, and research programmes. If evidence-based medicine is science, knowledge claims should be derived using a process that corresponds to one of these theories. This paper analyses whether this is the case. In the first section, different theories about the nature of science are introduced. In the second section, the claim that evidence-based medicine is science is reinterpreted as the claim that knowledge claims derived from randomized controlled trails and meta-analyses are science. In the third section, the knowledge claims valued within evidence-based medicine are considered from the perspective of inductivism, falsificationism, Kuhnian paradigms, and research programmes. In the final section, possible counter arguments are considered. It is argued that the knowledge claims valued by evidence-based medicine are not justified using inductivism, falsificationism, Kuhnian paradigms, or research programmes. If these are the main criteria for evaluating if something is science or not, evidence-based medicine does not meet these criteria.
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Affiliation(s)
- Joseph Vere
- Department of Orthodontics and Restorative Dentistry, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Barry Gibson
- Dental Public Health, School of Clinical Dentistry, Sheffield, UK
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33
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Lazuardi E, Bell S, Newman CE. A 'scoping review' of qualitative literature about engagement with HIV care in Indonesia. Sex Health 2019; 15:283-291. [PMID: 30021685 DOI: 10.1071/sh17163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/01/2018] [Indexed: 01/19/2023]
Abstract
Background The Indonesian response to HIV has been informed largely by quantitative evidence. This review examines what is known about the Indonesian HIV care cascade from published qualitative research. METHODS A 'scoping review' method was used to synthesise and interpret the findings of 17 eligible peer-reviewed publications. RESULTS Qualitative findings are reported in relation to two themes. Factors influencing successful engagement include a lack of HIV-related knowledge among clients, fear of stigma or lack of privacy/confidentiality at services, limited accessibility and affordability, and poor linkages between services. Factors affecting the broader response include a failure to adapt programs to specific socio-cultural settings, political issues in the distribution of donor funding, distrust and poor communication between service users and providers, the need for cultural privacy in particular community settings, and systemic experiences of gendered stigmatisation. CONCLUSIONS Enhancing understanding of the Indonesian context would benefit from future qualitative research on HIV care in urban settings, describing the experiences of the most at-risk populations, and examining the role of clinics and providers in delivering HIV care in an increasingly decentralised health system.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen Bell
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Gaspar M, Rosenes R, Burchell AN, Grennan T, Salit I, Grace D. Diagnosing uncertainty: The challenges of implementing medical screening programs for minority sub-populations in Canada. Soc Sci Med 2019; 244:112643. [PMID: 31698281 DOI: 10.1016/j.socscimed.2019.112643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/29/2022]
Abstract
The social science literature on medical screening has documented a notable disjuncture between the promises of population-based screening programs and the complex realities of their rollout in everyday practice. We contribute to this scholarship by examining how healthcare providers confront numerous uncertainties associated with the implementation of anal cancer screening programs in Canada given the absence of standardized national evidence-based guidelines. The data was derived from in-depth interviews conducted with 13 physicians and 2 clinical researchers about anal cancer screening for gay, bisexual and other men who have sex with men living with HIV, the minority sub-population at the highest risk for HPV-associated anal cancer. Despite having unknown utility and low specificity, an initial anal Pap test was used to triage patients into anal dysplasia clinics for high-resolution anoscopy. This process led to technological scepticism toward the Pap's accuracy, diagnostic ambiguity related to the interpretation of the cytology results and increased patient anxiety regarding abnormal results. Physicians navigated a tension between wanting to avoid exposing their patients to additional uncertainties caused by screening and pre-cancer treatment and wanting to ensure that their patients did not develop anal cancer under their care. A high number of abnormal anal Pap results paradoxically reintroduced some of the capacity issues that the Pap was meant to resolve, as the existing dysplasia clinics were incapable of seeing all patients with abnormal results. We define this sequence as the epistemic-capacity paradox, a dynamic whereby seeking evidence to improve healthcare capacity simultaneously produces evidence that introduces capacity challenges and generates additional uncertainty. The epistemic-capacity paradox demonstrates the limitations of evidence-based medicine frameworks at determining best practices in the context of rarer health conditions affecting minority sub-populations, where smaller population numbers and limited institutional support pose systemic challenges to the acquisition of sufficient evidence.
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Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Ron Rosenes
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Irving Salit
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Wienroth M, Pearce C, McKevitt C. Research campaigns in the UK National Health Service: patient recruitment and questions of valuation. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1444-1461. [PMID: 31119753 DOI: 10.1111/1467-9566.12957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system.
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Affiliation(s)
- Matthias Wienroth
- Policy, Ethics and Life Sciences Research Centre, School of Geography Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Caroline Pearce
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
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Hoeyer K, Bauer S, Pickersgill M. Datafication and accountability in public health: Introduction to a special issue. SOCIAL STUDIES OF SCIENCE 2019; 49:459-475. [PMID: 31382859 PMCID: PMC6767643 DOI: 10.1177/0306312719860202] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In recent years and across many nations, public health has become subject to forms of governance that are said to be aimed at establishing accountability. In this introduction to a special issue, From Person to Population and Back: Exploring Accountability in Public Health, we suggest opening up accountability assemblages by asking a series of ostensibly simple questions that inevitably yield complicated answers: What is counted? What counts? And to whom, how and why does it count? Addressing such questions involves staying attentive to the technologies and infrastructures through which data come into being and are made available for multiple political agendas. Through a discussion of public health, accountability and datafication we present three key themes that unite the various papers as well as illustrate their diversity.
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Affiliation(s)
- Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Bauer
- Centre for Technology, Innovation and Culture, University of Oslo, Oslo, Norway
| | - Martyn Pickersgill
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
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Friesen P. Mesmer, the placebo effect, and the efficacy paradox: lessons for evidence based medicine and complementary and alternative medicine. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1597967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Phoebe Friesen
- Nuffield Department of Population Health, University of Oxford - Ethox Centre, Oxford, United Kingdom of Great Britain and Northern Ireland
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Hughes D, Doheny S. Doing evidence-based medicine? How NHS managers ration high-cost drugs. Soc Sci Med 2019; 235:112304. [PMID: 31306883 DOI: 10.1016/j.socscimed.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/18/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Bell HS, Odumosu F, Martinez-Hume AC, Howard HA, Hunt LM. Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility. Med Anthropol 2019; 38:224-238. [PMID: 29912575 PMCID: PMC6298860 DOI: 10.1080/01459740.2018.1476508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.
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Affiliation(s)
- Hannah S Bell
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Funmi Odumosu
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Anna C Martinez-Hume
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Heather A Howard
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Linda M Hunt
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
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Abstract
The rights to health and to culturally respectful care are inextricably linked in the documents supporting Peruvian Maternal Health Policy. Strategies of Intercultural Birthing and Maternal Waiting Houses were purported to reduce maternal deaths, while extending the right to health to marginalized indigenous women. Based on 17 months of field research in Peru, I argue that the narrow focus on achieving "good numbers" creates and sustains coercive modes of strategy applications. As a result, the on-the-ground implementation of these innovative strategies made them incompatible with right to health and culturally respectful care approaches.
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Affiliation(s)
- Lucia Guerra-Reyes
- Department of Applied Health Science, School of Public Health, Indiana University , Bloomington , Indiana , USA
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Senzon SA. The Chiropractic Vertebral Subluxation Part 5: The First Research Era From 1928 to 1949. JOURNAL OF CHIROPRACTIC HUMANITIES 2018; 25:67-85. [PMID: 31019421 PMCID: PMC6472114 DOI: 10.1016/j.echu.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation theories between 1928 and 1949. DISCUSSION Theories during this period grew in complexity and developed in 4 primary ways: upper cervical models, reflex models, global models, and models based on the work of Speransky. Authors, theorists, and technique developers during this time included B. J. Palmer, R. J. Watkins, Galen Price, John Hurley, Hugh Logan, Major Bertrand DeJarnette, Richard Van Rumpt, Roy Ashton, Joseph Janse, Henri Gillet, James Firth, and J. R. Verner. At least 8 perspectives on chiropractic vertebral subluxation were advanced through research, modeling, and applied clinical methods. By understanding the complexity of this period and analyzing the research, the modern practitioner will be able to appreciate this era. The foundations of modern clinical practice and theoretical applications have roots in this period. CONCLUSION Theories during this period developed in levels of complexity, expanding existing models and clinical practice methods. The theories and research from this period had an effect on the chiropractic profession for the subsequent decades.
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Affiliation(s)
- Simon A. Senzon
- Corresponding author: Simon A. Senzon, MA, DC, 218 E Chestnut Street, Asheville, NC 28801. Tel: +1 828 251 0815.
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Senzon SA. The Chiropractic Vertebral Subluxation Part 3: Complexity and Identity From 1908 to 1915. JOURNAL OF CHIROPRACTIC HUMANITIES 2018; 25:36-51. [PMID: 31019419 PMCID: PMC6472124 DOI: 10.1016/j.echu.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) between 1908 and 1915. DISCUSSION Evidence from the works of Daniel D. Palmer, Bartlett J. Palmer, Joy Loban, Willard Carver, James Firth, Alva Gregory, John Howard, Arthur Forster, and Harold Swanberg demonstrates that chiropractic during this period was characterized by increasingly complex theories of CVS, which contributed to defining the profession. Critiques of CVS as a central identifier of the profession begin with this early period when students of D. D. Palmer's early graduates became school leaders and theorists. Textbooks were self-published during this period, including D. D. Palmer's final works, 4 books from his son B. J. Palmer, and texts from their students. Chiropractic graduates of subsequent schools also contributed to emerging writings and concepts. Chiropractic vertebral subluxation was central to nearly all texts and schools. There was disagreement about what defined chiropractic, and various schools taught different practices. However, the theories from this period had an important role in the evolution of thought in the profession. CONCLUSION Theories presented from 1908 through 1915 built upon previous concepts from earlier years of chiropractic. The plethora of books and ideas about CVS from these early pioneers shaped the profession, and some of these viewpoints still have relevance today.
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Affiliation(s)
- Simon A. Senzon
- Corresponding author: Simon A. Senzon, MA, DC, 218 E Chestnut Street, Asheville, NC 28801. Tel.: +1 828 251 0815.
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Gröndal H. Harmless, friendly and lethal: antibiotic misuse in relation to the unpredictable bacterium Group A streptococcus. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1127-1141. [PMID: 29707795 DOI: 10.1111/1467-9566.12742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Evidence-based treatment guidelines for managing infections in health care are promoted as tools to prevent unnecessary use of antibiotics. Antibiotic misuse has been examined as regards the doctor-patient relation and the social context of medical practice. Less attention has been paid to how the very conceptualisation of human-microbial relations may influence understandings of antibiotic misuse. The article examines a medical controversy concerning guidelines for managing throat infection and antibiotic treatment in Sweden. It demonstrates how this controversy unfolds around two different ways of relating to a specific bacterium - Group A Streptococcus. The analysis shows how two 'microbiopolitics', involving different understandings of human-microbial relations, are created in the controversy and how different antibiotic prescribing practices are justified. By focusing on Group A Streptococcus, which is commonly observed, but also unpredictable and potentially dangerous, the article provides new insights into the relations between bacteria, humans and policy in an age of antimicrobial resistance. It argues, in particular, that the definition of antibiotic misuse is unstable and consequently that policy measures aimed at reducing misuse must be related to how specific infections and bacteria are conceptualised in the actual context the policy addresses.
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Abstract
AbstractIn recent years, there have been positive changes to the health research landscape, with increasing interest amongst community organisations and university investigators in establishing research partnerships and with more funding opportunities for community-engaged work. However, creating a community–university partnership requires new skills, new types of knowledge, and new ways of creating and maintaining relationships. On both sides of the research equation, people are looking for guidance. The discussion here uses our experience to offer concrete tips in plain language for strategies that can be used to build capacity for community–university partnerships for organisations and researchers in pre-partnership and early partnership stages. We comment on debates about epistemology and knowledge production in research and how anthropologists are well positioned to contribute to this process.
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Diamond-Brown L. “It can be challenging, it can be scary, it can be gratifying”: Obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making. Soc Sci Med 2018; 205:48-54. [DOI: 10.1016/j.socscimed.2018.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/31/2023]
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Qazi HA, Chen H, Zhu M. Factors influencing dialysis withdrawal: a scoping review. BMC Nephrol 2018; 19:96. [PMID: 29699499 PMCID: PMC5921369 DOI: 10.1186/s12882-018-0894-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/11/2018] [Indexed: 11/15/2022] Open
Abstract
Background Research on factors associated with dialysis withdrawal is scarce. This study examined the predictors that might influence rate of dialysis withdrawal. Existing literature is summarized, analyzed and synthesized to identify gaps in the literature with regard to the factors associated with dialysis withdrawal. Methods This scoping review used a systematic search to synthesize research findings related to dialysis withdrawal and identified gaps in the literature. The search strategy was developed and applied using PubMed, EMBASE and CINHAL databases. The selection criteria included articles written in English and published between 1997 and 2016 that examined dialysis withdrawal and associated factors in patients with any modality of renal dialysis.. Case reports and studies only including renal transplant patients were excluded. Fifteen articles were selected in accordance with these selection criteria. Results The literature review revealed a scarcity of research on dialysis withdrawal and associated factors. Furthermore, the study findings were inconsistent and inconclusive. Authors have defined dialysis withdrawal in terms of dialysis discontinuation, withholding, death, withdrawal, treatment refusal/cessation, or technique failure. Authors have selected homogeneous patient population on either hemodialysis (HD) or peritoneal dialysis (PD) patients, thus making comparisons of studies and generalization of findings difficult. Conclusion Future studies should explore the influence of both HD and PD on patient-elected dialysis withdrawal using a large a priori calculated sample size. Electronic supplementary material The online version of this article (10.1186/s12882-018-0894-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hammad Ali Qazi
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Helen Chen
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Meng Zhu
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Ducey A, Nikoo S. Formats of responsibility: elective surgery in the era of evidence-based medicine. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:494-507. [PMID: 29314096 DOI: 10.1111/1467-9566.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article illustrates what pragmatic sociology refers to as investments in form, by examining the formats created and used by a group of surgeons to determine when elective surgery for pelvic floor disorders could be responsibly undertaken. Drawing upon ethnographic observations of surgical consultations at an academic medical centre in Canada, we show how two specific formats - that the patient is sufficiently bothered and the patient accepts the risks of surgery - allow for justifiable action in conditions of uncertainty and contingency and in light of the demands of dominant imperatives in medicine and health care, especially evidence-based medicine (EBM). We argue that an analytic of justification is necessary for understanding when and how surgery is offered and elected for, and for considering how surgical consultations might be improved.
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Affiliation(s)
- Ariel Ducey
- Department of Sociology, University of Calgary, Canada
| | - Shoghi Nikoo
- Cumming School of Medicine, University of Calgary, Canada
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Turner S, D'Lima D, Hudson E, Morris S, Sheringham J, Swart N, Fulop NJ. Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback. Implement Sci 2017; 12:145. [PMID: 29202772 PMCID: PMC5715650 DOI: 10.1186/s13012-017-0669-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A range of evidence informs decision-making on innovation in health care, including formal research findings, local data and professional opinion. However, cultural and organisational factors often prevent the translation of evidence for innovations into practice. In addition to the characteristics of evidence, it is known that processes at the individual level influence its impact on decision-making. Less is known about the ways in which processes at the professional, organisational and local system level shape evidence use and its role in decisions to adopt innovations. METHODS A systematic scoping review was used to review the health literature on innovations within acute and primary care and map processes at the professional, organisational and local system levels which influence how evidence informs decision-making on innovation. Stakeholder feedback on the themes identified was collected via focus groups to test and develop the findings. RESULTS Following database and manual searches, 31 studies reporting primary qualitative data met the inclusion criteria: 24 were of sufficient methodological quality to be included in the thematic analysis. Evidence use in decision-making on innovation is influenced by multi-level processes (professional, organisational, local system) and interactions across these levels. Preferences for evidence vary by professional group and health service setting. Organisations can shape professional behaviour by requiring particular forms of evidence to inform decision-making. Pan-regional organisations shape innovation decision-making at lower levels. Political processes at all levels shape the selection and use of evidence in decision-making. CONCLUSIONS The synthesis of results from primary qualitative studies found that evidence use in decision-making on innovation is influenced by processes at multiple levels. Interactions between different levels shape evidence use in decision-making (e.g. professional groups and organisations can use local systems to validate evidence and legitimise innovations, while local systems can tailor or frame evidence to influence activity at lower levels). Organisational leaders need to consider whether the environment in which decisions are made values diverse evidence and stakeholder perspectives. Further qualitative research on decision-making practices that highlights how and why different types of evidence come to count during decisions, and tracks the political aspects of decisions about innovation, is needed.
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Affiliation(s)
- Simon Turner
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, UCL Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, UK
| | - Emma Hudson
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK
| | - Nick Swart
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK
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Berg H, Slaattelid R. Facts and values in psychotherapy-A critique of the empirical reduction of psychotherapy within evidence-based practice. J Eval Clin Pract 2017; 23:1075-1080. [PMID: 28418089 DOI: 10.1111/jep.12739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/21/2016] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
This paper addresses an implicit presupposition in research-supported psychological treatments and evidence-based practice in psychology. It argues that the notion of research-supported psychological treatments is based on a reductive conceptualisation of psychotherapy. Research-supported psychological treatments hinge upon an empirical reduction where psychotherapy schools become conceptualized as mere collections of empirical propositions. However, this paper argues that the different psychotherapy schools have distinct ethoses that are constituted by normative claims. Consequently, the evaluation of the different psychotherapy schools and the practice of psychotherapy should include the underlying normative claims of these ethoses.
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Affiliation(s)
- Henrik Berg
- University of Bergen, Centre for the Study of the Sciences and the Humanities, N-5020, Bergen, Norway
| | - Rasmus Slaattelid
- University of Bergen, Centre for the Study of the Sciences and the Humanities, N-5020, Bergen, Norway
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