bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Transnasal Transpterygopalatine Fossa Approach to the Lateral Recess of the Sphenoid Sinus
Authors: Al‐Nashar Ismail S. , Carrau Ricardo L. , Herrera Alfredo , Snyderman Carl H.
Published: February 2004

Objectives Lesions affecting the lateral recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the lateral recess of the sphenoid and to illustrate the detailed surgical steps of the procedure.

Study Design Retrospective review.

Methods Clinical charts of patients who had lesions originating from or extending into the lateral recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach.

Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow‐up period.

Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid lateral recess.
Vitamin E Reduces Cisplatin Ototoxicity
Authors: Kalkanis James G. , Whitworth Craig , Rybak Leonard P.
Published: February 2004

Objectives/Hypothesis Cisplatin ototoxicity is a major dose‐limiting factor in the treatment of several neoplasms. Vitamin E, a slow‐acting free radical scavenger, has been shown to ameliorate nephrotoxicity and endothelial cell damage in animals receiving cisplatin. The purpose of the study was to determine the effectiveness of vitamin E as an otoprotectant.

Study Design Prospective, randomized controlled trial in the rat model.

Methods Wistar rats (weight, 261–386 g) were sedated using 172.4 mg/kg intramuscular ketamine and 3.4 mg/kg xylazine. Baseline auditory brainstem response (ABR) testing was performed in response to clicks and 8‐, 16‐, and 32‐kHz tone bursts. After auditory thresholds were determined, the animals received intraperitoneal drug administration according to one of three group classifications. Group 1 received 4 g/kg vitamin E followed after 30 minutes by 16 mg/kg cisplatin. Group 2 received 6 mL/kg soybean oil followed after 30 minutes by cisplatin. Group 3 received soybean oil followed after 30 minutes by 16 mL/kg saline. After 3 days' follow‐up, ABR testing was performed and threshold changes were recorded. Cochleae were removed and processed for scanning electron microscopy after follow‐up auditory testing was carried out.

Results Group 2 animals showed marked hearing loss with average threshold shifts of 28.75 ± 2.3 dB for clicks, 30.0 ± 1.9 dB at 8 kHz, 21.25 ± 4.0 dB at 16 kHz, and 45.0 ± 4.2 dB at 32 kHz. No significant loss was observed in group 3 with shifts of 2 ± 1.3 dB, 3 ± 3.0 dB, −2.2 ± 3.1 dB, and −1.1 ± 4.0 dB for clicks and tone bursts at 8, 16, and 32 kHz, respectively. Significant protection was seen in group 1 animals compared with group 2 animals. In the former group, threshold shifts of 12.5 ± 3.1 dB for clicks, 7.5 ± 2.5 dB at 8 kHz, 5.0 ± 3.3 dB at 16 kHz, and 24.4 ± 5.6 dB at 32 kHz were observed. These findings were supported by the scanning electron microscope observations that severe outer hair cell destruction occurred in group 2 rats, whereas outer hair cells were preserved to a much greater extent in the cochleae of rats in group 1 that were pretreated with vitamin E.

Conclusion Vitamin E appears to have a protective effect against cisplatin ototoxicity.
Dimensional Stability of the Free Fascia Grafts: A Human Study
Authors: Indorewala Shabbir , Pagare Rajendra , Aboojiwala Shabbir , Barpande Swati
Published: February 2004

Objectives/Hypothesis In animals it has been shown that autologous free fascia grafts (fascia lata and temporal fascia) change dimensions during the vital first 5 days of healing. Poor dimensional stability of these grafts can be an important reason for failure of complete closure of tympanic membrane perforations in tympanoplasty operations, particularly in large perforations. Dimensional stability of these fascias has been studied in humans.

Study Design Prospectively, 11 patients were studied.

Methods Patients who were subjected to open mastoid cavity surgery were included in the study. The mastoid cavity was exteriorized, and the fascia graft was used to seal the perforation and cover a part of the bare mastoid bone in the routine way. At this stage, equally cut pieces of temporal fascia and fascia lata were laid on the remaining part of the bare mastoid bone. The mastoid cavity was then packed with Gelfoam and wound sutured. The pieces of graft material under study were removed after 5 days, leaving the graft used to seal the tympanic membrane perforation undisturbed. The harvested grafts were measured for their dimensional variations, if any.

Results It was observed that free autologous temporal fascia grafts exhibited poor dimensional stability as compared with free autologous fascia lata grafts.

Conclusion Poor dimensional stability of free temporal fascia grafts as seen in animals was confirmed in the present human study. This poor dimensional stability of temporal fascia grafts might be contributing to failure of closure of tympanic membrane perforations in tympanoplasty.
Prevention of Vocal Fold Scarring by Topical Injection of Hepatocyte Growth Factor in a Rabbit Model
Authors: Hirano Shigeru , Bless Diane M. , Rousseau Bernard , Welham Nathan , Montequin Douglas , Chan Roger W. , Ford Charles N.
Published: February 2004

Objectives/Hypothesis Vocal fold scarring disrupts the layer structure of the vocal fold lamina propria that is essential for optimal mucosal vibration. Prevention of vocal fold scarring remains challenging. Hepatocyte growth factor (HGF) has strong antifibrotic activity. The authors' previous studies have found that HGF stimulates hyaluronic acid production and suppresses collagen production from vocal fold fibroblasts, suggesting that HGF has therapeutic potential in prevention of vocal fold scarring. The present study aimed to demonstrate the effects of HGF on vocal fold scarring in an in vivo rabbit model.

Study Design Animal experiment.

Methods The vocal fold mucosa was stripped unilaterally in 20 rabbits, then HGF or saline (sham‐treated group) was immediately injected into the injured site. At 6 months after the procedure, histological, rheological, and physiological examinations of vibratory behavior were completed.

Results Histological examination revealed excessive collagen deposition and disorganized elastin in the sham‐treated group, whereas the HGF‐treated group presented with better wound healing exhibiting less collagen deposition. Contraction of the injured vocal folds observed in the sham‐treated group did not occur in the HGF‐treated group. Rheological data indicated that the HGF‐treated vocal folds were less stiff and viscous compared with the sham‐treated group. Mucosal vibration of HGF‐treated vocal folds appeared much better than the sham‐treated group in terms of phonation threshold pressure, vocal efficiency, mucosal wave amplitude, and glottal closure.

Conclusion Hepatocyte growth factor proved to be useful in preventing vocal fold scarring and maintaining viscoelastic shear properties of the vocal fold.
Epiglottitis in the Hemophilus influenzae Type B Vaccine Era: Changing Trends
Authors: Shah Rahul K. , Roberson David W. , Jones Dwight T.
Published: February 2004

Objective To describe the epidemiology, natural history, and treatment of epiglottitis in the Hemophilus influenzae type B (Hib) vaccine era.

Design Ten‐year retrospective study.

Setting Tertiary‐care children's hospital.

Patients Nineteen patients with a discharge diagnosis of epiglottitis.

Intervention As indicated by the presentation of the patient, including direct laryngoscopy, intubation, intravenous antibiotics, and steroids.

Main outcome measures Presentation, management, and microbiology.

Results Presenting symptoms included fever, drooling, and hot potato voice. Patients' ages ranged from 15.8 months to 17.5 (mean 8.9) years. From 1992 to 1997, the mean age was 5.8 years; from 1998 to 2002, the mean age was 11.6 years. Sixty‐eight percent of patients were transferred from an outside hospital. A lateral neck radiograph was recorded in 84% of patients. Mean leukocyte count was 16,600. Direct laryngoscopy with intubation was performed in 79%; intubation was for an average of 3.5 days. H. influenzae was cultured in six patients, five of which had up‐to‐date immunizations. The most commonly administered antibiotics were ampicillin/sulbactam and ceftriaxone. Steroids were administered to 63% of patients. Complications included deep neck space infection (2), seizure (1), recurrent illness (1), and vocal granuloma (1). There were no deaths.

Conclusion The demographics, causative organisms, and natural history of epiglottitis have changed substantially in the Hib vaccination era. The clinician evaluating and treating patients with epiglottitis should be aware of current trends.
Untreated Chronic Rhinosinusitis: A Comparison of Symptoms and Mediator Profiles
Authors: Kuehnemund Matthias , Ismail Chaim , Brieger Juergen , Schaefer Dirk , Mann Wolf J.
Published: February 2004

Objectives/Hypothesis Since the early 1990s, the knowledge of inflammatory mediators involved in chronic rhinosinusitis has increased extensively. However, until the present no data on trends in mediator levels in the natural course of the exacerbation‐free interval of chronic rhinosinusitis have been published. The purpose of the study was to examine how levels of inflammatory mediators and clinical findings in chronic rhinosinusitis relate over time in the absence of acute exacerbation.

Study Design Prospective study.

Methods The authors investigated 12 untreated patients with chronic rhinosinusitis and repeated clinical examinations and measurements of inflammatory mediators in the nasal mucosa (messenger RNA [mRNA]of interleukin‐1β; interleukins 3, 5, 6, and 8 [IL‐3, IL‐5, IL‐6, and IL‐8]; interferon gamma; tumor necrosis factor‐α [TNF‐α]; monocyte chemotactic proteins 1, 3, and 4 [MCP‐1, MCP‐3, and MCP‐4]; and granulocyte‐macrophage colony‐stimulating factor [GM‐CSF]), as well as measurements of peptido‐leukotriene [PLT] and prostaglandin E2 [PGE2]) in nasal secretion over a period of 4 weeks.

Results Clinically speaking, the symptom score significantly improved over the period of 4 weeks, whereas other clinical parameters (computed tomography score, endoscopy score, rhinomanometric values, saccharine transport time, ciliary beat frequency, and olfaction) varied insignificantly. Regarding proinflammatory and inflammatory mediators, only mRNA of IL‐1β, IL‐6, IL‐8, MCP‐1, and TNF‐α were detected in relevant amounts in nasal mucosa, and their levels decreased only insignificantly over the 4‐week period. In nasal secretion, a slight decrease of PGE2 and PLT levels was observed over the same time period.

Conclusion Subjective symptoms may show a spontaneous improvement of approximately 25% in patients with so‐called “stable” chronic rhinosinusitis over a 4‐week period, whereas objective clinical parameters vary insignificantly. Messenger RNA of IL‐1β, IL‐6, IL‐8, MCP‐1, and TNF‐α, as well as PLT and PGE2 levels, are detectable and appear to play a role in the persistence of inflammation in chronic rhinosinusitis. Their levels decrease only insignificantly over time, even in the absence of acute exacerbation of disease, possibly rendering the mucosa more prone to recurrent acute episodes.
Nonsyndromic 35 delG Mutation of the Connexin 26 Gene Associated With Deafness in Syndromic Children: Two Case Reports
Authors: Venail Frédéric , Roux Anne‐Françoise , Pallares‐Ruiz Nathalie , Claustres Mireille , Blanchet Patricia , Gardiner Quentin , Mondain Michel
Published: February 2004

Objectives/Hypothesis Several genetic diseases, such as velocardiofacial syndrome Del(22q11) and Down syndrome, are associated with hearing impairment.

Study Design Case reports.

Methods The authors reported two cases of hearing‐impaired children, one with Del (22q11) and one with Down syndrome, both with bilateral nonevolutive profound sensorineural deafness. Because of unusual features of their deafness and familial history, genetic evaluation was proposed. A homozygous 35delG mutation on the Connexin 26 gene was found in both children (DFNB1 phenotype).

Results A review of the reported otological features of Del (22q11) and Down syndrome showed that sensorineural deafness is rare and seldom profound. The authors found no evidence for a genetic link between Del(22q11) or Down syndrome and 35delG mutation on the Connexin 26 gene.

Conclusion The case reports reveal a coincidental association between DFNB1 and a multiple congenital anomaly syndrome. The clinician must be aware of this type of association to manage genetic counseling, appropriate otological care, and suitable treatment.
Delayed Nerve Repair Is Associated With Diminished Neuroenhancement by FK506
Authors: Brenner Michael J. , Fox Ida K. , Kawamura David H. , Yu Vivian M. , Lowe James B. , Hunter Daniel A. , Mackinnon Susan E.
Published: February 2004

Objectives/HypothesisThe immunosuppressive agent FK506 has been shown in many studies to enhance nerve regeneration and to accelerate functional recovery after immediate nerve repair. However, in clinical practice the diagnosis and treatment of patients with peripheral nerve injuries is often delayed. The study investigated whether FK506 would retain its neuroregenerative properties when nerve repair and initiation of FK506 therapy were delayed for 7 days.

Study DesignIn vivo laboratory study.

MethodsThirty‐two Lewis rats underwent tibial nerve transection and were randomly assigned to four experimental groups: immediate repair with FK506 treatment, immediate repair without FK506 treatment, 7‐day delayed repair with FK506 treatment, and 7‐day delayed repair without FK506 treatment. Treated animals received daily subcutaneous injections of 2 mg/kg FK506. Serial walking track measurements were performed at 14, 16, and 18 days after nerve repair. On day 18 after repair, peripheral nerves were injected with a fluorescent tracer for retrograde labeling. On day 21, peripheral nerves and spinal cords were harvested for histomorphometric analysis and motor neuron cell body counts, respectively.

ResultsAnimals that underwent immediate repair with FK506 had significantly higher fiber counts and percentages of nerve than the other three groups (P< .05) but did not show statistically significant earlier functional recovery. The remaining three groups had intermediate levels of nerve regeneration that were not significantly different. Retrograde abled motor neurons counts were decreased in animals with delayed nerve repair that received no FK506 (P< .05).

ConclusionIn a rat tibial nerve transection model, the neuroregenerative effects of FK506 diminished markedly when repair and initiation of FK506 therapy were delayed by 7 days.
Does Cerumen Have a Risk for Transmission of Hepatitis B?
Authors: Kalcioglu M. Tayyar , Durmaz Riza , Ozturan Orhan , Bayindir Yasar , Direkel Sahin
Published: February 2004

Objectives/Hypothesis Chronic hepatitis B virus infection is a significant worldwide health problem. It affects 350 to 400 million people. The patients with chronic hepatitis B virus infection have a significant risk for the development of cirrhosis or hepatocellular carcinoma. Full awareness of the mechanisms of transmission can allows susceptible individuals to refrain from this infection. Cerumen has never been studied as a route for hepatitis B transmission. The aim of the study was evaluate the importance of cerumen in transmission of hepatitis B virus infection.

Study Design This study was performed on forty patients with confirmed hepatitis B virus infection.

Methods Forty cerumen specimens collected from the patients with hepatitis B virus DNA in their sera were prospectively analyzed for the presence of hepatitis B virus DNA by real‐time polymerase chain reaction.

Results Eleven of 40 cerumen specimens (27.5%) were positive for hepatitis B virus DNA, with counts ranging from 4.2 × 102 to 4.7 × 106 copies per sample. There was positive correlation between hepatitis B virus DNA concentrations of serum and cerumen. Half of hepatitis B e antigen (HBeAg)–positive patients had detectable hepatitis B virus DNA levels (5.7 × 102 to 4.7 × 106 copies) in cerumen specimens, whereas 12.5% of cerumen specimens from anti‐HBe–positive patients had hepatitis B virus DNA levels (4.2 × 102 to 7.0 × 103 copies).

Conclusion Cerumen can be a potential source of transmission. Therefore, this route should be investigated in further studies for horizontal, nosocomial, and occupational transmission of hepatitis B.
Mal de Debarquement and Posture: Reduced Reliance on Vestibular and Visual Cues
Authors: Nachum Zohar , Shupak Avi , Letichevsky Vadim , Ben‐David Jacob , Tal Dror , Tamir Ada , Talmon Yoav , Gordon Carlos R. , Luntz Michal
Published: February 2004

Objective The neural mismatch theory assumes that the intersensory conflicts leading to motion sickness are resolved by changes in the relative weighting of the various senses that contribute to orientation. If this sensory rearrangement persists after disembarkment, it might result in mal de debarquement (MD): ataxia and a rocking sensation sometimes felt after landing. The objective of the present study was to examine possible changes in sensory organization in naval crew members with differing susceptibility to MD with computerized dynamic posturography (CDP).

Study Design Cross‐sectional parallel‐group design.

Methods Seventeen subjects susceptible to MD (SMD) and 17 subjects nonsusceptible to MD (NSMD) (healthy male volunteers aged 18–22) participated in the study. CDP was performed twice with each subject, before and immediately after sailing, using the EquiTest system (NeuroCom, Inc., Clackamas, OR).

Results The SMD group showed a significant reduction in their scores on sensory organization tests 3, 4, and 5 after sailing. Sensory pattern analysis revealed reduced use of inputs from the vestibular and visual systems to maintain balance. Prolonged latencies of the motor responses to unexpected pitch perturbations were also recorded in the postsailing CDP of the SMD group. Reduced performance on the presailing CDP task, which presents the greatest challenge to the vestibular system, was found to control for the presence of MD postsailing.

Conclusions The results show that MD is associated with postural instability, slower motor reflexes, and larger sways in response to abrupt changes in the body's center of gravity. These findings may be explained by under reliance on vestibular and visual inputs and increased dependence on the somatosensory system for the maintenance of balance.
Nasal Fractures: The Taming of the Shrewd
Authors: Fernandes Sylvester Valentine
Published: February 2004

Objective/Hypothesis Closed reduction of nasal fractures has not been a satisfactory approach. Graduated protocols yield better results. Because a significant proportion of these closed reduction patients refuse a second operation, would it be better to resort to a full septorhinoplasty at the first operation and therefore decrease the post first operation deformity rate?

Study Design Retrospective review of patients treated by the closed reduction technique and with a full septorhinoplasty approach.

Methods Thirty‐four patients treated by the closed reduction technique were surveyed by telephone, and thus only patient satisfaction, which is usually higher in most studies, was allowed to influence the outcome. In another study, 52 patients treated with a full septorhinoplasty were reviewed by the surgeon.

Results Sixty‐two percent of the closed reductions had esthetic or obstructive concerns. Of these with esthetic or obstructive concerns, 62% will not have a second operation for correction. Only 11.5% of those undergoing a full septorhinoplasty had esthetic concerns.

Conclusion It may be necessary to adopt an early full septorhinoplasty approach in the initial treatment of nasal fractures to reduce the post first operation deformity/obstruction rates.
A data mining approach to neural network training
Authors: Belhadjali Moncef , Whaley Gary L.
Published: March 2004

Neural networks are widely used in model building. Applications include predicting bankruptcy, and assessing the relationship quality between a customer and a salesperson. This paper utilizes data from an Internet users survey to investigate Internet usage for personal and not for work or school related needs, and the impact of pattern presentation order and frequency on the learning accuracy of the network. The data were sorted using the association‐rule mining approach. The software used is BrainMaker from California Scientific Software.
Evaluating Devolution in Wales
Authors: Kay Adrian
Published: February 2004

Reviews of devolution in Wales have been focussed so far on empirical description and positive analysis; there has been almost no discussion of how it should be judged or evaluated. I redress this imbalance by considering the arguments for devolution and the various normative values that may be used to evaluate the process. The arguments for devolution are of two basic kinds. Some are consequentialist: that devolution is desired on the grounds that it is believed to have good or desirable effects. Others are deontological: that devolution is thought to be intrinsically valuable. Any attempt to justify and evaluate devolution by consequentialist reasoning amounts to post hoc ergo propter hoc rationalisation. The social sciences are a long way from allowing the prediction of the global long-term net equilibrium effects of a major institutional change such as devolution in Wales. I further argue that the nonconsequentialist value of autonomy is the underlying justification for the devolution process. Devolution should be judged according to how it appeals to, supports or embodies this value.
European Governance and Civic Participation: Beyond Elitist Citizenship?
Authors: Magnette Paul
Published: February 2004

Since the end of the 1990s, ‘new modes of governance’ have been presented by academics and political actors as an answer to the EU's ‘democratic deficit’. Analysing the intellectual roots of this idea, and the concrete proposals made by those who, like the European Commission, support it, this paper argues that it is very unlikely to reach this ambitious purpose. Far from breaking with the Community method, these participatory mechanisms constitute extensions of existing practices, and are underpinned by the same élitist and functionalist philosophy. They remain limited to ‘stakeholders’ and will not improve the ‘enlighted understanding’ of ordinary citizens and the general level of participation. The paper examines the obstacles to the politicisation of the EU inherent in its institutional model, and discusses other options which might help bypass the limits of ‘governance’.
Does Inclusion Require Democracy?
Authors: Tebble Adam James
Published: February 2004

Iris Marion Young's theory of democracy aims to accommodate the idea of difference by combining anti-essentialist, identity conferring social groups and mediated socio-economic relations. In this way they are supposed to combine instrumental rationality with inclusiveness and the recognition of difference. Using the political thought of F.A. Hayek, this paper mounts a critique of Young's difference theory. In particular it argues that Young's theory of group representation at the institutional level of politics contradicts her commitment to an anti-essentialist account of groups. Whereas her account of group identity is necessarily fluid and inclusive, her account of recognition is rigid and exclusionary. Furthermore the epistemological demands of democratic communication and economic coordination undermine her instrumental account of public-decision making. In contrast it will be argued that Hayek's political thought provides instructive alternative way of addressing the tensions at the heart of Young's theory.
Australian occupational mortality, 1965–67: cause specific or general susceptibility
Authors: Najman Jackob M. , Congalton Athol A.
Published: February 2004

Summary There have been few attempts to examine theories of disease causation using occupational mortality data. This may be due in part to the fact that only a few countries have systematically produced details of occupational mortality. It is well known that some occupational groups are clearly at increased mortality risk from a number of specific causes of death (e.g. industrial workers and accidents). Other occupational groups may be at increased risk from a number of causes of death (e.g. miners and lung cancer, emphysema, industrial accidents). A third, and more interesting group of workers, are those who may be at increased risk from most causes of death. Such workers may be described as being subject to a general susceptibility to disease and death. Using Australian mortality data, a number of occupational groups and their mortality patterns are examined. Two theories of disease causation (psychosom‐aticist and sociosomaticist) have been advanced to explain the finding that some occupational groups exhibit a general susceptibility to most causes of death.
Coping and social action: theoretical reconstruction of the life‐event approach
Authors: Gerhardt Uta
Published: February 2004

Summary Despite the wide range of literature about life‐events, there has been very little on life‐event research. This paper attempts a critical analysis of the theoretical assumptions which go into life‐event research. The focus is sociological, i.e. the question is asked in what way coping can be conceptualized as social action. Three types of coping are discerned in the life‐event literature, namely, psycho‐physiological, psychological, and social. It is argued that the analysis of psychological coping calls for an ethnomethodological paradigm while the study of social coping necessitates a Marxist approach.
Review Article
Authors: Davies Celia
Published: February 2004

Books reviews in this article:

Vincente Navarro, Class Struggle, the State and Medicine: an historical and contemporary analysis of the medical sector in Great Britain.

Brian Watkin, The National Health Service: the first phase, 1948–1974 and After.
Review Article
Authors: Helman Cecil
Published: February 2004

Book review in this article:

A. Kleinman, Patients and Healers in the Context of Culture.
The evolution of relations between French physicians and the state from 1880 to 1980
Authors: Herzlich Claudine
Published: February 2004

Abstract The paper reviews changing relationships between the medical profession and the state in France in the nineteenth and twentieth centuries. It traces the process of negotiation and compromise surrounding state mediation of the doctor‐patient relationships. The changing nature of professional autonomy in France is outlined.
Sentimental work in the technologized hospital
Authors: Strauss Anselm , Fagerhaugh Shizuko , Suczek Barbara , Wiener Carolyn
Published: February 2004

Abstract Sentiment is frequently involved in work either to get work done efficiently or because of humanistic considerations. This paper explores several questions: Are there different kinds of sentimental work? How is sentimental work carried out? When and where is it done; when not? Who does it? What is its relation to other types of work? When is it likely to be in focus for the workers? When is it visible, when invisible and to whom? What are its consequences: for work, staff, client and organization? The illustrative materials used in this paper are taken from research on the impact of technology on medical work in hospitals.
Perinatal mortality: the current debate
Authors: Russell Jill
Published: February 2004

Abstract Using the parliamentary 'Short Report’on perinatal and neonatal mortality as a focus for analysis, this paper attempts a critical examination of recent trends in perinatal health policy debate, and suggests a polemical explanation of such trends. The paper begins by outlining the major concerns of current debate and unravelling the assumptions and apparent contradictions in both‘official’and popular arguments. It then utilises a framework and perspective adopted by Lewis in her recently published analysis of Edwardian maternal and infant welfare policy, in an attempt to make sense of the major contradictions identified. The importance of considering the ideological‘ends’of social policy movements ‐ in this instance, a restating of the ideology of motherhood — over and above purported societal‘needs’— i.e. a reduction in perinatal mortality rates — is highlighted.
Negotiation and the structure of discourse in medical consultation
Authors: Drass Kriss A.
Published: February 2004

Abstract Using audio tape recordings of consultations between mid‐level providers and patients in a health maintenance organization, a model of medical negotiation is presented. This model conceptualizes negotiation as a process in which mid‐level providers and patients introduce their perspectives on the definition and treatment of medical problems by linking together units of discourse (acts, turns, sequences and phases). This model clearly locates negotiation in observable activities of interactants and demonstrates how the process changes over the course of an encounter as provider and patient participate in the taking of a medical history, the performance of a physical examination, and the discussion of the problem and treatment. Because of the formal yet flexible nature of this model, it lends itself for use in comparative studies of medical practitioner‐patient negotiation.
Pain perceptions, emotions and gender
Authors: Bendelow Gillian
Published: February 2004

This research explores the relationship between perceptions of pain and the social characteristics of the individual, with a focus on the role of gender in the process, with an emphasis on the meaning of ‘lay’ understanding of the phenomena of pain. In order to broaden the definition of pain a multi‐method form of enquiry was adopted and significant gender differences were found in the emphasis on the role of the emotions and the social expectations of the ability to cope in experiences and perceptions of pain. Analysis of the qualitative fieldwork revealed how experiences of pain incorporate feelings and vulnerabilities, existential and religious beliefs as well the sensory components. The attribution, by both sexes, of the superior capacities of women in coping with pain are linked to their biological and reproductive functioning, but are underpinned by cultural expectations of roles and socialisation. The ‘findings’ of the study both reflect the particular experiences of people living in a multi‐racial inner‐city area, and provide a basis for developing new approaches to the understanding of pain, and the relationships between pain, gender, culture and embodiment.
Talking delicacy: speaking about sexuality during gynaecological consultations
Authors: Weijts Wies , Houtkoop Hanneke , Mullen Patricia
Published: February 2004

Although survey research has shown that both parties in medical consultations have difficulties with discussing issues relating to sexuality, little is known about how talk about sexuality is actually organised in medical consultations. Drawing, in part, on methods from conversation analysis, the present study reveals how both patients and physicians in gynaecological consultations mark potentially delicate matters by ‘expressive caution’, represented by delays, avoidances and depersonalisations. This expressive caution is co‐operatively accomplished between the professional and the client. It will be shown that a detailed analysis of how talk is produced in consultations can generate findings relevant to medical practice.
Patient participation in decision‐making and consent to treatment: the case of general surgery
Authors: Meredith Philip
Published: February 2004

Recent political initiatives have sought to encourage patients to seek increased participation in decision‐making on treatments. In NHS surgical care, the consent process begins most commonly with an outpatients consultation within which the implicit rules of communication and participation are conveyed to patients by the setting, and the routines of the service providers. The signing of the consent form just prior to surgery while on the ward tends to be a re‐affirmation of the strengths and weaknesses of the relationship established there and the discourse on which it is based.

The reflections of surgical patients and staff reported here suggest that politico‐legalistic measures to encourage and increase patient participation in surgical decision‐making will continue to be frustrated. This may occur not simply because of a natural desire on the part of surgeons to reaffirm established professional rights to control the form and content of consultations, but because more demanding patients will disrupt the methods by which surgeons and other service providers have been able to fulfil the demands for patient throughput which a pressured health care system places on them.
Controlling the ‘bed state’: negotiating hospital organisation
Authors: Green Judith , Armstrong David
Published: February 2004

This paper examines hospital staff's reports of the ‘problem’ of the acute emergency admission. It is argued that from the initial framing of the problem in terms of crisis and efficiency, through to the apparent solution in a management regime of Bed Management, an important aspect of the organisation of the hospital was achieved. This aspect of organisation stressed the ascendancy of the hospital as the main unit of organisation ‐ together with its associated management regimes ‐ against the more local configuration of the hospital's wards which traditionally had formed the basis of clinical power.
Coping with change: physicians in prepaid practice
Authors: Budrys Grace
Published: February 2004

This paper examines the efforts of physicians to cope with changing role expectations particularly the integration of gatekeeping expectations. The subjects of the study are US physicians who are members of a prepaid practice group that is affiliated with a Health Maintenance Organisation. The respondents say that they are committed to gatekeeping; however, they complain about the frustrations associated with this function. They differ in the extent to which they complain. The paper focuses on factors which account for this variation. Two factors are discussed in detail ‐ specialty differences and structural characteristics associated with the office site. The discussion begins with a review of the general sociological literature which employs the gatekeeping concept.
The Belgian medical profession, the order of physicians and the sickness funds (1900–1940)
Authors: Schepers Rita
Published: February 2004

How a profession is regulated and by whom are generally considered to be crucial questions. In Belgium, the most important regulator of the medical profession is the Order of Physicians. This institution is generally acknowledged to be a cornerstone of the Belgian profession's ‘overwhelming dominance’ and great autonomy. In this article, I will discuss the developments which led to the establishment of the Order of Physicians in 1938. One of the central themes is that in order to understand its establishment fully one has to take into account the ongoing struggle between profession, sickness funds and government as to the position of the profession within the planned obligatory health insurance system. It is likely that the typically Belgian involvement of interest groups and social movements in the political arena, in order to fight off political interference in issues considered to be private ones, facilitated the acceptance and the establishment of the Belgian Order of Physicians in 1938.
All in the family: social processes in ovarian egg donation between sisters
Authors: Lessor Roberta
Published: February 2004

Interviews and participant observation were conducted at a US infertility clinic with women who were attempting to become pregnant with eggs donated by their biological sisters. Sisters who donated eggs were also followed and interviewed regarding their experiences, as were a number of husbands of recipients. Five significant social processes characterising the sisters’ passage through egg donation are discussed: (1) negotiating dissimilar treatment experiences, (2) communicating cautiously, (3) interacting in a triad, (4) disclosing to others, and (5) ‘gift‐giving’. Although participants are generally satisfied with their decision to do sister‐to‐sister egg donation, the unprecedented procedure presents a number of difficulties. If sister‐to‐sister egg donation as a means to biological motherhood continues in the future, these sociological findings suggest areas in which medical personnel may need to provide social and emotional support.
Managing ‘minor’ disorders: pathways to a hospital accident and emergency department
Authors: Calnan Michael
Published: February 2004

Empirical research examining the decision‐making processes involved in the management of problematic signs and symptoms has either focused on a specific condition or examined more general decision rules. The problem with these approaches is the difficulty in identifying which elements are specific to certain complaints and which are more generally applicable. The study presented here shows a comparison of the processes involved in the decision to seek medical care for sufferers with different types of complaint. This comparison identified various different elements in the decision‐making processes which were shown to have considerable implications for their pattern of help‐seeking behaviour and their pathways to the hospital accident and emergency department.
Loss of self: a fundamental form of suffering in the chronically ill
Authors: Charmaz Kathy
Published: February 2004

Physical pain, psychological distress and the deleterious effects of medical procedures all cause the chronically ill to suffer as they experience their illnesses. However, a narrow medicalized view of suffering, solely defined as physical discomfort, ignores or minimizes the broader significance of the suffering experienced by debilitated chronically ill adults. A fundamental form of that suffering is the loss of self in chronically ill persons who observe their former self‐images crumbling away without the simultaneous development of equally valued new ones. As a result of their illnesses, these individuals suffer from (1) leading restricted lives, (2) experiencing social isolation, (3) being discredited and (4) burdening others. Each of these four sources of suffering is analysed in relation to its effects on the consciousness of the ill person. The data are drawn from a qualitative study of 57 chronically ill persons with varied diagnoses.
Class, perceptions of ‘disordered’ behaviour, and suggestions for therapy: a tri‐cultural comparison
Authors: Heller Peter L. , Quesada Gustavo M. , Chalfant H. Paul
Published: February 2004

This paper presents findings from a tri‐cultural study in which we argue that class differences pertain not only to rates of mental illness but also to recognition of symptoms of mental illness and to recommendations concerning what should be done by those exhibiting ‘disordered behaviour’. It is hypothesized that regardless of respondent's cultural background, the extent to which a deviant behaviour will be defined as a mental health problem, and professional therapy will be suggested as a source of help for that problem, will be positively related to class. Findings from a sample selected from two small West Texas communities, and samples selected from Durange, Mexico, and Juiz de Fora, Brazil, indicate strong support for the first prediction only among the West Texas sample, whereas the second hypothesis concerning therapy suggestions is strongly supported among respondents in all three cultural settings. We conclude that these class differences in perceptions and suggestions concerning five examples of ‘disordered’ behaviours read to respondents relate to conditions of lower‐class life in general. Particularly, structural support found for our hypothesis leads us to suggest a need for informal, nonbureaucratic mental health care systems created to serve lower‐class populations residing in class‐oriented societies, regardless of cultural differences which may exist among these societies.
Discourse processes and the social organization of group therapy sessions
Authors: Vandewater Steven R.
Published: February 2004

The social organization of group therapy sessions held in a community mental health center is investigated by analysing transcripts of audiotaped and videotaped sessions as well as ethnographic data (field notes and interviews). After describing the structural (i.e. hierarchical and sequential organization of activities during sessions, discourse processes by which group members accomplish this structure are examined. Analyses of participants’ communicative strategies provide insights into the cognitive and behavioral components of the interactive competence required of group members. In contrast to findings of previous research on group therapy, interactive control is found to be distributed among certain clients as well as the therapists.
Time, risk and routine in general practice1
Authors: Horobin Gordon , McIntosh Jim
Published: February 2004

The paper is based on interviews with a sample of 50 general practitioners. It explores their concepts of time’ and ‘task’ in relation to their attempts to create satisfying work roles. There is a contrast between practitioners in urban and rural settings. For urban practitioners the economy of time as a scarce resource generates an element of risk from brief, ‘routine’ diagnosis. For rural practitioners time is not seen as a scarce resource, but they face the risk of working without additional specialist services. For most practitioners the problem is dealt with pragmatically by varying the mix of risky and routine work.
Compliance and risk‐taking: the case of alcoholic liver disease
Authors: Blaxter Mildred , Cyster Richard
Published: February 2004

This paper describes an exploratory study of ‘compliance’ with doctors’ advice in an extreme situation: reduction of drinking, or abstention from alcohol, in patients with alcoholic liver disease. A preliminary postal survey had suggested that at least three‐quarters of these patients continued to drink. An intensive interview study explored the reasons for this. Only a minority of the patients were identified as alcoholic, or had a history suggesting dependence. It was concluded that communication between doctor and patient, and factors involved in the patients’ perception of their illness, were crucial first steps towards a change of behaviour. The statements of doctors had to be reinforced by a subjective appreciation of danger. Even if advice about the management of their condition was understood and accepted, however, what then constituted ‘compliance’ in the patients’ eyes depended very much upon social norms. Even then, the success or failure of attempts to follow the doctors’ advice depended crucially upon the circumstances of the patients’ lives. The model of ‘compliance’ or ‘non‐compliance’ which thus emerges is a complex one which has several stages.
Participation in the medical consultation: the co‐ordination of verbal and nonverbal behaviour between the doctor and patient
Authors: Heath Christian
Published: February 2004

The following paper is concerned with the coordination of verbal and nonverbal behaviour by the doctor and patient in the medical consultation. It explores the relationship between the talk of the patient and the nonverbal behaviour of the doctor and demonstrates how the gaze direction of the doctor plays a crucial part in the articulation of an utterance by the patient. In examining a series of examples drawn from primary health care consultations, the analysis reveals how patients, or more generally speakers, use gestural activity to realign the gaze of their recipient(s) and encourage their participation in talk. In this fashion the paper addresses the problem of how the participants maintain a state of mutual involvement and sustain their integration within social interaction.
Research note: proxy responses in health surveys: a methodological issue
Authors: Briscoe Monica E.
Published: February 2004

The practice of using proxy respondents in health surveys has been identified as a possible cause of confusion in the literature concerning sex differences in morbidity. Specifically, it has been suggested that proxy respondents (usually female) tend to under‐report illnesses of absent persons (usually male) and hence the observation that women suffer from more illness than men may simply be an artifact of this method of data collection. In order to investigate proxy effects, 50 married couples were asked to report symptoms recently experienced by their spouses as well as themselves. A high level of agreement was found between husbands and wives regarding the number and severity of symptoms experienced by each individual, despite considerable differences in health status between sub‐groups. Where there was a discrepancy, it was in the direction of the proxy respondent (of either sex) over‐reporting symptoms. It follows from this that, if anything, the over‐use of female interviewees would tend to minimise observed sex differences in illness. Thus, the excess female morbidity found in health surveys is not attributable to proxy effects but is more likely to result from differences in the way in which men and women experience symptoms.
Integration or marginalisation? Clinical psychology as a strategy for dealing with psychosocial issues in a South African neurosurgery ward
Authors: Miller Tracey , Swartz Leslie
Published: February 2004

Biomedicine has been criticised for its failure to take adequate account of psychosocial issues. One attempt to address this has been to employ clinical psychologists in general hospital wards. In order to examine this phenomenon, four cases referred to the first author while she was an intern clinical psychologist working in a Neurosurgery ward are reported and discussed. In addition, interviews were conducted with two clinical psychologists and the head of this Department of Neurosurgery. Issues that emerged from the data included evidence of referral of what could be more accurately termed social or structural problems rather than psychological problems; power imbalances between psychologists and neurosurgeons, and the elaboration of these factors within the particular context of South Africa. Taking account of psychosocial issues by employing clinical psychologists in medical settings may fail in that it may ironically facilitate the marginalisation of these issues, and allow social and political issues to be individualised and pathologised.