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Cultivating Health

Los Angeles Women and Public Health Reform

Jennifer Lisa Koslow

Cultivating Health, an interdisciplinary chronicle, details women's impact on remaking health policy, despite the absence of government support. Jennifer Lisa Koslow explores community nursing, housing reform, milk sanitation, childbirth, and the campaign against venereal disease in late nineteenth and early twentieth century Los Angeles. She demonstrates how women implemented health care reform and civic programs and highlights women's home health care, urban policy-changing accomplishments, and pays tribute to what would become the model for similar service-based systems in other American centers.

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Culture and PTSD

Trauma in Global and Historical Perspective

Edited by Devon E. Hinton and Byron J. Good

Since the 1970s, understanding of the effects of trauma, including flashbacks and withdrawal, has become widespread in the United States. As a result Americans can now claim that the phrase posttraumatic stress disorder (PTSD) is familiar even if the American Psychiatric Association's criteria for diagnosis are not. As embedded as these ideas now are in the American mindset, however, they are more widely applicable, this volume attempts to show, than is generally recognized. The essays in Culture and PTSD trace how trauma and its effects vary across historical and cultural contexts.

Culture and PTSD examines the applicability of PTSD to other cultural contexts and details local responses to trauma and the extent they vary from PTSD as defined in the American Psychiatric Association's Diagnostic and Statistical Manual. Investigating responses in Peru, Indonesia, Haiti, and Native American communities as well as among combat veterans, domestic abuse victims, and adolescents, contributors attempt to address whether PTSD symptoms are present and, if so, whether they are a salient part of local responses to trauma. Moreover, the authors explore other important aspects of the local presentation and experience of trauma-related disorder, whether the Western concept of PTSD is known to lay members of society, and how the introduction of PTSD shapes local understandings and the course of trauma-related disorders.

By attempting to determine whether treatments developed for those suffering PTSD in American and European contexts are effective in global settings of violence or disaster, Culture and PTSD questions the efficacy of international responses that focus on trauma.

Contributors: Carmela Alcántara, Tom Ball, James K. Boehnlein, Naomi Breslau, Whitney Duncan, Byron J. Good, Mary-Jo DelVecchio Good, Jesse H. Grayman, Bridget M. Haas, Devon E. Hinton, Erica James, Janis H. Jenkins, Hanna Kienzler, Brandon Kohrt, Roberto Lewis-Fernández, Richard J. McNally, Theresa D. O'Nell, Duncan Pedersen, Nawaraj Upadhaya, Carol M. Worthman, Allan Young

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The Death of a Disease

A History of the Eradication of Poliomyelitis

Edited by Bernard Seytre and Mary M. Shaffer

In a national survey, 19 million Americans said they have a family member with Alzheimer's, and 37 million said they knew someone who had it. But when Rosette Teitel found herself in the role of caregiver to her ailing husband, she could find no books that answered her practical needs: How do you give a 170-pound man a shower? How do you pick him up when he falls? What support networks are available? When is it time to consider a nursing home and how do you find one?While many books about Alzheimer's disease focus on the illness and the patient, Teitel draws on her own experience to tackle subjects rarely dealt with in other self-help books. She covers topics such as managing the expenses of long-term care through Medicaid, estate planning, and preparing for the patient's death and the loss of someone whose daily survival has been at the center of one's existence. The chapters contain information on diagnosis, treatment, and the progression of the disease; the physical and emotional changes involved with the day-to-day caregiving; support networks; nursing homes; finances; death of the patient; mourning, and life after the patient's death; and interviews with caring children of parents with Alzheimer's disease. In addition, Teitel provides a helpful list of frequently asked questions, scheduling and memory aids, and websites where readers can find resources.

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Disease and Discovery

A History of the Johns Hopkins School of Hygiene and Public Health, 1916–1939

Elizabeth Fee

At the end of the nineteenth century, public health was the province of part-time political appointees and volunteer groups of every variety. Public health officers were usually physicians, but they could also be sanitary engineers, lawyers, or chemists—there was little agreement about the skills and knowledge necessary for practice. In Disease and Discovery, Elizabeth Fee examines the conflicting ideas about public health’s proper subject and scope and its search for a coherent professional unity and identity. She draws on the debates and decisions surrounding the establishment of what was initially known as the Johns Hopkins School of Hygiene and Public Health, the first independent institution for public health research and education, to crystallize the fundamental questions of the field.

Many of the issues of public health education in the early twentieth century are still debated today. What is the proper relationship of public health to medicine? What is the relative importance of biomedical, environmental, and sociopolitical approaches to public health? Should schools of public health emphasize research skills over practical training? Should they provide advanced training and credentials for the few or simpler educational courses for the many?

Fee explores the many dimensions of these issues in the context of the founding of the Johns Hopkins school. She details the efforts to define the school’s structure and purpose, select faculty and students, and organize the curriculum, and she follows the school’s growth and adaptation to the changing social environment through the beginning of World War II. As Fee demonstrates, not simply in its formation but throughout its history the School of Hygiene served as a crucible for the forces shaping the public health profession as a whole.

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Divining without Seeds

The Case for Strengthening Laboratory Medicine in Africa

Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. In Divining without Seeds, Iruka N. Okeke forcefully argues that laboratory diagnostics are essential to the effective practice of medicine in Africa.

The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers-including malaria-to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. Divining without Seeds makes clear that routine use of appropriate diagnostic support should be part of every drug delivery plan in Africa and that diagnostic development should be given high priority.

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Doctors Serving People

Restoring Humanism to Medicine through Student Community Service

Edward J. Eckenfels

Today's physicians are medical scientists, drilled in the basics of physiology, anatomy, genetics, and chemistry. They learn how to crunch data, interpret scans, and see the human form as a set of separate organs and systems in some stage of disease. Missing from their training is a holistic portrait of the patient as a person and as a member of a community. Yet a humanistic passion and desire to help people often are the attributes that compel a student toward a career in medicine. So what happens along the way to tarnish that idealism? Can a new approach to medical education make a difference? Doctors Serving People is just such a prescriptive. While a professor at Rush Medical College in Chicago, Edward J. Eckenfels helped initiate and direct a student-driven program in which student doctors worked in the poor, urban communities during medical school, voluntarily and without academic credit. In addition to their core curriculum and clinical rotations, students served the social and health needs of diverse and disadvantaged populations. Now more than ten years old, the program serves as an example for other medical schools throughout the country. Its story provides a working model of how to reform medical education in America.

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Doctors Without Borders

Humanitarian Quests, Impossible Dreams of Médecins Sans Frontières

Renée C. Fox

Médecins Sans Frontières / Doctors Without Borders (MSF) is a private international medical humanitarian organization that was created by a small group of French doctors and journalists in 1971. In 1988, MSF was awarded the Nobel Prize for Peace in recognition of the worldwide assistance it provides for people in distress who are victims of manmade and natural disasters and armed conflict. Committed to the principles of neutrality, impartiality, and independence, the men and women of MSF bear witness by speaking out about conditions of extreme need and suffering, acts of violence against individuals or groups, and threats or hindrances to medical care that they observe in the course of carrying out their work. Renée C. Fox is a sociologist known particularly for her pioneering work in medical sociology and for her ethnographic research and writing. Doctors Without Borders is based on the first-hand research she conducted about and within MSF since 1993. Its vivid, “thickly descriptive” data are derived from her participant observation, in-depth interviewing, and collection of primary and secondary documents in numerous MSF contexts. The book begins on the ground with the blogs of women and men of MSF in the field, recounting their experiences in moving detail. From there it chronicles MSF’s early history and development, paying special attention to its inner struggles, during the first decades of its existence, to clarify and implement its principles and to more fully realize its “without borders” transnational vision. Detailed case studies form the core of the book, describing MSF in postapartheid South Africa, dealing with that nation’s rampant epidemic of HIV/AIDS, and MSF in postsocialist Russia, responding to the thousands of homeless persons on the streets of Moscow and to the massive epidemic of tuberculosis in the penal colonies of Siberia. The book ends with an account of the fortieth anniversary meeting of MSF in Paris and with the author’s exit from the field. Doctor Without Borders tells a narrative enriched by photographs of MSF missions and by ironic, self-critical cartoons drawn by a member of the Communications Department of MSF France.

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The Door of Last Resort

Memoirs of a Nurse Practitioner

Frances Ward

Having spent decades in urban clinical practice while working simultaneously as an academic administrator, teacher, and writer, Frances Ward is especially well equipped to analyze the American health care system. In this memoir, she explores the practice of nurse practitioners through her experiences in Newark and Camden, New Jersey, and in north Philadelphia.

Ward views nurse practitioners as important providers of primary health care (including the prevention of and attention to the root causes of ill health) in independent practice and as equal members of professional teams of physicians, registered nurses, and other health care personnel. She describes the education of nurse practitioners, their scope of practice, their abilities to prescribe medications and diagnostic tests, and their overall management of patients’ acute and chronic illnesses. Also explored are the battles that nurse practitioners have waged to win the right to practice—battles with physicians, health insurance companies, and even other nurses.

The Door of Last Resort
, though informed by Ward’s experiences, is not a traditional memoir. Rather, it explores issues in primary health care delivery to poor, urban populations from the perspective of nurse practitioners and is intended to be their voice. In doing so, it investigates the factors affecting health care delivery in the United States that have remained obscure throughout the current national debate

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Drinking Smoke

The Tobacco Syndemic in Oceania

Mac Marshall

Tobacco kills five million people every year and that number is expected to double by the year 2020. Despite its enormous toll on human health, tobacco has been largely neglected by anthropologists. Drinking Smoke combines an exhaustive search of historical materials on the introduction and spread of tobacco in the Pacific with extensive anthropological accounts of the ways Islanders have incorporated this substance into their lives. The author uses a relatively new concept called a syndemic—the synergistic interaction of two or more afflictions contributing to a greater burden of disease in a population—to focus at once on the health of a community, political and economic structures, and the wider physical and social environment and ultimately provide an in-depth analysis of smoking’s negative health impact in Oceania.

In Drinking Smoke the idea of a syndemic is applied to the current health crisis in the Pacific, where the number of deaths from coronary heart disease, cancer, diabetes, and chronic obstructive pulmonary disease continues to rise, and the case is made that smoking tobacco in the form of industrially manufactured cigarettes is the keystone of the contemporary syndemic in Oceania. The author shows how tobacco consumption (particularly cigarette smoking after World War II) has become the central interstitial element of a syndemic that produces most of the morbidity and mortality Pacific Islanders suffer. This syndemic is made up of a bundle of diseases and conditions, a set of historical circumstances and events, and social and health inequities most easily summed up as “poverty.” He calls this the tobacco syndemic and argues that smoking is the crucial behavior—the “glue”—holding all of these diseases and conditions together.

Drinking Smoke is the first book-length examination of the damaging tobacco syndemic in a specific world region. It is a must-read for scholars and students of anthropology, Pacific studies, history, and economic globalization, as well as for public health practitioners and those working in allied health fields. More broadly the book will appeal to anyone concerned with disease interaction, the social context of disease production, and the full health consequences of the global promotional efforts of Big Tobacco.

Mac Marshall is emeritus professor of anthropology and community and behavioral health at the University of Iowa.

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Ebola's Message

Public Health and Medicine in the Twenty-First Century

edited by Nicholas G. Evans, Tara C. Smith, and Maimuna S. Majumder

The 2013–2015 outbreak of the Ebola virus disease (EVD) was a public health disaster: 28,575 infections and 11,313 deaths (as of October 2015), devastating the countries of Guinea, Liberia, and Sierra Leone; a slow and mismanaged international response; and sensationalistic media coverage, seized upon by politicians to justify wrongheaded policy. And yet there were also promising developments that may improve future responses to infectious disease epidemics: the UN Security Council’s first involvement in a public health event; a series of promising clinical treatments and vaccines for EVD; and recognition of the need for a global public health system to deal with epidemics that cross national borders. This volume offers a range of perspectives on these and other lessons learned, with essays on the science, politics, and ethics of the Ebola outbreak. The contributors discuss topics including the virology and management of EVD in both rich and poor nations; the spread of the disease (with an essay by a leader of Médecins Sans Frontières); racist perceptions of West Africa; mainstream and social media responses to Ebola; and the ethical issue of whether to run clinical trials of experimental treatments during an outbreak. Contributors Christian L. Althaus, Daniel G. Bausch, Adia Benton, Michael J. Connor, Jr., Kim Yi Dionne, Nicholas G. Evans, Morenike Oluwatoyin Folayan, Stephen Goldstein, Bridget Haire, Patricia C. Henwood, Kelly Hills, Cyril Ibe, Marjorie Kruvand, Lisa M. Lee, Maimuna S. Majumder, Alexandra L. Phelan, Annette Rid, Cristine Russell, Lara Schwarz, Laura Seay, Michael Selgelid, Tara C. Smith, Armand Sprecher

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