Medical malpractice,social structure,and social control

The origin and handling of doctor-patient conflict can be understood with reference to the sociological aspects of professional health care. This premise is explored by applying Black's theory of social control to the empirical evidence concerning malpractice litigation in the United States. The vertical, organizational, and relational distances between the health care provider and the patient are particularly relevant for predicting when malpractice claims will be made and how they will be resolved. These social-structural variables help explain several patterns in the American malpractice experience, including the aggregate increase in claim rates over the past four decades; the persistence of toleration as the modal response to medical injury; why poorer patients are less suit-prone than higher income patients; why surgical specialties have higher claim rates than general practice and psychiatry; why hospitals are sued disproportionately less often than individual doctors; and the relatively high frequency of prodefendant decisions when lawsuits are decided by a judge or jury.An earlier version of this paper was presented at the annual meeting of the American Sociological Association in Pittsburgh, Pennsylvania, August 1992.     

Cultural Trailblazers: Exploring the Career Development of Latina First‐Generation College Students

Latinas in the United States have had historically low college graduation rates, are overrepresented in lower paying occupations, and experience culture‐ and values‐based struggles in obtaining career goals. As Latinas increase their presence as a cultural group in higher education and grow in the U.S. workforce, researchers are called to uncover the challenging and complex career development experience of this diverse group of students. This qualitative study used a grounded theory methodology to explore the values and life‐role salience associated with the career development of Latina 1st‐generation college students at a primarily Caucasian institution. Results included 2 overarching themes with 5 subthemes supporting culturally sensitive career counseling practices while working with this sample. Future research implications examining the efficacy of interventions to help Latina 1st‐generation college students succeed in college are provided.     

Naloxone administration for suspected opioid overdose: An expanded scope of practice by a basic life support collegiate-based emergency medical services agency

Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer intranasal naloxone for patients with suspected opioid overdose. While normally not within the scope of practice of basic life support prehospital agencies, the recognition of an increasing epidemic of opioid abuse has led many states, including the District of Columbia, to expand access to naloxone for prehospital providers of all levels of training. In particular, intranasal naloxone is a method of administering this medication that potentially avoids needlestick injuries among EMS providers. Universities with collegiate-based EMS agencies are well positioned to provide life-saving treatments for patients acutely ill from opioid overdose.     

Clustered data with small sample sizes: Comparing the performance of model-based and design-based approaches

Two classes of methods properly account for clustering of data: design-based methods and model-based methods. Estimates from both methods have been shown to be approximately equal with large samples. However, both classes are known to produce biased standard error estimates with small samples. This paper compares the bias of standard errors and statistical power of marginal effects for generalized estimating equations (a design-based method) and generalized/linear mixed effects models (model-based methods) with small sample sizes via a simulation study. Provided that the distributional assumptions are met, model-based methods produced the least-biased standard error estimates and greater relative statistical power.     

Arab-American male identity negotiations: caught in the crossroads of ethnicity,religion, nationality and current contexts

We examine how the identities of male adolescents of Arab descent (ArD) relate to their current physical and phenomenological contexts and to the negative fallout from recent ethnicity-related political events. Seventy-seven ArD adolescents in seven United States middle schools with varying proportions of ArD students participated in focus-group interviews. Qualitative analysis provides evidence that adolescents' social identities depended on complex combinations of personal, situational, and contextual factors. Findings extend Spencer's PVEST theory, demonstrating that the salience of adolescents' national, pan-Arab, hyphenated Arab-American, or assimilated American identity stems from phenomenological experiences within their current context and from the cognitive processes and associated affects of their prior experiences in other proximal and distal contexts.     

Racial/Ethnic Composition and Violence: Size‐of‐Place Variations in Percent Black and Percent Latino Effects on Violence Rates

According to racial invariance positions and mainstream sociological perspectives on race and crime, race differences in structural conditions should account for most if not all of the racial composition (or percent black) effect on aggregate‐level violence rates. However, prior research (mostly conducted prior to 1990) generally provides mixed or contrary evidence for this position, showing instead that greater concentrations of blacks are linked to increased violence even after accounting for racial differences in socioeconomic conditions. The current study uses recent data and a novel unit of analysis to go beyond extant research in two ways. First, we include percent Latino in our examination of the extent to which both racial and ethnic composition effects on violent crime rates are mediated by racial/ethnic disparities in socioeconomic disadvantage. Second, we test whether racial/ethnic composition effects are conditioned by size of place, through the use of census places as a uniquely varying unit of analysis. We find that both black and Latino composition effects are partly explained by controlling for structural conditions (especially structural disadvantage), but this characterizes smaller places much more than the largest, most urbanized places.     

Marital Status,Marital History,Body Weight,and Obesity

Marital status and marital history are associated with health. Marital history can be represented by the marital trajectory components of timing, transitions, sequence, and duration. We examined whether marital trajectory components add insights beyond marital status in predicting body weight in a retrospective analysis of 3,011 adults. Marital status findings revealed that married men were heavier than separated/divorced men, and never married women were heavier and more often obese than married women. Marital history findings showed that after adjusting for marital status, trajectory measures of age at first marriage, second marriage or second divorce, experiencing widowhood, and duration of separation/divorce were not clearly associated with body weight or obesity. Body weight and obesity appear to be associated with current marital status but not marital history.     

The Herman–Chomsky Propaganda Model: A Critical Approach to Analysing Mass Media Behaviour

The Propaganda Model (PM), developed by Edward Herman and Noam Chomsky and published in Manufacturing Consent in 1988, sought to explain the behaviour of the mass media in the United States. Analysing the function, operation and effects of the media are essential to any understanding of contemporary societies and the article begins by sketching out the contours of the liberal-pluralist vs. critical-Marxist debate about the role of the media. The article then presents an overview of the PM, locates it within the field of media and communication studies, considers its reception, discusses a number of complementary methodological and theoretical approaches, and argues that the PM, more than 20 years after its formulation, continues to provide an invaluable tool for understanding the media within contemporary capitalist societies.     

Medical Uncertainty in Students Entering Medical School

Abstract

Uncertainty is a fundamental characteristic of medical practice. Renee Fox described three types of uncertainty: limitations in the body of medical knowledge, incomplete mastery of existing knowledge, and distinguishing between limitations and mastery of knowledge. This investigation administered ten Likert-format questions about uncertainty to 171 incoming medical students at one state medical school Items were reliable over a six week test-retest, and validity was supported by correlations with an Intolerance of Ambiguity scale. Entering students recognized that uncertainty exists in medical knowledge and mastery of medical knowledge. Factor analysis of the ten item uncertainty scale revealed three dimensions: uncertainty of the profession, practice certainty, and growth in uncertainty. No significant differences in the uncertainty items, scale, or factors existed by demographic characteristics or medical specialty preferences. These findings suggest that students are aware of issues surrounding uncertainty in medicine as they begin medical school, but medical uncertainty at this early stage in medical socialization is not sufficiently powerful to be associated with medical specialty preference.