health

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USA Today reports on a recent study  that provides evidence for a “July effect” when it comes to medical mistakes.

The so-called July effect has long been suspected. It’s based on the fact that new U.S. doctors start their residencies (in-hospital training) each July 1 in thousands of “teaching hospitals” nationwide. But until recently, the idea that hospitals are especially dangerous in July was little studied.

Other studies have found no such effect when it comes to major surgical mistakes, but this new study hones in on another area of concern:

“It looks like medication error is the place to worry” about a July effect, says David Phillips, a sociologist at the University of California-San Diego. He reviewed 62 million deaths between 1979 and 2006 and focused on 244,388 fatal drug errors. The study found no spike in such deaths outside of hospitals or in counties without teaching hospitals.

And, Phillips says, he found no sign such deaths were decreasing amid rising concerns about patient safety and residents’ long work hours (which were cut in 2003). More study is needed, he says, to see if non-fatal drug errors also rise in July.

Phillips was also interviewed on NPR and discussed some potential contributors to the July effect. In addition to being inexperienced and overtired, medical residents may make more mistakes because they tend to work alone. Phillips contrasts this with surgical residents who, although also tired and inexperienced, tend to work in teams.  This factor may help prevent a similar spike in surgical errors during July.

Myung-Dong-Tofu-Cabin-San-Mateo_0008The Globe and Mail has published an interview with two University of Toronto sociologists who have written a new book on “foodies.” According to the article:

As the authors explain in their new book Foodies: Democracy and Distinction in the Gourmet Foodscape, for which they interviewed 30 people and analyzed hundreds of articles, today’s foodies might find classic French haute cuisine stuffy. They may be willing to try goat testicles and sheep brains. And they’ll happily visit the city’s best hole-in-the-wall eateries, no matter how dumpy the decor. But one thing foodies flat-out refuse to eat is dinner at a mundane, generic chain restaurant.

Sociologists Josée Johnston and Shyon Baumann argue that being a foodie isn’t just about consuming good food, it’s also about garnering cultural capital. Says Johnston:

A lot of elements of foodie culture are still relatively exclusive, and part of what foodie culture is about is dabbling in all sorts of different ethnic cuisines and food traditions. What makes that a kind of privilege is to have the kind of knowledge to go to all of these kinds of places [whether it’s a fancy restaurant or hole-in-the-wall eatery], so you’re not just familiar with one type of ethnic cuisine, you’re familiar with the whole range of them. And that can end up constituting a kind of cultural capital people use to display their sophistication.

However, this may entail ignoring inequalities. Says Baumann:

…if you’re going to be a foodie and value authentic and exotic cuisine, it’s going to lead you to places of poverty, to contexts of impoverished food production and consumption. Through romanticizing those conditions of poverty, you can get the good food without having to dwell on the uncomfortable fact of poverty.

The authors also noticed gender differences among foodies:

Johnston: One thing that was surprising to me was the different ways that men and women embody their foodie culture. Men often emphasize their expertise more, and they’re often much more interested in the exoticism, especially eating things that are wildly unconventional, like goat testicles. And women didn’t do that as much. They talked more about how their interest in food was also about protecting the health of their family.

Littmann
USA Today reports on a new study examining whether people who are overweight receive less care from their doctors.

Previous research has shown that some physicians find it awkward to work with obese patients and have low expectations for success. And heavy patients have reported feeling that doctors are biased and disrespectful because of their extra weight. To examine whether such attitudes translate into differences in actual practice, researchers at the University of Pennsylvania School of Medicine and the Philadelphia Veterans Affairs Medical Center evaluated the medical care of nearly 70,000 patients. They were Medicare beneficiaries or received care from Veterans Affairs (VA) hospitals.

The scientists compared how likely heavy and normal-weight people were to meet standard guidelines for preventive care, including diabetes care (eye exams, sugar and cholesterol testing), flu vaccines, pneumonia vaccines and screenings for breast, colorectal and cervical cancers.

Results showed that people in the study who were overweight or obese were just as, if not more, likely to receive preventative care from their doctors as people of normal weight.

The study’s lead investigator, who holds an MD and a PhD in sociology, comments:

“Physicians appear to be doing a good job at preventive care, despite surveys suggesting that physicians have negative attitudes toward obesity and patients’ perceptions that their doctors are biased,” says lead author Virginia Chang, an assistant professor of medicine and sociology at the University of Pennsylvania…

“It’s important to ensure that obese patients are getting equitable preventive care, as these services can save lives and reduce costs down the road,” Chang says.

Still, questions remain. “Our findings do not address patients’ satisfaction with their care,” she says. “And these findings may not be true of younger populations where the stigma of obesity may be greater.”

western unionAccording to the Jamaica Gleaner, University of West Indies sociologist Claudette Crawford-Brown has identified a new phenomenon: Western Union children.  She said this is replacing “barrel children” in Jamaica:

Barrel children in the past were identified as those who did not have the physical presence of their parents, but were sent goodies through shipments from overseas.  The sociologist, however, said that the barrel-children phenomenon has been surpassed by parents who give their children remittances. The difference between the two is the amount of care involved.

“You don’t have the barrel children as I highlighted seven years ago, where you had parents sending children things in a barrel. We now have what you call ‘Western Union’ children, and these are children who are parented by cellphones and they are sent the money. However, when you have a barrel child, that mother goes into K-Mart or Wal-Mart and I see them and watch them and they say: ‘I wonder if this going fit Sasha’, and she takes out the shoes with the mark out on the paper and match it with the shoes, and say this will fit her, this will fit her. You know what that shows? Some amount of care,” she said.

There are consequences of these changes in long-distance care:

Crawford-Brown pointed out even with remittances and barrels, the absence of mother in a child’s life has the same impact on youths as the absence of fathers. She noted that the absence of parental guidance leaves these children vulnerable to negative influences, where many turn to violence and drugs to cope.

According to her, many of these children who receive money through remittances are not given proper guidance, thus the money they have access to can be used to purchase drugs or facilitate their participation in illicit activities.

The noted child advocate and sociologist said many behavioural problems shown among some children are as a result of the breakdown in the family and exposure to violence. Crawford-Brown also said that Jamaica needs to tackle apathy towards murder in the society, which has trickled down to children she has worked with.

Crawford-Brown’s research on “Western Union children” was also recently featured in a column in the Jamaica Observer.

Science Daily highlighted a longitudinal study of aging and managing illness in a Florida retirement community:

Eva Kahana, Robson Professor of Sociology and director of the Elderly Care Research Center at Case Western Reserve, reported the findings from interviews with 100 cancer survivors. These survivors are part of a longitudinal study of 1,107 elderly adults living in a retirement community.

This study calls attention to generally accepting, timid behaviors that elderly patients report about their interactions with the healthcare system while battling cancer. Nevertheless the very same older adults offer advice to other older cancer patients to take a more activist stand and become advocates in their care.

This finding of the study overturns the notion that elderly patients are disinterested and disempowered health consumers, Kahana said.

In-depth interviews about their cancer experiences revealed elderly survivors became advocates for others battling cancer, though they had taken a more passive stance – “relying on physicians and family members” – during their own struggle. So…

The researchers said the findings suggest “a transition maybe occurring from passive to a more-active or even activist orientation due to the illness experience.”

Day 167/365 - Pure EvilMany skinny Americans are fed up with obesity, reports the Los Angeles Times:

“Americans as a society are getting fed up with the matter of obesity. No doubt about it,” said Douglas Metz, chief of health services for American Specialty Health, a San Diego-based company that offers wellness programs to employers. “Some pockets of society are taking positive action, and unfortunately others are taking negative action. That’s what happens when a society hasn’t figured out what the fix is.”

Recent notable actions include:

* A recent and ultimately unsuccessful plan at Lincoln University in Pennsylvania sought to take the body mass index of every enrolling student and require the obese to lose weight or take a fitness class before they could graduate.
* In Mississippi, legislators tried to pass a bill to let restaurants prohibit obese people from dining.
* In an interview with the New York Times last August, Toby Cosgrove, chief executive of the Cleveland Clinic, one of the nation’s largest medical centers, provoked national outrage when he said that, if it were up to him, he would stop hiring the obese. He later apologized for his remarks.
* Last summer in Florida, animal rights activists at People for the Ethical Treatment of Animals (PETA) took aim at heavy women in a “Save the whales” billboard campaign that featured an overweight, bikini-clad woman. It read: “Lose the blubber. Go vegetarian.” Angry reactions caused the organization to remove the signs.

Statistics about obesity are being assessed in the current debates on how to reduce the nation’s health care costs:

A report by Emory University researchers projected last November that by 2018 the United States could expect to spend $344 billion on healthcare costs attributable to obesity. Obesity-related costs would account for 21% of healthcare spending, up from 9.1% today, said the report, sponsored in part by the United Health Foundation and the American Public Health Assn.

Providing a different take on the issue, it’s time to call in the sociologist:

“In our society, being heavy has become more of a stigma lately because we’re struggling with other issues of consumption,” says Abigail Saguy, associate professor of sociology at UCLA.

The economic climate, a recent history of people buying more than they can afford as well as environmental issues, including the depletion of our planet’s resources, are making people feel more angry about society’s overconsumption, she says. Obviously overweight people are an easy target.

“They’re almost a caricature of greed, overconsumption, overspending, over-leveraging and overusing resources,” says Saguy. “Though it’s not entirely rational, it’s an understandable reaction, especially in a country founded on the Puritan ethics of self-reliance, sacrifice and individual responsibility. If people feel they’re sacrificing, then see someone spilling over an airplane seat, they feel angry that that person is not making the same sacrifices they are.”

Research indicates that discrimination based on weight has been increasing in recent years:

Rebecca Puhl, a researcher at Yale University’s Rudd Center for Food Policy and Obesity, published [two papers] last January — one in the journal Obesity, the other in the International Journal of Obesity — Puhl reported that weight discrimination in the United States increased 66% over the prior decade.

“Weight discrimination is highly prevalent in American society and increasing,” said Puhl, who cites several possible reasons. Among them are a lack of legislation to prohibit weight discrimination and an increase in media coverage of obesity (up fivefold from 1992 to 2003). Most media framed the problem of obesity as one of personal responsibility, she reported.

New research on the social network effects of obesity was recently reported in the Guardian UK:

Children at schools where older students are obese or otherwise overweight are significantly more likely to suffer weight problems themselves, researchers report.

For each one per cent increase in the prevalence of obese students aged 16 to 18 years, the odds of a student at 14 to 16 years old attending that school also being overweight increased significantly.

“It was the one risk factor that held true across every school we looked at,” said Dr Scott Leatherdale, the chair of research at Cancer Care Ontario and lead investigator with the School Health Action, Planning and Evaluation System.

Commenting on the obesity connection between older and younger students, Leatherdale says:

It could be that younger students look up to older students, and so emulate their sedentary behaviour and bad eating habits and do not judge the older children’s body shape.  Or it could be that the school doesn’t encourage enough physical activity among its students, and the older students’ weight issues are an indication of that.

Sociologist Steve Fuller at Warwick University concurs with his assessment:

Obesity is one phenomenon that medical sociologists have nominated as an ‘epidemic’ that is transmitted by copying the behaviour of peers.  Certain connections between overeating and social activities become contagious. Young people gather together in more stationary modes than in the past: in front of computers and video games rather than sports.

The reason it’s called an ‘epidemic’ is because the pattern is reinforced by regular contact, so that if one is not in regular contact with the pattern, one doesn’t spontaneously do it The idea is that you overcome obesity by breaking up the networks where it’s transmitted.

Controversial title?Countries are looking for ways to boost organ donation, according to the New York Times. Most recently, Israel has created a policy to give priority for organ transplants to those who sign up to be organ donors themselves.

Officials hope the incentive will increase the supply of available organs — of which there is a shortage across the world, but especially in Israel, where only one in 10 adults carries a donor card.

This is sure to be a closely watched change, as most countries have tried different measures to increase willingness to donate organs. Here’s a rundown of some of those efforts, which include (1) creating markets for organs; (2) making all citizens organ donors by default, unless they explicitly exempt themselves; and (3) investing in more health care infrastructure.

Such plans have raised a few ethical eyebrows, however:

Proposals to change the organ procurement systems in the United States and Great Britain to “presumed consent” have frequently provoked ethical objections. Critics worry that such a system would effectively coerce people into donating organs, even over the wishes of the next of kin.

Ethics aside, it’s also not clear that such programs actually produce more donations.

A sociologist comments on the quandry:

Perhaps this is because — as Kieran Healy, a sociologist at Duke University has found — “opt-out” and “opt-in” systems are really not that different in practice. In both, doctors still typically defer to the wishes of the deceased’s family, whatever the official donor status of the deceased.

In a 2006 article in the DePaul Law Review, Professor Healy argued that presumed consent laws didn’t seem to be the key to improving cadaveric organ donation rates. Rather, infrastructure investments did.

Countries that experienced the biggest donation increases in recent years, like Spain and Italy, were those that hired more transplant coordinators, started public awareness campaigns, installed 24-hour organ retrieval teams at hospitals and improved training for doctors who talk to grieving families.

He concludes:

Arguments about altruism versus self-interest and disputes over presumed and informed consent together constitute a good portion of the public discussion about organ donation. Yet neither debate helps us explain why some countries have many more organ donors than others. As best we can tell, countries with high procurement rates do not owe their success to any distinctive legal conception of consent, nor to any special way of institutionalizing exchange in human goods. Rather, more fine-grained organizational differences– specifically in logistics and process management — are responsible for their success.

Sociologists predict that half of all U.S. children will be on food stamps at some point in their childhood, according to the EBT
Philadelphia Inquirer
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In a stark and surprising finding, about half the children in the United States will be on food stamps at some point during their childhood, a new study of 29 years of data shows.

One in three white children and 90 percent of all black children – ages 1 through 20 – will use the program, according to the research, published this month in the Archives of Pediatrics and Adolescent Medicine.

“This means Americans’ economic distress is much higher than we had ever realized,” said Thomas A. Hirschl, a sociology professor at Cornell University and a coauthor of the study with Mark R. Rank, a sociologist at Washington University in St. Louis.

The survey finds that continued food-stamp usage signifies a kind of poverty that is “a threat to the overall health and well-being of American children, and, as such, represents a significant challenge to pediatricians in their daily practice.”

Although the data used in this study ends in 1997, and thus does not account for the current recession, these findings seem to correspond with a report published Monday by the U.S. Department of Agriculture:

The persistent poverty described in the survey dovetails with the findings of a U.S. Department of Agriculture study released Monday. It determined that 49 million Americans – 17 million of them children – were unable to consistently get enough food to eat in 2008. Nearly 15 percent of households were having trouble finding food, the highest number recorded since the agency began measuring hunger in 1995.

The study’s authors note that kids are often overlooked in U.S. social programs:

“The number-one poverty program in the United States is Social Security,” Hirschl said. “There is no such system for children.”

But how trustworthy is the prediction that 50% of all U.S. kids will use food stamps at some point in their childhood?

Because there was so much data, the authors were able to use a very long window of observation, which helped them extrapolate into the future about food-stamp usage, said John Iceland, a sociology professor at Pennsylvania State University. Iceland, who is familiar with the methodology used in the Hirschl-Rank paper, described it as “very solid work.”

“It’s like determining the likelihood of developing heart disease from health data,” Rank said.

The Michigan study is well-known and widely used by social scientists, and it has proven to be accurate over the years, Iceland said.

The finding that 50 percent of children will be on food stamps in their lifetime is conservative, Hirschl said.

That’s because only about 60 percent of households eligible for food stamps actually get them, a finding backed up by the newly released Department of Agriculture study. Stigma and ignorance of the program hold people back, he said.

Saddam?Some people still believe that Saddam Hussein was behind the 9/11 attacks, even with substantial evidence to the contrary.   AlterNet recently reported on a sociological study that provides insight into how some people rationalize such false information:

Of 49 people included in the study who believed in such a connection, only one shed the certainty when presented with prevailing evidence that it wasn’t true.  The rest came up with an array of justifications for ignoring, discounting or simply disagreeing with contrary evidence — even when it came from President Bush himself.

“I was surprised at the diversity of it, what I kind of charitably call the creativity of it,” said Steve Hoffman, one of the study’s authors and now a visiting assistant professor at the State University of New York, Buffalo.

The voters weren’t dupes of an elaborate misinformation campaign, the researchers concluded; rather, they were actively engaged in reasoning that the belief they already held was true.

Responses to the 9/11 commission’s finding that there was no link between Hussen and 9/11 included:

“Well, I bet they say that the commission didn’t have any proof of it, but I guess we still can have our opinions and feel that way even though they say that.”

Reasoned another: “Saddam, I can’t judge if he did what he’s being accused of, but if Bush thinks he did it, then he did it.”

Others declined to engage the information at all. Most curious to the researchers were the respondents who reasoned that Saddam must have been connected to Sept. 11, because why else would the Bush Administration have gone to war in Iraq?

Connecting 9/11 to the current health care debate, Hoffman said:

“I do think there’s something to be said about people like Sarah Palin, and even more so Chuck Grassley, supporting this idea of death panels in a national forum….[They] kind of put the idea out there, but what people then do with the idea … ” he said. “Our argument is that people aren’t just empty vessels. You don’t just sort of open up their brains and dump false information in and they regurgitate it. They’re actually active processing cognitive agents.”

Andrew Perrin, another one of the study’s authors, provided additional commentary: 

“I think we’d all like to believe that when people come across disconfirming evidence, what they tend to do is to update their opinions,” said Andrew Perrin, an associate professor at UNC and another author of the study.

That some people might not do that even in the face of accurate information, the authors suggest in their article, presents “a serious challenge to democratic theory and practice.”

“The implications for how democracy works are quite profound, there’s no question in my mind about that,” Perrin said. “What it means is that we have to think about the emotional states in which citizens find themselves that then lead them to reason and deliberate in particular ways.”

Evidence suggests people are more likely to pay attention to facts within certain emotional states and social situations. Some may never change their minds. For others, policy-makers could better identify those states, for example minimizing the fear that often clouds a person’s ability to assess facts and that has characterized the current health care debate.