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Biomedical subjects

M Nichter

Publications and source records attributed to M Nichter.

At least 19 recordsLinked to original sources
PubMed1995

Vaccinations in the Third World: a consideration of community demand.

Impressive increases in immunization rates have been reported in several less developed countries (LDCs) as a result of intensive EPI programs. An issue arises as to whether existing rates of immunization coverage can be sustained/increased given projected cutbacks in funding. This issue calls into question the assumption that as immunizable disease rates fall, local populations will need less encouragement to secure immunization services. This article considers how immunizations are perceived by lay populations and how perceptions of utility and need effect demand which in turn effects the sustainability of EPI programs. Among issues addressed is the observation that when specific diseases are not linked to specific immunizations, misimpressions related to the number of immunizations needed for "good health" abound. Also considered are metamedical reasons immunizations (and immunization programs) are both resisted and demanded in particular political contexts.

Africa↗
PubMed1995

Dieting and "watching" behaviors among adolescent females: report of a multimethod study.

PURPOSE: This study posits a distinction between "watching what you eat" and dieting behaviors in a sample of adolescent females. Findings suggest that the dichotomy of dieter/nondieter fails to capture a range of healthful behaviors practiced by many adolescent girls. METHODS: Anthropologic and nutritional research methods were used in this study. Data were drawn from 1 year of a longitudinal study of food intake and dieting behaviors in a sample of 231 adolescent females. Multiple methods including one ethnographic interview, a survey questionnaire, a telephone interview, and food records were collected from each informant. RESULTS: Although 44% of the girls in this sample reported trying to lose weight on the day of the survey, only 8.6% of the food records reflected dieting days. In interviews, many identified "watching what they eat" as a health-promoting strategy that allowed them to maintain their weight. Analysis of food record data confirmed a trend toward higher intakes of micronutrients. CONCLUSIONS: Research concerned with adolescent weight loss behaviors has focused more on negative than positive health attitudes and behaviors. The present study identified the behavior of "watching" as distinct from dieting. "Watching" was widely utilized by girls in this sample as a way to maintain weight and promote health.

Adolescent↗
PubMed1994

Agenda for an anthropology of pharmaceutical practice.

Over the last two decades, patterns of pharmaceutical-related behavior and the cultural interpretation of medicines have been examined by anthropologists in several cultural settings. In this paper the authors identify additional issues warranting study so as to broaden the scope of pharmaceutical anthropology, utilizing as a unifying focus the examination of pharmaceutical use in the context of social transformation. Ten interactive themes are presented which bridge micro-level and macro-level investigations of pharmaceutical use. The discussion moves from the discourse on 'rational drug use' to the rationales which underscore drug prescription, manufacture, and demand.

Advertising↗
PubMed1994

Illness semantics and international health: the weak lungs/TB complex in the Philippines.

Attention is drawn to illness semantics and the need to move beyond health social science research on discrete diseases to sets of illnesses perceived to be interrelated within popular health culture. Considered is the weak lungs/TB complex as it is conceptualized in relation to other types of lung disease as well as predisposing factors which influence the moral identity of the afflicted and the social relations of illness. The illness category weak lungs is broad and covers a variety of symptom states inclusive of TB. While some people equate weak lungs with TB, many others think of weak lungs as a condition which may develop into TB over time. TB is recognized to be contagious, but many people do not perceive weak lungs to be contagious. Treatment practice is discussed in relation to perceptions of illness severity, economics, expectations from medicines and coexisting health concerns. Faith in biomedicine is strong. Broad usage of the term weak lungs affects self-treatment practices and over-the-counter purchase of TB medications. Several TB medicines are labeled in such a way as to give the impression that they are vitamins for the lungs. This association leads people to think that the medication is useful for all illnesses which weaken the lungs, even if taken for a short duration. Attention is drawn to the manner in which inappropriate use of TB medication increases the chances of drug resistance. Data presented on TB drug resistance in the Philippines suggests why a consideration of illness semantics is important.

Antitubercular Agents↗
PubMed1994

Acute respiratory illness: popular health culture and mother's knowledge in the Philippines.

Acute respiratory infection (ARI) is one of the chief causes of morbidity and mortality in the third world. This ethnographic study of ARI in the Philippines draws attention to local knowledge, sign recognition, perceptions of severity, and cultural factors influencing health care seeking. The mix of research methods used to generate data on these issues is discussed.

Acute Disease↗
PubMed1993

Drowning.

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Acidosis↗
PubMed1993

Limitation of medical care: an ethnographic analysis.

This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.

Adult↗
PubMed1992

Do-not-resuscitate discussions: a qualitative analysis.

The literature to date on Do-Not-Resuscitate (DNR) decision-making is based upon data derived from structured questionnaires, hypothetical scenarios, descriptive epidemiology, or simulated discussions. Lacking in the literature has been a critical examination of the health care professional-patient-family relationship and its impact on decision-making regarding resuscitation. The purpose of this study is to identify and describe organizational and communication factors that affect the process and outcome of DNR discussions and decision-making. Individual and focus-group interviews were conducted with sixteen key informants professionally knowledgeable about resuscitative issues. Thematic analysis of these interviews revealed that a variety of cultural and professional values, as well as previous personal experiences, influenced the assumptions that providers made when engaging in DNR decision-making. Specific recommendations are made to help family physicians identify communication strategies that foster understanding and lead to participatory decisions about resuscitation among patients and families.

Attitude of Health Personnel↗
PubMed1991

Hype and weight.

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Body Image↗
PubMed1989

A question of medicine answering. Health commodification and the social relations of healing in Sri Lanka.

Biomedicine although institutionally powerful in Sri Lanka has not been able to depersonalize illness or promote a notion of treatment efficacy disconnected from social relations. An ideology of healing crosscuts the trend toward health commodification. This paper focuses on three concepts fundamental to the interactive dynamics of treatment efficacy: constitution, habit, and power of the hand. A movement between two distinct types of health care seeking behavior is described. One is inspired by finding the right medicine fix, the other by finding a practitioner having a sensitivity toward one's sense of person and all this entails.

Adolescent↗
PubMed1988

From aralu to ORS: Sinhalese perceptions of digestion, diarrhea, and dehydration.

This paper explores popular Sinhalese perceptions of diarrheal diseases and related health care behavior. Also addressed are cultural interpretations of dehydration and perceptions of oral rehydration solution (ORS). The social marketing of ORS is considered. It is suggested that the marketing of ORS be more closely linked to education programs which promote appropriate conceptualization of dehydration. The need to more closely integrate nutrition education and diarrheal management programs is discussed.

Child↗
PubMed1987

Cultural dimensions of hot, cold and sema in Sinhalese health culture.

Attention is focused on those for whom hot/cold and phlegm constitute special health concerns in Sri Lanka. A distinction is drawn between those at special risk to hot/cold and phlegm based on a sense of constitutional vulnerability and those at risk due to temporary illness or expected changes in physiological process. Socialization of the former risk group is considered in light of social labeling theory, while the health behavior of the latter group is highlighted. It is pointed out that a wide range of behavior from folk dietetics to bathing and from water boiling to the taking of birth control pills is influenced by hot/cold reasoning. It is emphasized that the hot/cold conceptual framework serves an integrative function in the traditional health care arena and provides a rationale for participatory action in a health culture undergoing rapid medicalization.

Body Constitution↗
PubMed1985

Drink boiled water: a cultural analysis of a health education message.

Water boiling is recommended by health educators in Sri Lanka, and boiled water is given to ill and vulnerable people, but it is not widely consumed by the public. The reasons for this behavior derive from long-standing notions about health care. This study complements one presented some years ago by Wellin, based on the health culture of Peruvians.

Attitude to Health↗
PubMed1984

Project community diagnosis: participatory research as a first step toward community involvement in primary health care.

'Community participation' and 'bottom up planning' have become fashionable themes in international health circles. However, in the absence of sociocultural perspective these themes remain largely rhetoric. In this paper, a deprofessionalization of social science is advocated in the service of participatory research as a first step towards community involvement in primary health care. Deprofessionalization is suggested as an adjunct to, not a replacement for in-depth professional social science research. An exploratory community diagnosis of health project conducted in rural south India is described. During the project, lay researchers received rudimentary social science field training and collected data on health behaviour deemed important to health planners as well as the health concerns of the community. Illustrative data, generated by the project is presented on the rural poors' utilization of government health facilities, their attitudes towards Primary Health Centre staff, and their ideas about how a proposed community health worker scheme could best serve them.

Community Health Workers↗
PubMed1983

Paying for what ails you: sociocultural issues influencing the ways and means of therapy payment in South India.

The dynamics of payment for therapy to traditional healers and cosmopolitan practitioners in rural South India is focused upon as a means of better understanding health care seeking behavior, patient-practitioner relationships and interactions, treatment decisions and referral. Payment to traditional practitioners involves the ideal of moral bonding while payment to cosmopolitan practitioners remains largely non-moral. Charging for therapeutic consultations through medicine costs and the layperson's means of estimating the cost of therapeutic services and regimes are investigated as factors influencing practitioner shopping, the practice of medicine, and the dynamics of prescription writing. The meaning and process of payment are identified as issues influencing both micro and macro, moral and pragmatic aspects of health care and health economy.

Culture↗