Ill communication : designing media, preventing risks, and defining responsibility

This dissertation investigates how health risks have historically affected the design of communications media in the United States. Concentrating upon the telephone from 1888 through 1913, and the cell phone from 1970 through 2003, I explore how these media intersected with three epidemic risks: tuberculosis in the early 1900s, coronary heart disease in the 1970s, and electrosensitivity from the 1990s through 2003. At these junctures, I examine three social groups – physicians, industrial designers, and everyday users – who attempted to influence the design of phones and determine if institutions or individual citizens would primarily prevent these health risks. This dissertation suggests that due to their socioeconomic status and professional expertise, physicians and designers were most effective in altering telephones and cell phones. They subsequently framed the prevention of health risks as the responsibility of individual users. This dissertation argues that such design decisions were shaped by strong social prejudices, specifically a desire to limit communications media use among poor and ethnic minorities in the U.S., a desire to reinforce the health of wealthy white users, and a desire to centralize authority over the identification and treatment of disease, as well as the process of design. However, the individualization of responsibility pursued by physicians and industrial designers may have produced an unintended effect, helping to generate considerable fragmentation at the intersections where communications media, design, and health risks meet. This dissertation plumbs the ramifications of physicians’ and designers’ work by surveying a community of everyday media users who challenge medico-technological authority, articulating undiagnosed health risks and designing unsanctioned forms of prevention.Radio-Television-Fil

Chronic pain in the community: a survey in a township in Mthatha, Eastern Cape, South Africa

Background: Comprehensive information is needed on the epidemiology and burden of chronic pain in the population for the development of appropriate health interventions. This study aimed to determine the prevalence, severity, risk indicators and responses of chronic pain among adults in Ngangelizwe, Mthatha, South Africa.Method: A cross-sectional survey utilising structured interviews of a sample of adult residents was used. Interviews elicited information on socio-demographic characteristics, general health status, and the prevalence, duration, frequency, severity, activity limitation and impact of chronic pain.Results: More than 95% (n = 473) of the sampled adults participated in the study. Of these, 182 [38.5%, 95% confidence interval (CI): 36.3-42.5%] reported chronic pain in at least one anatomical site. The most common pain sites were the back and head. The median pain score was 5 on a scale of 0 to 10 [interquartile range (IQR) = 4-7] and the median number of sites of pain was 1 (IQR = 1-2). Female gender [odds ratio (OR) = 2.6, 95% CI: 1.7-3.9] and being older than 50 years of age (OR = 3.5, 95% CI: 2.6-4.1) were identified as risk indicators for chronic pain in the sample. Over 65% of respondents reported that they self-treated; 92.1% had consulted with a doctor or nurse, 13.6% consulted a traditional healer, and 34.5% consulted a pharmacist because of their pain. Despite this, over 50% reported that relief of their pain was transient.Conclusion: Chronic pain is a common general complaint in this community, but there is a need for focused attention on women and the elderly.Keywords: chronic pain, community-based survey, epidemiology, Mthatha, Eastern Cape, South Afric

Geography matters: state-level variation in children's oral health care access and oral health status

To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those difference

Myths and legends of the anti-corporation : a history of Apple, Inc., 1976–1997

Apple, Inc. is today one of the wealthiest and most powerful corporations in the world, with annual revenues that rival the gross domestic products of nations such as New Zealand. Over the company’s four-decade history, however, Apple has consistently presented itself as an emblem of countercultural ideals, and its leaders have insisted that their pursuits of profits and influence are fundamentally altruistic, because their ultimate aim is to develop technologies that will empower individuals and serve the cause of social progress. Through an examination of Apple’s first two decades, from 1976 to 1997, this dissertation challenges the argument that Apple’s financial self-interest is synonymous with the public good. I conduct case studies of two main aspects of the company’s growth and evolution: Apple’s labor policies and the company’s influential role in the computerization of U.S. public schools. Through an extensive analysis of popular literature about Apple and archival materials chronicling labor practices and employee experiences at the company, I show that Apple cofounder Steve Jobs helped establish an exploitative and frequently abusive working environment at the company, which was designed to extract the maximum amount of worker labor at the lowest possible cost. I consider why many employees were nevertheless incredibly devoted to the company, and I examine the consequences of Apple employees’ willingness to forego formal labor rights and protections, which left them largely incapable of mounting any collective resistance to executives’ most ethically troubling practices and decisions. By turning to Apple’s lobbying efforts, business strategies, and charitable initiatives in U.S. public education, I show that the company repeatedly prioritized its commercial interests in schools over the needs of teachers and students. While Apple successfully turned educational computing into a multibillion-dollar business, I contend that the computerization of U.S. schools has achieved negligible positive results while draining scarce public resources, and in some instances has increased educational inequalities. Finally, I draw connections between Apple’s history, broader trends in Silicon Valley corporate culture, mounting wealth inequalities, and the current weakness of U.S. labor rights to challenge the concessions frequently made to corporations in contemporary U.S. public and political life.American Studie

Prevalence and risk indicators of chronic pain in a rural community in South Africa

Background: Despite the acknowledgement that chronic pain may be a problem for adults in rural settings, there is a lack of epidemiological investigations on its occurrence in rural South Africa. Objectives: To estimate the prevalence of chronic pain among adults in a rural community in South Africa and characterize the localization, severity, risk indicators and responses of pain sufferers. Methods: Cross-sectional analytical study using face-to-face interviews. Interviews elicited information on socio-demographic characteristics, general health status and presence of pain. Among those reporting pain, the duration, frequency, severity, activity limitation and impact was determined. Univariate statistics were used to describe the prevalence of chronic pain while bivariable χ2 tests and multivariable logistic regression models were used to assess the relationship of socio-demographic characteristics and reported health status with chronic pain. Results: A total of 394 adults were interviewed representing a response rate of 92.8%. Of these, 169 (42.9%; 95% CI: 37.4%-47.1%) reported suffering from chronic pain. The common sites were the back, knee, ankles, head and shoulders. The median pain score was 6 on a scale of 0-10 (IQR= 5-8) and the median number of sites of pain was 1 (IQR= 1-2). The type of pain slightly varied with age with younger adults reporting more back pain and headaches while older people reported more joint pain. Female gender (adjusted odds-ratio AOR= 2.2, 95% CI: 1.9-2.8) and being older than 50 years (AOR= 3.1, 95% CI:2.7-3.9) were identified as risk indicators for chronic pain in the sample. Respondents reported that they self-treated (88.3%); consulted with a doctor or nurse (74.3%); traditional-healer (24.5%) and spiritual-healer (4%). Most respondents (63.4%) reported only transient relief of their pain. Conclusions: Chronic pain is an important health problem in the surveyed community. Further comparative studies on the relationship with risk factors are needed meanwhile interventions targeting females and the elderly are recommended

Chronic pain in the community: A survey in a township in Mthatha, Eastern Cape, South Africa

Background: Comprehensive information is needed on the epidemiology and burden of chronic pain in the population for the development of appropriate health interventions. This study aimed to determine the prevalence, severity, risk indicators and responses of chronic pain among adults in Ngangelizwe, Mthatha, South Africa. Method: A cross-sectional survey utilising structured interviews of a sample of adult residents was used. Interviews elicited information on socio-demographic characteristics, general health status, and the prevalence, duration, frequency, severity, activity limitation and impact of chronic pain. Results: More than 95% (n = 473) of the sampled adults participated in the study. Of these, 182 [38.5%, 95% confidence interval (CI): 36.3-42.5%] reported chronic pain in at least one anatomical site. The most common pain sites were the back and head. The median pain score was 5 on a scale of 0 to 10 [interquartile range (IQR) = 4-7] and the median number of sites of pain was 1 (IQR = 1-2). Female gender [odds ratio (OR) = 2.6, 95% CI: 1.7-3.9] and being older than 50 years of age (OR = 3.5, 95% CI: 2.6-4.1) were identified as risk indicators for chronic pain in the sample. Over 65% of respondents reported that they self-treated; 92.1% had consulted with a doctor or nurse, 13.6% consulted a traditional healer, and 34.5% consulted a pharmacist because of their pain. Despite this, over 50% reported that relief of their pain was transient. Conclusion: Chronic pain is a common general complaint in this community, but there is a need for focused attention on women and the elderly.Department of HE and Training approved lis

Pain as a reason for primary care visits: cross-sectional survey in a rural and periurban health clinic in the Eastern Cape, South Africa

Background: The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a periurban clinic in the Eastern Cape (EC) Province. Method: cross-sectional descriptive survey was conducted among adult patients attending a rural and periurban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95% confidence interval (CI) of pain were estimated, and the relationship with demographic variables was determined at a significance level of P < 0.05. Results: Seven hundred and ninety-six adult patients were interviewed, representing a response rate of 97.4%. Almost three-quarters (74.6%; 95% CI: 63.2-81.4%) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4%; 95% CI: 32.1-61.0%) visits and was secondary in 201 (25.3%; 95% CI: 12.8-33.7%) visits. The common sites of pain were the head, back and chest. The median pain score was eight on a scale of 0-10 (interquartile range: 6-8). Respondents experienced limitations in a number of activities of daily living as a result of pain. Conclusion: Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province.Department of HE and Training approved lis

Kampagnenarbeit. Ein Weiterbildungsmodell zwischen Aktion und Reflexion

Unter dem Stichwort Regionalkampagne bzw. Kooperationskampagne soll am Beispiel der "Aktion Naturgarten Langenau 1990" ein Erwachsenenbildungsmodell vorgestellt werden, das inhaltlich und methodisch Perspektiven für neue Formen der Weiterbildung bieten kann und als Ergänzung zur klassischen Seminar- und Vortragsdidaktik zu werten ist - vor dem Hintergrund der Suche nach einer zeitgemäßeren Methodik und Didaktik im Bereich allgemeiner und politischer Bildung. (DIPF/Orig.

Dose-Weighted Adjusted Mantel-Haenszel Tests for Numeric Scaled Strata in a Randomized Trial

A recent three-arm parallel groups randomized clinical prevention trial had a protocol deviation causing participants to have fewer active doses of an in-office treatment than planned. The original statistical analysis plan stipulated a minimal assumption randomization-based extended Mantel-Haenszel (EMH) trend test of the high frequency, low frequency, and zero frequency treatment groups and a binary outcome. Thus a dose-weighted adjusted EMH (DWAEMH) test was developed with an extra set of weights corresponding to the number of active doses actually available, in the spirit of a pattern mixture model. The method can easily be implemented using standard statistical software. A set of Monte Carlo simulations using a logistic model was undertaken with (and without) actual dose-response effects through 1000 replicates for empirical power estimates (and 2100 for empirical size). Results showed size was maintained and power was improved for DWAEMH versus EMH and logistic regression Wald tests in the presence of a dose effect and treatment by dose interaction