The overdiagnosis of what? On the relationship between the concepts of overdiagnosis,disease, and diagnosis

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it “cancer screening” when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis.     

Charge of the right brigade? Communities, coverage, and care for the uninsured

The Robert Wood Johnson Foundation's Communities in Charge (CIC) program funded projects in fourteen communities that aimed to expand health insurance coverage and improve care for their uninsured residents. Our examination of seven program sites suggests that despite solid community leadership and carefully crafted plans, political, economic, and organizational obstacles precluded much expansion of coverage and constrained reforms. Redistribution of financial and organizational resources among both mainstream and safety-net institutions in these communities was hard to achieve. CIC's record offers little evidence that communities are better equipped than are other sectors of U.S. society to solve the problem of uninsurance.     

Health risks, ability to pay, and the use of primary care: is the distribution of service effective and equitable?

BACKGROUND: This study clarifies the confusion about what factors are consistent predictors of primary care service use, of which preventive services are a major component. A variety of health risk, predisposing, and enabling characteristics were assessed for their association with the use of primary care. Variable selection was guided by the use of the Andersen-Newman Behavioral Model of health service utilization. METHODS: The responses of 1,512 residents of Oklahoma to the BRFS survey were used in this study. Both probit and logistic analyses were used to assess the use of nine preventive services and a summary index of service use. RESULTS: The results indicate that those at greater risk of illness and least able to use finance services have the lowest rates of use among the nine preventive services individually and when combined as an index of overall primary care use. CONCLUSIONS: Problems persist with the adequate distribution of primary care among the medically vulnerable. Furthermore, recent welfare and health reforms may present added obstacles to their access to quality primary care services. The paper concludes with a discussion of policy options that may improve the effectiveness of primary care and redress inequities in the use of these services.     

Characterization of phase I and phase II drug metabolism and the effect of Β-naphthoflavone in the liver and posterior kidney of the channel catfish,Ictalurs punctatus

Immature channel catfish (Ictalurus punctatus) were injected intraperitoneally with 50 mg/kg -naphthoflavone (BNF) and its effects on phase I and phase II xenobiotic metabolizing enzymes of liver and posterior kidney were evaluated. Microsomal monooxygenases in control animals exhibited higher specific activities in liver than in kidney although if data are expressed as turnover numbers, both organs have comparable activities, -naphthoflavone treatment resulted in increases in hepatic microsomal cytochrome P-450 content and ethoxyresorufin deethylase activity. Renal monooxygenases were not responsive to BNF injection. The phase II xenobiotic metabolizing systems of liver or kidney did not respond to BNF treatment. With the exception of epoxide hydrolase which was higher in renal microsomes, phase II drug metabolizing activity of liver cell fractions was about two-fold that observed in fractions isolated from posterior kidney.     

How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions

Purpose  

To assess and compare content, validity, and specificity of the QuickDASH (Disability of the arm, shoulder and hand questionnaire) as compared to the full-length DASH and other instruments to give a recommendation for its use depending on a specific clinical situation.     

Accreditation, evaluation, and review in Australian programs: the end of the beginning?

The approaches to accreditation, evaluation and review, particularly in health services management education, in the U.S.A. and England are contrasted briefly. The Australian approaches, in first a binary system and then a unified national system, are described. Differences between the proposals in the Federal Policy Statement on higher education and actual practice in the establishment of accreditation as an external process with developmental objectives are analyzed. The introductory approach in developing a methodology for program self-review is outlined, as is the extensive but largely informal system of evaluation.     

A Comparison of the Effects of the Opioid Antagonists Naltrexone,Naltrindole, and β-Funaltrexamine on Ethanol Consumption in the Rat

The effects of the universal opioid antagonist naltrexone were compared to the δ-selective opioid antagonist naltrindole and the μ-selective opioid antagonist β-funaltrexamine on ethanol consumption in the absence of food or fluid deprivation using a limited access procedure in Wistar rats. Both naltrexone, at doses of 0.1, 0.25, 0.5, 1.0, 3.0, and 10 mg/kg, and β-funaltrexamine, at doses of 5.0 and 20.0 mg/kg, significantly decreased consumption of a 6% ethanol solution compared to saline control groups. Naltrindole, at doses of 5.0 and 15.0 mg/kg, failed to significantly reduce ethanol consumption. In addition, the highest doses of naltrexone, which antagonize δ as well as μ-opioid receptors, did not differ significantly from the lowest doses in their ability to reduce ethanol consumption. These data suggest that ethanol consumption using the limited access paradigm in the outbred rat is modulated by μ rather than δ-opioid receptors. Although this is not consistent with other data showing that δ antagonists decrease ethanol consumption, it is suggested that these difference may be related to the alcohol-preferring rats used in those experiments.     

Measles,the media,and MMR: Impact of the 2014–15 measles outbreak

ObjectiveIn late 2014, a measles outbreak beginning in California received significant media attention. To better understand the impact of this outbreak, we conducted a survey to assess and compare among vaccine hesitant and non-hesitant new mothers how this outbreak affected vaccine knowledge, attitudes, vaccination plans, and media use.MethodsA cross-sectional email survey of English-speaking women with a child ⩽1 year old using a convenience sample of women from nine obstetrics and gynecology (OB/GYN) practices in Colorado assessed vaccine hesitancy, knowledge and attitudes about MMR vaccines and the outbreak, MMR vaccination plans before and after the outbreak, and use of and trust for media sources related to the outbreak.ResultsThe response rate was 50% (351/701). Knowledge about the outbreak was high and vaccination attitudes were mostly favorable. Forty-eight percent of respondents thought MMR vaccine was more important after the outbreak. Online news (76%), television news (75%), and social media (68%) were the most frequently used media sources, yet were highly trusted by only 18%, 22%, and 1% of respondents respectively. Government websites (34%) and information from a doctor’s office (34%) were infrequently used, but were highly trusted by 62% and 60% of respondents. Knowledge of the outbreak was lower among vaccine-hesitant respondents. Few mothers changed MMR vaccination plans after the outbreak.ConclusionsNew mothers had high levels of knowledge and favorable attitudes about vaccination after the 2014–15 measles outbreak. Media sources used the most are not the most trusted. Communication about outbreaks of vaccine-preventable diseases should include spread of accurate information to new media sources and strengthening of existing trust in traditional media.     

In vitro bioaccessibility of the Cu,Fe, Mn and Zn in the baru almond and bocaiúva pulp and,macronutrients characterization

This study aimed to evaluate the in vitro bioaccessibility of copper, iron, manganese and zinc in the baru (Dipteryx alata Vog.) almond and the bocaiúva (Acrocomia aculeata (Jacq.) Lodd) pulp and, macronutrients characterization. Centesimal composition, Aw, phytic acid, color, ascorbic acid, carotenoids and pH were determined. The total mineral concentration and in vitro bioaccessibility was quantified by flame atomic absorption spectrometry. The samples showed a composition with high nutritional value, where the baru almond was distinguished by the proteins, lipids and total dietary fibers; the bocaiúva pulp by the sugars, lipids, vitamin C and carotenoids. The total mineral concentrations in baru almond were 1.80; 8.65; 8.85 and 4.83 mg/100 g and in vitro bioaccessibility was 16.8; 21.4; 80.3 and 81.3% for Cu, Fe, Mn and Zn, respectively. For the bocaiúva pulp, the total mineral concentrations were 0.5; 4.5; 0.2 and 1.7 mg/100 g and in vitro bioaccessibility was 13.6; 15.0; 20.1 and 57.6% for Cu, Fe, Mn and Zn, respectively. The Pearson correlation coefficient verified that the phytic acid and ascorbic acid can influence the in the bioaccessibility. The results indicate the baru almond and the bocaiúva pulp as a natural source of nutrients and of minerals bioaccessible to the human organism.     

Blood, sweat and semen: the economy of axé and the response of Afro-Brazilian religions to HIV and AIDS in Recife

This article provides an ethnographic analysis of Afro-Brazilian religious responses to the HIV epidemic in Recife. Drawing on participant observation and in-depth interviews conducted with Afro-Brazilian religious leaders and public health officials, it highlights the importance of the axé--a mystical energy manipulated in religious rituals that is symbolically associated with blood, sweat and semen. In an analysis of the relationship formed between the state AIDS programme and Afro-Brazilian religious centres, we conclude that the recognition of native categories and their meanings is one of the key elements to a fruitful dialogue between public health programmes and religious leaders that in the case studied, resulted in the re-signification of cultural practices to prevent HIV. Although the Afro-Brazilian religious leaders interviewed tended to be more open about sexuality and condom promotion, stigma towards people living with HIV (PLHIV) was still present within the religious temples, yet appeared to be more centred upon the perception of HIV as negatively affecting followers' axé than judgement related to how one may have contracted the virus. We discuss the tensions between taking a more liberal and open stance on prevention, while also fostering attitudes that may stigmatise PLHIV, and make suggestions for improving the current Afro-Brazilian response to the epidemic.