Medical sociology and epidemiology: convergences, divergences and legitimate boundaries

For the purpose of exploring the existence of problem areas that may give rise to the question whether there is a tendency to (illegitimately) trespass across boundaries between medical sociology and epidemiology, important convergences and divergences between both disciplines are described. To assemble arguments for the legitimacy of fields of study we trace comparatively the history of both disciplines, definitions of their fields under study and aims of study, as well as characteristic concepts and constructs. Current research themes are taken from international journals; divergent interests are briefly described and potential 'trespassing' of boundaries is discussed, referring to themes showing convergences of interest.     

Family medicine and family therapy: comparative development, methods, and roles

Family medicine and family therapy have evolved separately, but the fields are now increasingly in contact with each other. Today's family physician needs a deeper grasp of their similarities and differences. This paper compares the two disciplines in terms of their (1) membership criteria for treatment, (2) considered appropriateness for treatment, (3) contractual process, and (4) evolution of membership over time. Also explored are the disciplines' notions of illness and change; their differing attitudes toward technique are analyzed as well. Family therapists and family physicians appear likely to have increased exposure to one another. As they do, common approaches may develop, and conceptual differences may present a mutual stimulus for growth and change.     

Nutrients, age and cognition

Our knowledge about the influence of nutritional supplements on human cognition, especially in the elderly, rests largely on animal behavioural research and neurochemical experiments in vitro, while only a few epidemiological studies and even fewer controlled experiments in humans are reported. This is an inherent problem, due partly to the difficulty of conducting controlled nutritional experiments in humans, but may also partly be due to the gap between the research disciplines of nutritional and neurobehavioral experimental science. LEARNING OBJECTIVES: The aim of this paper is to discuss some new findings in this line of research, and to stress the importance of the need to start bridging the gap between disciplines by identifying possible human experimental models of altered cognitive function, which can elucidate the specific mechanisms of action through which nutritional supplements may enhance cognitive performance in humans in vivo. These experimental models are important because the research in this field is mostly based on epidemiological studies, which describe associations between nutrients and cognitive functions. Contrary to epidemiological studies, experimental models mimic associations between nutrients and cognition by manipulating their presumed mechanisms of action and can eventually explain the causal nature of found associations.     

From international health to global health: how to foster a better dialogue between empirical and normative disciplines

Background

Public health recommendations are usually based on a mixture of empirical evidence and normative arguments: to argue that authorities ought to implement an intervention that has proven effective in improving people’s health requires a normative position confirming that the authorities are responsible for improving people’s health. While public health (at the national level) is based on a widely accepted normative starting point – namely, that it is the responsibility of the state to improve people’s health – there is no widely accepted normative starting point for international health or global health. As global health recommendations may vary depending on the normative starting point one uses, global health research requires a better dialogue between researchers who are trained in empirical disciplines and researchers who are trained in normative disciplines.

Discussion

Global health researchers with a background in empirical disciplines seem reluctant to clarify the normative starting point they use, perhaps because normative statements cannot be derived directly from empirical evidence, or because there is a wide gap between present policies and the normative starting point they personally support. Global health researchers with a background in normative disciplines usually do not present their work in ways that help their colleagues with a background in empirical disciplines to distinguish between what is merely personal opinion and professional opinion based on rigorous normative research.If global health researchers with a background in empirical disciplines clarified their normative starting point, their recommendations would become more useful for their colleagues with a background in normative disciplines. If global health researchers who focus on normative issues used adapted qualitative research guidelines to present their results, their findings would be more useful for their colleagues with a background in empirical disciplines.

Summary

Although a single common paradigm for all scientific disciplines that contribute to global health research may not be possible or desirable, global health researchers with a background in empirical disciplines and global health researchers with a background in normative disciplines could present their ‘truths’ in ways that would improve dialogue. This paper calls for an exchange of views between global health researchers and editors of medical journals.

     

Epidemiology and bioethics: a plea for reconnecting with the public

The author takes the position that both epidemiology and bioethics, as practiced within academic establishments, have largely although not entirely abstracted the public context of health and well-being from their respective disciplines. It is argued that by and large both disciplines have been highly successful at what they do. However, this success can in part be attributed to each limiting its ability to look beyond its respective academic niche and thus embrace challenges which are socially challenging, politically charged, and academically messy. This narrow focus has become self-serving and ultimately detracts from fundamental remits of both disciplines in protecting the public from harm. Furthermore, it may re-enforce the inequalities of research into health overall, whereby the greatest concentration of effort remains firmly focused upon those who already have the most. Currently marginalized approaches to each of these disciplines - such as social epidemiology, global bioethics, and critical bioethics - provide us with platforms that challenge mainstream academic epidemiologists and bioethicists to seek out and reconnect their expertise with questions that are more relevant to real-world situations.     

Quality of Statutory Inpatient Database Before Introducing DRGs

According to the legislation of the Federal Republic of Germany (Gesundheitsstrukturgesetz 1993) defined performance figures must be listed for each case of inpatient care. As hospital morbidity data are essential for further development of the health care system and for introducing the DRGs, the corresponding statistical data of a German federal territory of the year 2000 were studied in respect of several aspects of their quality: conformity with the requirements of law, plausibility and ability to transport essential medical information. Notable variations were found between the departments and different medical disciplines without interdependence to variant hospital status. Only about 40 % of departments of surgical disciplines transferred data according to legal requirements. Some disciplines showed higher percentages of unspecific coding (e.g. traumatology). The described deficits impair data reliability. The study offers a feedback to hospital departments with regard to their formal data quality. Periodic investigation may thus help to improve data quality in future.     

Translating genetics, cognitive science, and other basic science research findings into applications for prevention

A growing body of research across genetics, cognitive science, and other basic science suggests the complexity and interconnectedness of multiple factors contributing to individual variation in susceptibility to engage in risk behaviors. Advances in these disciplines may direct new research directions and the development and evaluation of innovative intervention components for prevention that consider novel but central susceptibility factors. This article highlights findings from three interrelated areas of basic science research--genetics, neuroscience, and cognitive science--that together continue to inform prevention science. A primary objective of this article is to suggest how this research might guide primary prevention interventions. Translating findings from these disciplines can help to facilitate testable hypotheses for prevention science and explain potential limitations of current intervention approaches.     

Culture, Self-Rated Health and Resource Allocation Decision-Making

It has been observed that some groups in society tend to report their health to be better than would be expected through more objective measures. The available evidence suggests that while variations in self-assessed measures of health may act as good proxies of mortality and morbidity in homogeneous populations, in some groups, such as the Aboriginal and Torres Strait Islander communities of Australia, these subjective measures may provide a misleading picture. Useful insights into the formation of health perceptions can be drawn from a range of disciplines, in particular, from social comparison theories, models of illness behaviour, survey literature and linguistics. These theories and models help to provide an understanding of the different ways in which illness may be perceived, evaluated and acted upon by different kinds of people. Such considerations can have very direct implications for those planning and evaluating public health programs as well as those responsible for funding such programs. This revised version was published online in August 2006 with corrections to the Cover Date.     

Epidemiology, social medicine, environmental medicine--a plea for a difficult but necessary integration

The origins of environmental medicine date back more than 2000 years. The increasing incidence of environmental disease together with successful research into their etiology and pathogenesis have caused an impetus for this discipline in quantitative terms. A growing interest of patients, but also of politicians and parts of the industry in actual or suspected environmental risk factors for health have given rise to controversies--rendering the development of a rational, quality-oriented environmental medicine difficult, if not impossible. Given these controversies surrounding environmental health issues formal demarcations between the traditional disciplines (environmental) epidemiology, social medicine, occupational medicine, and environmental medicine become obsolete. Instead, a common agenda with respect to research, quality assurance, risk communication, and prevention as well as patient counselling and policy advising calls for a conceptual and institutional integration of these disciplines.     

实施重点学科升级战略推动医院创新发展

本文着眼新形势和新任务,以推动医院创新发展为目标,提出并实施重点学科升级战略,系统论述了重点学科升级战略的战略目标、战略举措和战略途径：深化认识,强化重点学科升级战略的历史作用;统筹力量,优化重点学科升级战略的保障条件;打造特色,提高重点学科升级战略的科技含量;配强团队,蓄积重点学科升级战略的发展后劲。     

A survey of interdisciplinary differences in attitudes and morale within a psychiatric hospital

Summary This survey has examined a number of jobrelated attitudes. Staff members in a traditional, hierarchically organized psychiatric hospital were the respondents. Differences between disciplines may be greater in this type of organization. It would be of interest to compare our sample with samples from hospitals structured along less traditional lines, such as in hospitals experimenting with program rather than discipline budgeting. These organizations, while creating unique problems of their own, might eliminate some of the differences found between disciplines in our survey. The data for this study were collected while V. Hans was in the department of psychology, University of Toronto.     

Not lost in translation: nutrition education, a critical component of translational research

Translational research is an emerging field of science, embracing disciplines in medicine and public health to create a full-spectrum research agenda. Often described as science "from bench to bedside and back again," translational research may be better described as "from bench to behavior," as it strives to apply laboratory results to clinical settings. Because the demand for translational research has emerged, it is critical for nutrition educators to ensure that translational research includes community and policy areas and to recognize themselves as translation researchers. The purpose of this report is to provide a framework for nutrition educators to better understand translational research and to recognize their role in translational research, using type 2 diabetes as an example.     

Facilitating collaboration among academic generalist disciplines: a call to action

To meet its population's health needs, the United States must have a coherent system to train and support primary care physicians. This goal can be achieved only though genuine collaboration between academic generalist disciplines. Academic general pediatrics, general internal medicine, and family medicine may be hampering this effort and their own futures by lack of collaboration. This essay addresses the necessity of collaboration among generalist physicians in research, medical education, clinical care, and advocacy. Academic generalists should collaborate by (1) making a clear decision to collaborate, (2) proactively discussing the flow of money, (3) rewarding collaboration, (4) initiating regular generalist meetings, (5) refusing to tolerate denigration of other generalist disciplines, (6) facilitating strategic planning for collaboration among generalist disciplines, and (7) learning from previous collaborative successes and failures. Collaboration among academic generalists will enhance opportunities for trainees, primary care research, and advocacy; conserve resources; and improve patient care.     

上海卫生系统学科人才建设现况和成效分析及前瞻

笔者回顾了上海医学学科建设和人才培养的历史沿革，评估了上海医学学科人才建设计划的工作绩效，着重对学科人才建设工作模式创新的探索和工作绩效的成因进行了分析，提出了整合各种有效资源，形成新的活力和合力、加大公共卫生领域学科人才建设，增强疾病预防控制能力、增强临床医学中心和重点学科辐射力，提升卫生事业软实力、构筑人才高地，组建全行业多层次的优秀团队等政策建议，同时还对未来全行业医学学科建设与人才培养发展的美好愿景进行了前瞻。     

浅议医学重点学科的建设与管理

重点学科的建设管理是一项科学细致的工作，需要结合实际认真加以研究，才能取得好的效果，我们就医学重点学科的建设管理提出以下思路。     

Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes

OBJECTIVES: To determine thematic similarities and differences in the implementation of common-content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes. METHODS: Communications skills training based upon the Kalamazoo consensus statement of communication skills in the clinical encounter was implemented in 4 residency programmes. Field notes of the CST sessions in each programme were analysed and coded for themes, considering the domains of Context, Input, Process and Product ('CIPP' methodology). Immediate learning outcomes were quantitatively assessed using retrospective pre/post methodology. RESULTS: Important differences were noted in the implementation of CST in the 4 disciplines. The 2 surgical disciplines showed relatively less reflective language and greater concentration on straight skill acquisition, whereas the 2 medical disciplines concentrated on the residents' role as teachers of communication skills for buy-in. Thematic similarities between disciplines included similar challenges to being good communicators in practice, as identified by residents (e.g. inadequate time and space), as well as lack of formal training. Quantitative learning outcome data from the educational intervention were significant in all groups (P < 0.05). CONCLUSIONS: Common material in CST can be adapted to different disciplines. By analysing for thematic similarities and differences in implementation in the 4 disciplines, a picture of different pedagogic 'subcultures' emerged, with different behavioural norms and values related to the doctor's role as communicator. In shared core competency training, it may be useful to consider these differences in planning, so that the training may be both sensitive to the behavioural norms of different disciplines, and effective.     

高校一流期刊培育和“双一流”建设互融共生的相关思考

【目的】 探索高校一流期刊培育和“双一流”建设互融共生的措施和建议。【方法】 分析我国高校主办的科技期刊和一流学科建设关联现状,针对如何促进二者的互融共生提出切实可行的建议。【结果】 我国高校期刊和一流学科的融合度有待提升,期刊和学科建设的内生关系尚未形成,各高校应重视科技期刊和学科发展的互融共生,期刊围绕一流学科建设重点任务优化期刊栏目结构和组约稿件,助力学科重大、关键科学和技术问题聚焦,加强高校期刊在引进和培育人才中的作用,围绕学科发展需求/利用学科平台优势创办新刊,将主办高水平期刊纳入国家学科评价体系中,实现期刊与学科的互融共促。【结论】 实现期刊和学科的互融共生对于我国学术发展具有特殊意义,通过世界一流科技期刊培育与“双一流”建设互促发展,推动我国科技期刊高质量发展,服务科技强国建设。     

Public health genetics--potential for public health?

Although it is well understood that the disciplines of medicineand public health are different in their goals and practices,in the context of genomics this difference is even more pronounced.While medical genetics concerns the clinical decision made bya doctor to use genomic knowledge for the benefit of the patient,public health genetics may be defined as the systematic integrationof genomics into public health research, policy and practice.¹     

The clinical learning environments in medicine, paediatrics and surgery clerkships

Using questionnaires, the students of the 1981 graduating class from McGill's Faculty of Medicine were investigated for their perceptions of the nature of the clinical instruction and of the roles of the consultant, resident and intern staffs during clerkships in medicine, paediatrics and surgery. Personal student diaries were used to assess time spent on various clinical activities. The results indicated that students perceived learning to be different in the three disciplines, with the acquisition of clinical skills (technical and problem-solving skills) greater in medicine and surgery than in paediatrics, and the acquisition of interpersonal skills and factual knowledge greater in paediatrics than in medicine and surgery. Students perceived themselves as passive observers in surgery and formed personal relationships more easily with staff in medicine and paediatrics than in surgery. In contrast, students perceived more emphasis on team effort in surgery. Time spent on activities related to direct patient encounter was greatest in medicine. The findings suggest that the learning environments in clinical disciplines are not homogeneous and this has implications for curricular planning and clinical teaching.     

Therapeutic landscapes of the mind: theorizing some intersections between health geography,health promotion and immigration studies

For over a decade, the concept of therapeutic landscapes has provided health geographers with a useful framework for investigating the dynamics between place and well-being. However, its application has been largely restricted to physical places in which human co-presence is a necessary condition. Through both a review of the literature on therapeutic landscapes and four personal narratives from immigrants to Canada, the concept is extended to interpret experiences of migration and to explore, in particular, the personalized mental strategies that individuals enact to enhance their mental health and promote their well-being in times of change. These involve memories of home and a range of practical methods that are employed to strengthen them. Given these findings, it is argued that the therapeutic landscape concept should be extended beyond physical sites to include everyday and personalized place-related memories. The authors term this expanded concept ‘therapeutic landscapes of the mind’. Given this proposed broader definition, the concept may usefully be applied beyond health geography as a theoretical framework by other health-focused academic disciplines.