There has been a modern epidemic of heart attacks in the western world, and this paper is concerned with this ânewâ medical condition and how it arose. Two competing theories are commonly proposed, relating either to conventional accounts of medical science, or to social construction. Whilst recognising that aspects of both theories have some validity, it is claimed that neither is wholly adequate. This issue has particular relevance for heart attacks and is explored in some detail, but it (...) also points to some more general conclusions. First that medical knowledge cannot be separated into âscientificâ and âsocialâ compartments but is united by its human aspect; and second that although medical knowledge has a special dimension, when understood in this way, it may also resonate with a more general re-examination of the relationship between scientific and human knowledge. (shrink)
Definition of the problem: In 1997, Percutaneous Transluminal Coronary Angioplasty (PTCA) was performed in 138.001 cases in Germany. The standard indications, single vessel disease and badly controlled angina, are more and more extended to multivessel disease with and without severe angina, unstable or preinfarction angina, and acute myocardial infarction (AMI) itself. Dilating asymptomatic stenoses of more than 70–80% is a widely used indication, intending prophylaxis of complete occlusion and AMI. Actually there is no generally accepted guideline for (...) the different new indications, conservative versus invasive treatment schedule. It is difficult for the patient to get appropriate information before his decision between mechanical procedures and conservative methods; authentic informed consent actually seems to be in a very bad position. In 1992 the working group called ”Arbeitsgemeinschaft leitender kardiologischer Krankenhausärzte (ALKK)” decided to start a registry of all PTCA procedures, in order to gain knowledge about the present status of PTCA in Germany. Up to March 1999, 198.608 PTCA are logged.Arguments: Each PTCA was included on an intention-to-treat basis. The registry succeeded in a nearly complete recording with 98,6% of all PTCA procedures complete on March 17th, 1999. 93,5% of stenosed and 72,2% of the total occluded vessels were successfully dilated. In 4.729 cases (2,63%) the PTCA caused severe complications. The overall in-hospital mortality was only 0,5%, if the procedures done for AMI were excluded (including AMI it was 1,1%). The calculation of complications should be an essential part of the patients informed consent.Conclusion: Complete recording of all PTCA procedures is feasible even on a nationwide basis. Some results of the registry, as the indication control and the complication rate may help to realize a better doctor-patient-conversation on risks and benefits of either concept. The trend of many CHD patients is ”modern”: It should be done what can be done (mechanically), with results at once. Although said somehow paternalistic, this point of view cannot be tolerated: Proper informed consent today includes the realistic alternative of modern medicaments, especially those with an aggressive cholesterol lowering potency. (shrink)
A number of arguments have shown that randomization is not essential in experimental design. Scientific conclusions can be drawn on data from experimental designs that do not involve randomization. John Worrall has recently taken proponents of randomized studies to task for suggesting otherwise. In doing so, however, Worrall makes an additional claim: randomized interventional studies are epistemologically equivalent to observational studies, providing the experimental groups are comparable according to background knowledge. I argue against this claim. In the context of testing (...) the efficacy of drug therapies, well-designed interventional studies are epistemologically superior to well-designed observational studies because they have the capacity to avoid a type of selection bias. Although arguments for interventional studies are present in the medical literature, these arguments are too often presented as an argument for randomization. Randomization in interventional studies is defended on Bayesian grounds. (shrink)
Critical congenital heartdisease screening is rapidly becoming the standard of care in the United States after being added to the Recommended Uniform Screening Panel in 2011. Newborn screens typically do not require affirmative parental consent. In fact, most states allow parents to exempt their baby from receiving the required screen on the basis of religious or personally held beliefs. There are many ethical considerations implicated with allowing parents to exempt their child from newborn screening for CCHD. Considerations (...) include the treatment of religious exemptions in our current legal system, as well as medical and ethical principles in relation to the rights of infants. Although there are significant benefits to screening newborns for CCHD, when a parent refuses for religious or personal beliefs, in the case of CCHD screening, the parental decision should stand. (shrink)
The aim of this paper is to characterize some personality traits of women with ischemic heartdisease, in order to determine their relationship to activity and inactivity, and define the implications of that relationship for ways of coping with coronary pain. The study comprised N = 100 women aged 33 to 80 years, hospitalized in the Department of Cardiology, who underwent angiography for the assessment of coronary arteries. Psychological studies have been conducted using clinical interviews, involving (...) the IPAT Anxiety Scale Questionnaire, the Pain Coping Strategies Questionnaire and the NEO Five-Factor Personality Inventory. The results obtained indicate that where a group of one hundred women with ischemic heartdisease was concerned, their level of anxiety and fear stood at an almost neurotic level. In the structure of anxiety and fear one may observe the predominance of a strong tendency towards self-blame, experiencing feelings of guilt, and exhibiting high levels of internal tension. Among the personality traits in question, the following clearly dominated: extroversion, agreeableness and conscientiousness. The principal strategies for dealing with pain on the part of women with IHD were “prayer and hope”, “declarations of coping” and “diverting attention”. In women with ischemic heartdisease, it would thus be advisable to employ psychotherapeutic strategies aimed at lowering the tendency towards selfdestructive behaviour and reducing any elevated levels of internal tension. Psychotherapeutic activities conducted among women with IHD should focus on strengthening psychological resilience, and on working out ways to cope with the disease by undertaking tasks which give them a chance to enrich their own development. (shrink)
Heartdisease is a complex condition that is a leading cause of death worldwide. It is often seen as a disease of affluence, yet is strongly associated with a gradient in socio-economic status. Its highly complex causality means that many different facets of social and economic life are implicated in its aetiology, including factors such as workplace hierarchy and agricultural policy, together with other well-known factors such as what passes for individual 'lifestyle'. The very untangling of causes (...) for heartdisease thus inevitably raises social, moral and political issues. These include the proper role of the individual and of larger social forces in its aetiology, prevention and treatment. The construction of risk factors for heartdisease likewise is enmeshed with questions of distributive justice in the responsible targeting of those at risk for heartdisease, a debate which has received much overt attention in the medical literature, but less attention within the ethical literature. Strategies for addressing a condition of such complex causality can be highly diverse, from pharmaceutical to social interventions, and value issues attach to the choice and presentation of such strategies. For example, prevention strategies may raise complex issues of responsibility and of judgements of what it is to 'live well'. Further ethical debate on this highly political disease would be welcome. (shrink)
The arts can aid the exploration of individual and collective illness narratives, with empowering effects on both patients and caregivers. The artist, partly acting as conduit, can translate and re-present illness experiences into artwork. But how are these translated experiences received by the viewer—and specifically, how does an audience respond to an art installation themed around paediatric heart transplantation and congenital heartdisease? The installation, created by British artist Sofie Layton and titled Making the Invisible Visible, was (...) presented at an arts-and-health event. The piece comprised three-dimensional printed medical models of hearts with different congenital defects displayed under bell jars on a stainless steel table reminiscent of the surgical theatre, surrounded by hospital screens. The installation included a soundscape, where the voice of a mother recounting the journey of her son going through heart transplantation was interwoven with the voice of the artist reading medical terminology. A two-part survey was administered to capture viewers’ expectations and their response to the piece. Participants expected to acquire new knowledge around heartdisease, get a glimpse of patients’ experiences and be surprised by the work, while after viewing the piece they mostly felt empathy, surprise, emotion and, for some, a degree of anxiety. Viewers found the installation more effective in communicating the experience of heart transplantation than in depicting the complexity of cardiovascular anatomy. Finally, analysis of open-ended feedback highlighted the intimacy of the installation and the privilege viewers felt in sharing a story, particularly in relation to the soundscape, where the connection to the narrative in the piece was reportedly strengthened by the use of sound. In conclusion, an immersive installation including accurate medical details and real stories narrated by patients can lead to an empathic response and an appreciation of the value of illness narratives. (shrink)
In India, non-communicable diseases accounted for nearly 62% of all deaths in 2016. Four NCDs – high blood pressure, diabetes, asthma and heartdisease – together accounted for over 34% of these deaths. Using data from two rounds of the India Human Development Surveys, levels and changes in the prevalence rates of the four NCDs among adults aged 15–69 years in India between 2004–05 and 2011–12 were examined by socioeconomic and demographic factors and for five broad occupation categories. (...) The socioeconomic and demographic risk factors for each of these NCDs were determined using multiple linear logistic regression analysis of pooled data from two rounds of the IHDS. The results showed that while urban residence, age, female sex and education were associated with higher odds of high blood pressure, diabetes and heartdisease, household economic status was associated with higher odds for all four NCDs. Furthermore, increased higher odds of high blood pressure, diabetes and heartdisease were found for the legislator/senior official/professional occupation group compared with non-workers. Skilled agricultural/elementary workers had lower odds of high blood pressure, diabetes, asthma and heartdisease. Craft/machine-related trade workers had higher odds of high blood pressure and diabetes, and reduced odds of asthma and heartdisease. Compared with non-workers, the odds ratios for asthma were lower for all other occupational categories. During the two study decades, the Government of India implemented several programmes designed to improve the health and well-being of its people. However, more focused attention on the adult population is needed, and special attention should be paid to the issue of the occupational health of the working population through the strict implementation of work place safety protocols and the removal of potential health hazards. (shrink)
Living things are often plastic during their early development and are moulded by the environment. Many human fetuses have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronaryheartdisease, stroke, diabetes and hypertension.
ABSTRACTThe use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and...
Hospitalization is a unique health-illness transition for most elderly people. Whether the patient's health-related needs are met or not often iiifluence his or her appraisal of quality of life during hospitalization. This qualitative study explored the health needs of elderly Chinese male cardiac patients during their hospitalization. Eighteen subjects were recruited from a veterans' hospital in northern Taiwan. These men all lived alone before their hospital admission. Data were gathered using semistructured interviews and then analysed by content analysis. Ninety-four per (...) cent of the subjects described up to three categories of needs: met needs (72%), unmet needs (78%), and expected needs (50%0). Needs that participants believed were met were those for psychological support, spiritual support, tangible support and information. Unmet needs were those for participation in decision making, maintaining daily activities and resuming a preadmission lifestyle. The expected needs included those for learning self-care strategies to maintain their daily activities after discharge from the hospital. The factors that framed the participants' perceptions of different health needs were identified to be lack of family support and locus of control. Finally, a discussion of the context background of this phenomenon, as well as some suggestions for its implications, are provided from a culturally sensitive ethical aspect. (shrink)
