Lower-class Patients Research Articles

An audit of Ear, Nose and Throat diseases in a tertiary health institution in South-western Nigeria

IntroductionThis study is aimed at determining the pattern of ear, nose and throat diseases and their relationship with socio-demographic factors with auditing intent in a tertiary hospital in South-western Nigeria.MethodsMedical records of patients managed at the Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria from 2006 to 2010 were reviewed for all essential clinical data.ResultsThere were 2641 (52.8%) males and 2360 (47.2%) females. Two thousand and fifty (41%) patients had age ≤15years old. Sixty three percent of the patients were Christians, 37% were Muslims and less than 1% had other religions. There were more patients in lower occupational classes than those in the upper classes. The average number of patients with ear, nose and throat diseases managed per month was eighty three. Patients with ear diseases were 3136 (62.7%), the nose diseases were 1153 (23.0%), the throat diseases were 479 (9.6%) and head/neck diseases were 233 (4.7%).ConclusionThis study showed that otitis media, obstructive adenoid, foreign bodies in the ear and throat infections were the common ear, nose, throat disorders seen in patients aged ≤15years whereas, hearing loss, rhinosinusitis and tumors were the common disorders of ear, nose and throat seen in patients aged 16 years and above. Although these disorders are not yet considered to be of public health importance, they contribute significantly to the existing burden of health problems in our environment. Therefore, there is a need for improved public awareness on ear, nose and throat diseases.

Study on Serum Levels of Thyroid Hormones and Thyroid Stimulating Hormone in Different Trimester of Normal Pregnancy

Objective: The present study was conducted to study the changes in serum levels of thyroid hormones and thyroid stimulating hormone (TSH) in different trimesters of normal pregnancy.
 Methods: This cross-sectional study was conducted in the Department of Physiology, Rangpur Medical College Hospital over a period 1 year from July 2008 to June 2009. Apparently healthy pregnant women aged between 20 - 35 years were consecutively included in the study. Patients suffering from thyroid disorders or any other systemic diseases and lactating mothers were excluded from the study. A total of 100 subjects - 75 pregnant women (25 selected from each trimester of pregnancy) and 25 non-pregnant women were purposively selected as case and control groups respectively.
 Result: The mean age was almost identically distributed between the two groups (23.8 ± 3.9 vs. 24.9 ±4.6, p = 0.343). Lower class patient was predominant in case and control group (68% vs. 64%, p =0.756). The mean serum T3 level was higher in case group compared to control group. The mean serum T3 level was identically distributed in 1st and 3rd trimester (p = 0.536 and p = 0.145 respectively) but significant difference was found in 2nd trimester (p = 0.001). The mean serum T4 level of control group did not experience any change throughout the whole observation period. The serum T4 level was 210 nmol/L at 1st trimester then it began to increase almost a plateau at 2nd trimester and then gradually dropped 232.2 nmol/L at third trimester. The mean serum TSH level was 1.1 mIU/L at 1st trimester then it began to increase sharply assumed a mean score 1.3 mIU/L at 2nd trimester. From 2nd trimester onwards it began to decrease upto the end of observation when no change in the non-pregnant women in 1st, 2nd & 3rd trimester.
 Conclusion: Thyroid hormones (T3, T4) increase in the 2nd trimester of pregnancy and fall again in the 3rdtrimester but TSH does not experience any significant change throughout the pregnancy.
 Ibrahim Cardiac Med J 2012; 2(2): 19-23

Experience With Corrective Surgery for Postburn Contractures in Mumbai, India

Postburn contracture is a source of significant morbidity in India, even though its occurrence can be reduced significantly by comprehensive postburn injury care, including surgical intervention. This study investigates whether limited access to initial medical care after burn injury has been associated with increased contracture formation among lower socioeconomic class patients in Mumbai, India. During a surgical mission in Mumbai, India, patients presenting with functionally debilitating burn contractures and minimal income were surveyed for initial care received immediately after burn injury. The survey consisted of questions regarding the history of burn injury and details of any initial treatment. Demographic data were collected by chart review. Thirty-eight patients from the state of Maharashtra participated in the study (mean age 28.1 years). The most common etiology of burn injury was from kerosene stove blasts (74%), and the most common morbidities were contractures of the neck and upper extremity. On average, time elapsed since the original injury was 2.8 years. Nearly all patients sought initial medical care at hospitals (97%) with the majority receiving only dressing changes for their full-thickness or deep-dermal burns (61%). The most common reason for not seeking out delayed burn reconstruction was perceived cost (65%). Ultimately, 60 operations were performed, of which 9 (15%) developed postsurgical complications. These data suggest that a subset of lower socioeconomic class burn patients in Maharashtra received suboptimal initial intervention. Comprehensive initial therapy after burn injury may provide better outcomes and limit the number of patients requiring delayed reconstruction.

Broad spectrum antidermatophytic drug for the control of tinea infection in human beings

During antifungal evaluation of various plant extracts, free and bound flavonoids of Piper betle were found to be most effective as an antidermatophytic against human pathogenic dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes, Microsporum gypseum and Candida albicans. Dermatophytic fungi cause both superficial and internal mycoses. These mycoses, although normally not lethal, are unpleasant and difficult to cure and cause considerable financial losses. Earlier workers prove that allopathic drugs are still found effective against dermatomycoses, but these drugs could not be accepted as a routine treatment for every case, because they are expensive and require long treatment. It is almost unaffordable by middle and lower class people. In view of such prospects and constraints, our aim was to explore more new compounds of plant origin for controlling dermatophytic infections. Author explored water, methanolic and flavonoid extracts for screening as antidermatophytic agent. Plant extracts that showed good results in vitro were selected for clinical studies. The study may give cheaper treatment for medium and lower class patients suffering with tinea and may provide them much relief. Well-established paper disc method was used for the screening of different extracts of their antidermatophytic activity. Moreover, it did not exhibit any adverse side effect on mammalian skin. Flavonoids in the form of ointment Pi be I and Pi be II were subjected to topical testing on patients attending out patients department of S.M.S. Hospital, Jaipur, India. Patients were diagnosed as tinea corporis, tinea capitis, tinea manum or tinea pedis. All patients showed positive potassium hydroxide (KOH) results at the beginning of trial. Patients between the ages of 3 months to 58 years were enrolled. At the end of treatment, while 64% of patients cured completely, 24% showed significant improvement and 12% showed little improvement from the disease. Allopathic treatment took 4-8 weeks when compared with only 1-5 weeks taken by Pi be I and Pi be II ointments. The ointment, thus not only showed maximum affectivity but was also found to be a better and cost effective alternative to allopathic drug for tinea infections. The acceptability of alternative medicines, particularly herbal medicines, has now become a critical need of the times.

Epidemiology of Spondyloarthritis in Argentina

IntroductionSpondyloarthritis (SpA) includes a group of diseases that share immunogenetic, clinical and radiologic findings, with a particular involvement of the axial skeleton and the entheses. MethodsSpA patients attending ambulatory care in 11 rheumatology services located in 6 Argentine provinces were included in a prospective, observational multicentre cohort of SpA in Argentina (Iberoamerican Spondyloarthritis Registry [RESPONDIA]). Data collected were transmitted online and stored in the Spanish spondyloarthritis registry (REGISPONSER) Web site. Sociodemographic, clinical features and diagnosis, disease activity, functional status, quality of life, work status, radiographic changes and treatment data were collected by means of validated tools. ResultsA total of 402 patients were included; 59% were male, with median age of 48.3 years and median disease duration of 8 years; 68.7% of patients belonged to middle and lower-middle social classes. Eighty-six patients were diagnosed with ankylosing spondylitis (AS), 242 with psoriatic arthritis, 25 with reactive arthritis, 10 with SpA associated with inflammatory bowel disease, 33 with undifferentiated SpA and 6 with juvenile AS. The median score was 2.6 for the Bath AS Functional Index, 3.8 for the Bath AS Disease Activity Index and 5 for the Bath AS Radiology Index. The lower social class patients achieved a worse Bath AS Functional Index than other social classes and a worse Bath AS Disease Activity Index, compared with upper-middle class. ConclusionsThe sociodemographic distribution pattern observed in these SpA patients was similar to that expected in the general population of Argentina, with worse functional capacity and higher disease activity observed in the lower social classes.

Soziale Ungleichheit in der medizinischen Rehabilitation

The association of social inequality and health is well known and well documented. Numerous studies have shown that a lower socio-economic status is associated with higher morbidity and mortality. This association is caused by various circumstances such as unfavourable work and living conditions, unhealthy life styles and risk factors and, last but not least, the access to medical care depending on socio-economic status. These aspects are correlated in various ways, at any rate they cause a higher prevalence of diseases and lower quality of life in persons with lower socio-economic status. The present article discusses the association between social inequality and medical rehabilitation, a problem which is rarely investigated in present research on social inequality and health. In our study, 911 rehabilitation patients were included. Analyses of socio-economic differences with respect to rehabilitation care address the following questions: are there differences in access to medical rehabilitation, in rehabilitation care, with respect to success of rehabilitation and satisfaction with rehabilitation? To assign patients to a social class - lower, middle and upper class - we constructed an indicator of social status based on education, occupation and income level. Our findings in a sample of rehabilitation patients are in line with the results of existing research on social inequality and health. Patients from the lower social class enter the rehabilitation care system with a poorer health state and leave it with less favourable results than patients with higher social status. However, with regard to the effect of rehabilitation care, middle class patients benefit least. It can be speculated that systematic information of patients about the aims of the rehabilitation programme and specific after care focusing on relevant aspects of daily living may reduce the disadvantages of lower class patients.

Impact of family environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes

Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. This study's results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. The results highlight the importance of studying family variables in adolescents' diabetes care within the wider cultural factors affecting the patient.

Comparison of Participants and Non-Participants in a Randomized Psychosocial Intervention Study Among Patients With Malignant Melanoma

The authors investigated barriers for entering a randomized psychosocial intervention study among patients with malignant melanoma. Data on age, sex, prognostic factors, social class, marital status, mood, coping, social relations, and social desirability from participants and non-participants were compared in a regression model. More patients in lower socioeconomic classes declined participation. Non-participation was associated with low levels of distress and adaptive coping and higher levels of empathy and congruence from spouses. The type of intervention offered in this study may have more appeal to patients belonging to higher socioeconomic classes.

Usefulness of N-Terminal Pro-B-Type Natriuretic Peptide to Predict Clinical Course in Patients With Hypertrophic Cardiomyopathy

This study was designed to assess the value of plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels in predicting clinical courses in 80 patients with hypertrophic cardiomyopathy. Patients were followed for a mean of 571 +/- 294 days for clinical end points, defined as a composite of cardiovascular death and hospitalization for worsening heart failure symptoms. NT-pro-BNP plasma level (hazard ratio 1.6, 95% confidence interval 1.10 to 2.55, p = 0.015) and New York Heart Association (NYHA) functional class (hazard ratio 3.7, 95% confidence interval 1.17 to 12.09, p = 0.025) were the independent variables associated with increased risk for experiencing clinical end points. NT-pro-BNP plasma level > or =1,500 pg/ml detected patients with clinical end points with sensitivity, specificity, and accuracy of 83%, 81%, and 81%, respectively. The hypertrophic cardiomyopathy population was stratified into low-, medium-, and high-risk subgroups using 2 simple variables, NYHA functional class and NT-pro-BNP. Patients in lower NYHA classes and with NT-pro-BNP levels <1,500 pg/ml were significantly free of clinical end points. In conclusion, for patients with hypertrophic cardiomyopathy, plasma levels of NT-pro-BNP seem a reliable parameter to identify those at risk for clinical deterioration at long-term follow-up in conjunction with symptomatic status.

Social class and type of schizophrenia

Objective Current and past research strongly indicates a high prevalence of schizophrenia in the lower class in the USA and other stratified societies. To date, no study has tested for a connection between type of schizophrenia and socioeconomic status (SES). We tested for an interrelationship between schizophrenic subtype, SES and race. Methods Positive and negative symptom scales were used to evaluate 436 schizophrenic patients at a state hospital in the USA. All patients were also diagnosed by DSM standards. Social class of origin was assessed by the Occupational Classification Distributions of the U.S. Bureau of the Census. Multivariate analysis was conducted with the likelihood ratio chi-square. Results We uncovered a distinct propensity for deficit schizophrenia to be elevated among the poor. The finding presents as a pure SES effect since the likelihood of deficit schizophrenia does not vary by race when social class is held constant. Conclusion The finding is potentially an important new insight into the epidemiology of schizophrenia. It offers a better understanding for poor outcome among lower class patients in stratified societies such as the United States. It is also consistent with longitudinal research by European investigators.

Gastroesophageal reflux disease in obese patients: the role of obesity in management

Gastroesophageal reflux disease (GERD) is common in obese patients. The implications of obesity in the etiology, management and outcomes in treatment for GERD have become increasingly important due to an epidemic of obesity. The increasing prevalence of patients with both obesity and GERD merits evaluation of the appropriate surgical intervention for GERD and its symptoms. With the additional advantages of weight loss and resolution of weight-related morbidity (including GERD) bariatric procedures should be the procedure of choice in patients with medically complicated obesity. Patients in lower obesity classes with body mass indices (BMI) of 30-35 kg/m2 without other substantive weight-related comorbidity should prompt consideration of both fundoplication and bariatric procedures, tailoring the best approach based on the specific patient and future implications. Patients classified as overweight but not obese (BMI < 30) are likely best treated with fundoplication; however, no randomized trials comparing fundoplication with the current antireflux bariatric procedures exist.

From Curing to Witchcraft: Afro-Mexicans and the Mediation of Authority

From Curing to Witchcraft: Afro-Mexicans and the Mediation of Authority Joan Cameron Bristol In 1618 Esteban Dominguez, a Spaniard, reported to Inquisitors in Mexico City that a mulatto woman named Ana de Pinto had treated his sick friend, the Spanish alguacil (constable) Bartolomé Ruiz. Ana had applied a poultice to Bartolomé’s stomach and prepared special drinks for him. She then sewed a small bag embroidered with a cross into his shirt on the side over his heart, and made “the sign of the cross over the chest and ears of the sick man, at the same time making crosses everywhere in the name of the Holy Trinity God the father God the son and God the holy spirit” while murmuring words that Esteban could not decipher.2 Although Esteban had not questioned Ana’s treatment of Ruiz on his first visit to the sickroom, on a subsequent visit he became apprehensive when he saw the small bag sewn into Bartolomé’s shirt. He cut it off and, finding that it contained loose hairs, concluded that Ana was practicing hechicería, or witchcraft. When Bartolomé Ruiz was called to testify, however, he claimed that he had welcomed Ana de Pinto’s treatments. Even when an indigenous observer had speculated that the drinks that she prescribed contained peyote, a hallucinogen associated with indigenous rituals and prohibited by Inquisitorial edicts, Bartolomé had obediently submitted to her cures, apparently without question.3 In fact, when Ana had asked him if he would drink what she gave him, Bartolomé had responded “that to have health there was nothing that he wouldn’t take.”4 The example of a Spanish official deferring so completely to a mulatto woman, a person who would have been considered far inferior to him in terms of gender, wealth, color, and power, seems to contradict what we know about New Spain’s social hierarchy. Novohispano social identities were expressed through the concept of calidad (literally translated as quality or status), used to define people in order to differentiate Spaniards from the non-Spanish majority. Calidad was based on factors such as skin color, clothing, occupation, personal relationships, cultural practices, and limpieza de sangre (purity of blood, meaning that the bearer could prove Christian ancestry).5 Yet, despite differences in calidad between clients and curers, consultations with indigenous and Afro-Mexican curers were routine events for colonial people of every caste. This was due to various factors, including the lack of trained medical personnel in the colony. Between 1607 and 1738 only 438 people earned medical degrees in Mexico. Such a small number of physicians could not satisfy the medical needs of even the Spanish population of New Spain, which numbered 13,780 in 1646, much less the majority non-Spanish population.6 Furthermore, most physicians resided in cities and were thus inaccessible to people in rural areas. Empirics, licensed practitioners such as teeth pullers, bone setters, and midwives who were trained as apprentices, were also concentrated in cities. Furthermore, lower-class patients could not afford to consult physicians and empirics, whose services were more expensive than those of unlicensed curers. The limitations of academic medical knowledge, based on Galen’s humoral theory,7 also made curers an attractive option for ailing people. Even when licensed doctors and empirics were available they did not always have the tools or knowledge to heal illness, and curers might be called in when physicians’ treatments failed.8 Ideas about calidad also may have created demand for non-Spanish practitioners. Spaniards defined Africans, Native Americans, and their descendants as unrefined and close to nature. The idea that they were more in tune with the natural world may have led many to believe that non-Spanish curers had special abilities that were more effective than the scientific methods of Spanish physicians.9 Finally, curers handled a greater range of problems than trained physicians did, including helping with romantic troubles and finding lost things. Thus curers were necessary members of novohispano society, valued for their skills and frequently consulted for the most intimate problems. Given their importance, how did curers and clients, especially those of different castes, negotiate their relationships? What role did the social identities...

How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling?

20–40% of cancer patients show emotional distress. Psychosocial support should be offered to severely distressed patients. However, little is known about the selection of patients to whom such support should be offered. This study investigated oncologists' ability to identify such patients. In a consecutive series of 298 cancer patients undergoing radiotherapy, distress, perceived social support and desire for supportive counselling were assessed using screening instruments. Simultaneously, 8 oncologists estimated patient distress and need for psychosocial support. A complete set of data was obtained in 80.2% of cases. Concordance of the oncologists' estimation of patient distress and perceived social support with the results of the screening instruments was weak (κ = 0.10 and κ = 0.05). Oncologists recognized the presence of severe distress only in 11 of the 30 severely distressed patients. Correct perception of distress was lower in patients with head and neck cancer and lung cancer and in lower class patients. Oncologists' recommendations for supportive counselling did not correlate with patient distress or the amount of perceived support but rather with progressive disease and less denial behaviour. Our results underline the need for educating oncologists in order to improve their ability to identify patient distress. © 2001 Cancer Research Campaign http://www.bjcancer.com

Technology in the Hospital: Transforming Patient Care in the Early Twentienth Century by Joel D. Howell

770 Book Reviews TECHNOLOGY AND CULTURE Technology in the Hospital: Transforming Patient Care in the Early Twentienth Century. By Joel D. Howell. Baltimore: Johns Hopkins Uni­ versityPress, 1995. Pp. xv+341; illustrations, figures, tables, appen­ dices, notes, index. $47.50 (hardcover). During the first two decades of the 20th century, the American hospital evolved from a benevolent institution that served lower-class patients and elite physicians to a medical workshop that served pa­ tients of all classes and a broader cross section of physicians. This modern hospital was to become central to medical education, medi­ cal care, and clinical investigation. Medical historians have attrib­ uted the transformation of the hospital to factors both internal to medicine (such as the growth of medical technology, the rise of sci­ entific medicine, and reforms of medical education) as well as fac­ tors external to it (such as urbanization, immigration, and industrial­ ization). Previous accounts have concentrated on the impact of medical technologies, such as Wilhelm Roentgen’s 1895 discovery of x rays, as a major force in this transformation, suggesting that physicians readily incorporated them into their hospital practices. In this bookJoel D. Howell, a physician and medical historian at the University of Michigan—Ann Arbor, primarily focuses not on the machines but on the social contexts in which they were developed, defined, and applied. In 1900 the clinical exam dominated medical decision making. Although some laboratory tests existed, such as urinalysis and x rays, they rarely influenced diagnosis or therapy. By 1925 medical care was dominated by science and technology. Howell examines the fac­ tors behind this change by analyzing case records from 1900 and 1925 at two hospitals, Pennsylvania Hospital in Philadelphia and New York Hospital in New York City. Howell begins his book with an examination of how the ideals of the Progressive Era influenced hospital organization and medical practice. He argues that business technologies more than medical ones prompted the transformation of the hospital. As hospitals grew in scale they developed new administrative units, introduced ac­ counting techniques, and embraced standardized recording—all hallmarks of the efficiency movement and scientific management. Howell contends that the reorganization of the hospital along the lines of a factory was a prerequisite for the reception of medical technology. Hospitals needed efficient systems to manage the com­ plexity of the operating room and the x-ray lab. Howell spends the bulk of the book comparing the use of three medical technologies—urinalysis, x ray, and blood counts—at the two hospitals. The analysis of urine was a part of physicians’ arma­ mentarium at the turn of the century. By 1925, the meaning and clinical uses of the test had changed. It had moved from an admis­ sion ritual of litde utility for patient care to an important gauge of TECHNOLOGY AND CULTURE Book Reviews 771 specific clinical conditions. Howell ties this evolution, in part, to phy­ sicians’ traditional familiarity with the test, to the increased precision and scope of the technique, and to simultaneous reforms in medical education that emphasized laboratory-based medicine. Howell makes plain that the utilization of technology by physi­ cians was a socially negotiated process and that tensions often devel­ oped over its adoption. X rays were initially seen as a medical curios­ ity rather than a diagnostic and therapeutic tool. It took more than two decades after both hospitals purchased x-ray equipment before physicians began to use it routinely even for fractures. Some physi­ cians resisted the introduction of medical technologies, such as blood tests to evaluate appendicitis, because they feared that their use might devalue the status of physicians whose expertise lay in clinical skills rather than in technical ones. Howell also found re­ gional differences in the application of technologies—a finding that underscores the importance of analyzing technology within a social context. For example, at Pennsylvania Hospital women were signifi­ cantly less likely than men to receive an x ray, while the opposite was true at New York Hospital. Local medical culture and experi­ ences likely account for the variation. The use of patient records is the greatest strength of Howell’s book. It allows him to look beyond physical artifacts as causal agents in...

Alcohol consumption of patients attending two accident and emergency departments in north-west England.

The impact of alcohol use on the workload of two accident & emergency departments in north-west England was assessed by blood alcohol concentration (BAC) measurement, inspection of clinical records and interview of all patients aged 16 and over attending throughout a two-week period. The frequency of intoxication was similar to the previous reported rate in Scotland: 13.2% of all patients had a positive BAC. Inebriated injured patients arrived at all times of the day--varying in frequency from 2.5% of midday attenders to 78% of those presenting after midnight. The incidence of alcohol-related industrial accidents was low, but 60% of all assaulted patients were inebriated, many having sustained head injuries. Of patients attending within 2 hours of an accident at home, 19% also had a positive BAC, but 92% of those with ankle sprains were sober. Patients in lower social classes reported higher rates of alcohol consumption. The popularity of beer in comparison to wines and spirits was inversely related to age and unrelated to social class. Alcohol abuse is commonly associated with injuries sustained at home and with assaults occurring in public places. Prevention campaigns directed at the reduction of these types of incidents should be as concerned with the inebriation of the patient as with the architectural, environmental and legal framework within which the 'accident' occurs.

The relation of social class to risk factors, rehabilitation, compliance and mortality in survivors of acute coronary heart disease.

We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality.

Social class and psychiatric practice: a revision of the Hollingshead and Redlich model.

In 1958, Hollingshead and Redlich demonstrated that there were major differences in mental health care for lower-class patients: they primarily received low-intervention treatments from nonprofessional staff. The authors report a follow-up study initiated by F.C. Redlich that reveals new trends at the community mental health center (CMHC) serving the region studied by Hollingshead and Redlich. More than half of the lower-class patients who sought evaluation at this CMHC were discharged without a treatment assignment. Many lower-class patients, however, gained access to the CMHC's psychotherapy unit. Most of these patients were women, employed, and diagnosed as psychoneurotic. The authors conclude that the effect of social class on psychiatric care is less complete than Hollingshead and Redlich originally demonstrated.

Social class and psychiatric inpatient care: a twenty-five year perspective.

The authors present the major inpatient findings of the final survey conducted by the Trends in Mental Health project. This project, initiated by F.C. Redlich in 1975, is a limited follow-up of Hollingshead and Redlich's,Social class and mental illness. In spite of an enormous proliferation in psychiatric services in the survey's study region over the past 25 years, social class remains a major predictor of locus of inpatient care. In general, class II–IV patients have made significant shifts toward receiving private inpatient care. However, certain subgroups of lower-class patients — blacks, women and those with serious psychiatric disorders — still have limited access to private inpatient treatment. In addition, class V patients continued to exclusively utilize the public system. Deinstitutionalization and the shift of class IV and higher patients to private facilities have created a pooling of the most socially disabled patients on the public inpatient units. For example, almost 80% of all public inpatients were chronically unemployed and 60% lived alone when not hospitalized. The public policy implications of limited social access and the increased relative percentage of socially debilitated patients on public inpatient facilities are addressed.

Eating attitudes in adolescent anorectic patients

Eating Attitudes Test (EAT) scores gathered from 18 female adolescent anorectic patients with very early onset of the disease were compared with existing literature, and analyzed in terms of their relationships to clinical and background variables and other scales measuring anorectic behavior. Trans-cultural comparisons revealed that this sample of German patients had lower scores than Canadian, British, and Dutch samples of older age. The scores of the EAT were independent of denial of illness. Vomiters and lower-class patients had fewer abnormal scores. Therapeutic change between admission and discharge from inpatient treatment was reflected in improved EAT scores. A number of significant correlations with other scales measuring anorectic behavior were detected.

From Asylum to Community

Before 1950, publicly supported psychiatric services (i.e., those of so-called public psychiatry) were provided primarily at state hospitals. Over the past 30 years public psychiatry has shifted its emphasis away from long-term custodial care to outpatient and community-based services. Paradoxically, this broadening of focus has become associated with both an expanded use of psychiatric services and a threatened decline in clinical standards and treatment goals. Five areas of policy confusion and contradiction threaten the stability of public mental-health services: the shift in emphasis from public to private services, the issue of rehabilitation and reintegration into society versus custodial care, the differential treatment of the lower-class patient, the demedicalization of public services, and conflict between professionals and blurring of roles within the psychiatric profession. These problems reflect public psychiatry's overemphasis on social reform and political rather than clinical definitions of treatment, its lack of specific treatment and of defined treatment goals, and its inability to change psychiatry's (and society's) historical assignment of low status to the public patient.