The use of unorthodox therapies and marginal practitioners

This study examines the extent of utilization of unorthodox therapies and marginal practitioners among patients with one broad category of chronic disease, rheumatic disorders. Almost all respondents (94%) had tried some unorthodox remedy or practitioner, and several had used 13 different unorthodox remedies or practitioners. There was no relationship between age, sex, race, geographic location and magnitude of usage of treatments. There was no statistically significant relationship between education and income and amount of usage, although there was some variation by income group in which unorthodox remedies were employed. Thus, this study provides evidence that some elements of folk medicine practice continue to exist among most segments of the American population and this issue deserves further research. An important role for medical sociologists is to examine disease and disease treatment from the perspectives of the lay culture, as well as that of the medical community.

Regulation, retrenchment-- The DRG experience: Problems from changing reimbursemwnt practice

A study of 227,771 discharge abstracts from one U.S. state's short-term, acute care hospitals compares changes in the inpatient market available to the oldest old Medicare patients (85 and older) with those less than 70 and those 70-84 between 1981, the last year when all hospitals were under cost-based reimbursement, and 1984, the first year in which all hospitals were under a prospective payment system based on diagnosis related groups (DRGs). All three populations experienced retrenchment in services as hospitals pursued practice changes to enhance revenue potential. An older, sicker client was admitted as hospitals implemented changes in admission patterns to avoid denial of reimbursement for an admission deemed inappropriate by the Peer Review Organization (PRO). Evidence demonstrates compression in service markets and retrenchment in services for less profitable DRGs and/or cohorts. Inpatient services were reduced the most for the oldest old population although this cohort was the sickest. Changes were observed in utilization of special care units, such as in coronary and intensive care units. Large increases in readmissions in all three cohorts suggests that DRG incentives to reduce length of hospital stay may have promoted premature discharge. Or, perhaps these readmissions resulted from 'unbunding', a practice of splitting patient problems into multiple admissions, as hospitals sought ways to enhance revenue instead of practicing cost-containment. Policy, perceived to be economically stringent, can affect hospital practice and produce undesired results with long-reaching untoward effects on certain segments of the population.discharge abstracts acute care hospitals Medicare prospective payment system diagnosis related groups (DRGs)

Sexwork in Trucking Milieux: 'Lot Lizards,' Truckers, and Risk

Abstract: Background: Long-haul truckers often engage in risk-laden sexual mixing and drug exchanges with female sex workers while on the road, which increase their vulnerability to sexually transmitted infections/blood borne infections (STI/BBI)

STI/HIV risks for Mexican migrant laborers: Exploratory ethnographies

Abstract: The influx of Latino laborers into the U.S. and the confluence of migration-driven factors in an environment ripe for risk-taking have the potential to exacerbate already rising STI/HIV rates among migrants and their social networks at both the home and receiving regions. This paper focuses on Mexican migrant laborers who are among the most marginalized and exploited Latinos in the U.S. This study used ethnographic methods to delineate the sociocultural and spatial contexts and social organization of migrant farmwork, and examined how intertwined individual and environmental factors render migrant farmworkers vulnerable to STI/HIV risks. Findings indicate the presence of a number of factors in the study population of Mexican migrant workers (N = 23)-such as poverty, limited education, physical/social/cultural isolation, long work hours, constant mobility, hazardous work conditions, limited access to health care, low rates of condom use, multipartnering, and use of sexworkers-which increase their risks for STI/HIV transmission. To be successful, prevention efforts need to focus not only on condom education and HIV awareness and testing, but also on reducing migrants' social isolation and understanding their social networks