Sociomedical Perspectives on Patient Care

Social change has placed new demands on the practice of medicine, altering almost every aspect of patient care relationships. Just as medicine was encouraged to embrace the biological sciences some 100 years ago, recent directives indicate the importance of the social sciences in understanding biomedical practice. Humanistic challenges call for changes in curative and technological imperatives. In this book, social scientists contribute to such challenges by using social evidence to indicate appropriate new goals for health care in a changing environment. This book was designed to stimulate and challenge all those concerned with the human interactions that constitute medical practice. To encompass a wide range of topics, the authors include researchers; practicing physicians from the specialties of family, general, geriatric, pediatric, and oncological medicine; social and behavioral scientists; and public health representatives. Cutting across disciplinary boundaries, they explore the ethical, economic, and social aspects of patient care. These essays draw on past studies of the patient-doctor relationship and generate new and important questions. They address social behavior in patient care as a way to approach theoretical issues pertinent to the social and medical sciences. The authors also use social variables to study patient care and suggest new areas of sociomedical inquiry and new approaches to medical practice, education, and research. Its cross-disciplinary approach and jargon-free writing make this book an important and accessible tool for physician, scholar, and student. Jeffrey Michael Clair is assistant professor of sociology and medicine and director of the Medical Sociology Program at the University of Alabama at Birmingham. Richard M. Allman is associate professor of medicine and director of the University Center for Aging at the University of Alabama at Birmingham. Provides many unique and revealing perspectives on the doctor-patient relationship. —Journal of the American Medical Associationhttps://uknowledge.uky.edu/upk_medicine_and_health_sciences/1011/thumbnail.jp

Race and Sex Differences in Correlates of Systolic Blood Pressure in Community-Dwelling Older Adults

Objectives: To describe correlates of measured systolic blood pressure (SBP) among community-dwelling older African American and White Medicare beneficiaries. Methods: Participants completed an in-home assessment and factors significantly correlated with SBP were tested using multivariable models. Results: Among the 958 participants (mean age= 75.3 [SD = 6.8]; 49% African American; 49% female; 52% rural) African Americans were more often diagnosed with hypertension, more likely on anti-hypertensives, and on more anti-hypertensive medications. SBP was 2.7 mmHg higher in African Americans than Whites (p=.03). SBP was higher in women than men. Multivariable models revealed differences in the factors associated with SBP by race/sex specific groups. Having a history of smoking and reports of being relaxed and free of tension were associated with higher SBP among African American men. Discussion: Although more likely prescribed anti-hypertensives, mean SBP was higher for older African Americans than Whites. Results support the hypothesis that behavioral and psychosocial factors are more important correlates of SBP levels among older African Americans than among Whites

Salicylate toxicity model of tinnitus

Salicylate, the active component of the common drug aspirin, has mild analgesic, antipyretic, and anti-inflammatory effects at moderate doses. At higher doses, however, salicylate temporarily induces moderate hearing loss and the perception of a high-pitch ringing in humans and animals. This phantom perception of sound known as tinnitus is qualitatively similar to the persistent subjective tinnitus induced by high-level noise exposure, ototoxic drugs, or aging, which affects ∼14% of the general population. For over a quarter century, auditory scientists have used the salicylate toxicity model to investigate candidate biochemical and neurophysiological mechanisms underlying phantom sound perception. In this review, we summarize some of the intriguing biochemical and physiological effects associated with salicylate-induced tinnitus, some of which occur in the periphery and others in the central nervous system. The relevance and general utility of the salicylate toxicity model in understanding phantom sound perception in general are discussed

Housing, the Neighborhood Environment, and Physical Activity among Older African Americans

Abstract This study examines the association of neighborhood environment, as measured by housing factors, with physical activity among older African Americans. Context is provided on the effects of structural inequality as an inhibitor of health enhancing neighborhood environments. The study population included African Americans participating in the UAB Study of Aging (n=433). Participants demonstrated the ability to walk during a baseline in-home assessment. The strength and independence of housing factors were assessed using neighborhood walking for exercise as the outcome variable. Sociodemographic data, co-morbid medical conditions, and rural/urban residence were included as independent control factors. Homeownership, occupancy, and length of residency maintained positive associations with neighborhood walking independent of control factors. Housing factors appear to be predictive of resident engagement in neighborhood walking. Housing factors, specifically high rates of homeownership, reflect functional and positive neighborhood environments conducive for physical activity. Future interventions seeking to promote health-enhancing behavior should focus on developing housing and built-environment assets within the neighborhood environment

Satisfaction with Medical Encounters Among Caregivers of Geriatric Outpatients

Caregivers\u27 experiences and satisfaction with physicians and medical services provided to geriatric patients are reported. An outstanding predictor of satisfaction with physician communication and overall patient care was the extent to which caregivers were experiencing role strain. Other significant predictors included caregiver knowledge of clinic and social support services provided to patients. The data suggest that, irrespective of the quality of clinic services and physician communication style, some caregivers will be dissatisfied because their encounter is mediated by the stress of activities separate from the medical encounter. We assert the importance of specialized geriatric services and argue that if these services are not in place, caregiver satisfaction with the overall medical encounter will likely be much lower

The soft option: the legacy of Morton Feldman’s music in the context of the experimental music tradition in the UK and North America since the 1960s

Morton Feldman is one of the key experimental composers of the so-called New York School, informally presided over by John Cage in the 1940s, 1950s and 1960s. The purpose of this study is to explore his legacy for other composers in this category who were either younger contemporaries of Feldman or who started to compose considerably later, and, furthermore, to test a hypothesis that Feldman has been a decisive point of reference for music experimentalists. First there is an account of what experimental music is and an attempt at its definition – at least, in the world of ‘classical’ music – according to writers on the subject. At the same time, Feldman’s inclusion in the experimental music scene is assessed and confirmed, again with reference to the available literature. This is followed by a description of Feldman’s output from around 1950 up till his death in 1987, and its evolution. A qualitative survey is then undertaken to gauge the opinions of nineteen experimental composers on Feldman’s importance and influence, both generally and personally. For certain reasons explained here, these composers are all based in the UK and North America. The dissertation ends with a comparative framework wherein the music of these composers is examined alongside that of Feldman, where this is deemed appropriate. The findings of both the survey and the analysis that follows do indeed show that Feldman’s approach to composition has been a source of inspiration for many experimentalists, although, at the same time, no single composer seems to have succumbed to mere imitation of Feldman’s style. Feldman, then, remains an independent voice, even if there are two aspects of his work that have clearly had a major impact – his penchant for low dynamics and the general air of restraint that pervades his music