‘Health and well-being’: questioning the use of health concepts in public health policy and practice

In recent years health and well-being have been ‘mainstreamed’ as a policy issue and have become the concern of a widening range of agencies. Simultaneously, increasing weight has been placed on the measurement of population health status, the implementation of evidence-based practice in public health and the more effective evaluation of policy interventions targeted at health gain and health inequalities. Thus, at a time when greater conceptual clarity is crucial, there are more stakeholders in ‘health’, each with a potentially different perspective and understanding of what ‘health’ is. In this paper the authors explore the need for greater conceptual clarity in relation to health, using the term ‘well-being’ as an exemplar. They draw on findings from a research project undertaken with community and professional groups in the Black Country and Shropshire that explored shared ways to measure aspects, and determinants, of health. They suggest that a lack of attention to health concepts and their clarification, as indicated by the use of ‘well-being’ as an ill-defined tag to health, is having a negative impact on public health's ability to deliver health gain, and that commitment to clarifying concepts would lead to a range of benefits. At present, however, the term ‘well-being’ muddies the waters, acting more as an open-ended catch-all category than a clearly considered component of ‘health’.     

How can we achieve evidence-based practice if we have a theory–practice gap in nursing today?

The purpose of this paper is to discuss how nursing can achieve evidence-based practice when a theory-practice gap exists in nursing today. The paper commences with an introduction to the concept of evidence-based practice and a discussion of the relationships between theory, practice and the theory-practice gap. An analysis of the two concepts will then be presented from within the four pillars of nursing, namely management, practice, research and education. The paper will conclude with a discussion of whether evidence-based practice can be achieved in view of the theory-practice gap.     

Family life: the place of children's work around the house

Cultural groups vary considerably in their expectations of work around the house by children, and these variations provide a window for viewing ideas about the nature of children and of family life. This paper provides (a) a summary of differences found between two cultural groups in Australia (Australian-born and Lebanese-born), (b) a review of differences found within historical studies and within other cross-cultural comparisons, and (c) a report on approaches and concepts to children's work within a further Australian-born group (a report that considers views about money for work as well as some general underlying principles about work that can legitimately be asked of others and work that cannot). The important differences among cultures, it is argued, have to do not only with the expectations of work, but also with the way parents mark some jobs as different from others (e.g. “regular” vs. “extra”, boys' work or girls' work, can be pased on vs. cannot be), and with the way they use, as a sign of whether a child is acquiring the desired concepts of family life, the child's understanding of phrases such as “your job” and the child's recognition of the mother's work.     

The histopathology of fiberglass dermatitis in relation to von Hebra''s concept of eczema

A group of 36 normal control persons was patch-tested with glass fibers. The tested filaments had a length of about 3 to 5 mm and a diameter of 9 to 13 microns. The glass fibers were obtained from the normal production process. They were coated with cured epoxy resin. A group of 29 normal control persons was tested with the same type of fibers from which the epoxy finish had been burned off. Another group of 36 persons was patch-tested with ultrasmall glass globes with a diameter of 10 to 15 microns. Coated and uncoated glass globules were tested. On every person 5 patch tests with the same material were done. They were removed after 1, 5, 24, 48 and 72 h. On coated fiber, 12 of 36 tested people reacted with either a + or a ++ reaction. On the uncoated fibers a reaction could be noted in 10 out of 29 persons. The patch tests with coated as well as uncoated glass globules were all negative. A total of 60 biopsies was performed in those cases where + or ++ reactions were noted. The histological examination of the biopsies showed no differences between the reactions on coated and uncoated fibers. The skin reactions to glass fiber showed, besides microtraumatic changes, several histological characteristics of an eczematous reaction, like spongiosis and perivascular lymphocytic infiltration. The importance of these findings is discussed. It is emphasized that histological alterations are only one of the six points which must be taken into account when the diagnosis of eczema is considered.     

TEACHING AND LEARNING ABOUT PSYCHOANALYSIS: FILM AS A TEACHING TOOL, WITH REFERENCE TO A PARTICULAR FILM, MORVERN CALLAR

Using the film, Morvern Callar , directed by Lynne Ramsay (2002a ) in order to reflect on the impact of the countertransference, the author suggests that film is a powerful medium which can be used to communicate intense emotional and preverbal states, and to make sense of certain key psychoanalytic concepts via a direct emotional experience. Describing the film's narrative, with particular reference to the central character, she links this with predominantly Kleinian psychoanalytic thinking about schizoid states, and puts forward the idea that, by watching the film in a particular way, non-clinical students may have the proto-experience of aspects of clinical work, especially those linked with the countertransference. This, she suggests, offers a bridge towards clinical experience possibly obtained at a later date, where emotional states may be projected into the clinician.     

Review of expandable dental implants

In the last few years the dental implants market has grown both in developed and developing countries, and is associated with high aesthetic expectations and well-being. Although the success rate of commercial implants is high, some problems associated with a lack of initial stability, marginal bony resorption, and periodontal health, remain, especially with immediate placement and loading. The market offers different designs of dental implants, but cylindrical and tapered devices that are fixed to the bone via an external thread are dominant. One lesser-known but potentially useful design is the expandable dental implant (EDI). This paper presents a review of expandable dental implants that encompasses a survey of the literature, published patents, and available commercial devices. We found 15 articles: prospective human trials (n = 4), human case reports (n = 3), published independent discussions of other articles (n = 2), three big animal trials (n = 3), and in silico studies (n = 3). A total of 73 published patents were found and two expandable dental implants are commercially available to date. We propose a classification system that differentiates between the expansion mechanism and the origin of the expanding action. Some expandable designs have been shown to provide good primary stability, but evidence to date is limited. We encourage future clinical and biomechanical studies to clarify and optimise the potential benefits of these implants.     

Curb Your Embodiment

To explain how abstract concepts are grounded in sensory-motor experiences, several theories have been proposed. I will discuss two of these proposals, Conceptual Metaphor Theory and Situated Cognition, and argue why they do not fully explain grounding. A central idea in Conceptual Metaphor Theory is that image schemas ground abstract concepts in concrete experiences. Image schemas might themselves be abstractions, however, and therefore do not solve the grounding problem. Moreover, image schemas are too simple to explain the full richness of abstract concepts. Situated cognition might provide such richness. Research in our laboratory, however, has shown that even for concrete concepts, sensory-motor grounding is task dependent. Therefore, it is questionable whether abstract concepts can be significantly grounded in sensory-motor processing.