Objective: this part I article explores the different meanings of relevant keywords for General Practice/Family Medicine (GP/FM) in the prevention domain. The aim is to contribute to information process in GP/FM by keeping in line with the main terms used in health care organization. Methods: important keywords for GP/FM in the prevention domain were selected. Then, a search was carried out on the main sources in GP/FM databases, as well as in Medical Subject Heading and major terminological databases available online. Results and Discussion: there is discrepancy between the conceptual contents of major prevention models amongst the usual bibliographic sources of knowledge in GP/FM in particular and medicine in general. Conclusion: For GP/FM, distribution of preventive activities is now firmly established on a new constructivist model, privileging the doctor-patient relationships and introducing a cybernetic thinking on the health care activities with a special commitment to ethics and the positive duty of beneficence.
The words of prevention, part II: ten terms in the realm of quaternary preventionAs palavras da prevenção, parte II: dez termos no âmbito da prevenção quaternária AbstractObjective: this part II article about the 'words of prevention' presents in a terminological way the content of ten current concepts used in the prevention domain which are closely linked to quaternary prevention: (1) overinformation; (2) overdiagnosis; (3) medically unexplained symptoms; (4) overmedicalization; (5) incidentaloma; (6) overscreening; (7) overtreatment; (8) shared decision making; (9) deprescribing; and (10) disease mongering. Methods: with the support of the laboratory team of the University of Rouen, France, which is dedicated to medical terminology and semantic relationships, it was possible to utilize a graphic user interface (called DBGUI) allowing the construction of links for each of chosen terms, and making automatic links to MeSH, if any. Those concepts are analyzed in their environment in current literature, as well as in their MeSH counterparts, if any, and related semantic online terminologies. Results and Discussion: the rules in terminological development aspire to cover the whole field of a concept and in the meantime, they can help to avoid the noise due to proxy and not exactly related issues. This refers to exhaustivity and specificity in information retrieval. Our finds show that referring to MeSH only in information retrieval in General Practice/Family medicine can induce much noise and poor adequacy to the subject investigated. Conclusion: gathering concepts in specially prepared terminologies for further development of ontologies is a necessity to enter in the semantic web area and the era of disseminated data in family medicine. ResumoObjetivo: este artigo parte II sobre as 'palavras da prevenção' apresenta de uma forma terminológica o conteúdo de dez conceitos atuais utilizados no domínio da prevenção, que estão intimamente ligados à prevenção quaternária: (1) sobrecarga de informação; (2) sobrediagnóstico; (3) sintomas sem explicação médica; (4) sobremedicalização; (5) incidentaloma; (6) sobrerrastreamento; (7) sobretratamento; (8) tomada de decisão compartilhada; (9) desprescrição; e (10) comercialização de doenças. Métodos: com o apoio da equipe do laboratório da Universidade de Rouen, França, que se dedica à terminologia médica e às relações semânticas, foi possível utilizar uma interface gráfica de usuário (chamado DBGUI) permitindo a construção de links para cada um dos termos escolhidos, fazendo ligações automáticas para o MeSH, caso houvesse. Estes conceitos foram analisados no seu ambiente na literatura corrente, bem como os seus homólogos no MeSH, caso houvesse, e terminologias semânticas online a eles relacionadas. Resultados e Discussão: as regras em desenvolvimento terminológico aspiram cobrir todo o campo de um conceito, ao mesmo tempo em que podem auxiliar a evitar ruídos devido a aproximações e questões não exatamente relacionadas. Isto se refere à exaustividade e especificidade na recuper...
A través del fenómeno de la medicalización, multitud de procesos que anteriormente eran considerados ajenos a la jurisdicción de la medicina han pasado a ser explicados y tratados por médicos. Uno de ellos es el proceso natural del envejecimiento, y dentro de él, el declive en la actividad -principalmente sexual- del varón. Clásicamente llamado andropausia y considerado como un síndrome por falta de testosterona, ha pasado por momentos históricos en los que casi parecía desaparecido del discurso médico. Sin embargo, con el auge de los medicamentos para el sexo, la idea de la andropausia ha resurgido, a pesar de que numerosas evidencias científicas acumuladas en los últimos años hayan alimentado muchas dudas alrededor de este concepto.La información sobre salud ayuda a normalizar los procesos sociales por los que determinados problemas caen en el dominio de la medicina. La andropausia no ha sido ajena a este fenómeno. A través del análisis de noticias aparecidas en medios españoles de prensa escrita sobre la andropausia y la sexualidad del varón maduro, en el artículo se describen algunos ejemplos que muestran cómo los medios de comunicación han podido influir en la medicalización de este proceso. Igualmente, se analizará la influencia que ejercen los grupos de presión, a través de la financiación de los grupos mediáticos, y de los conflictos de interés de medios y profesionales de la comunicación en la selección de las fuentes de información y en los contenidos de la misma, así como el papel de las agencias de prensa y las asociaciones de periodistas.
We strongly disagree with the British Society for Sexual Medicine's "reflections" on testosterone. 1 Firstly, there is no consistent evidence that hormone replacement provides clear health or patient oriented benefits in most men with low testosterone values. The Endocrine Society therefore recommends against a general policy of offering testosterone to all older men with low testosterone values. 2 Secondly, the safety of testosterone treatment is not entirely clear. Hackett and colleagues state that treatment reduces cardiovascular mortality, citing data from an observational study plagued by limitations and bias. 3 Instead, a recent randomised clinical trial was stopped early because of an increase in deaths in the testosterone arm. 4 A tendency towards increased mortality was also shown in a earlier meta-analysis that didn't include this trial. 5Testosterone replacement in older men has been associated with a significantly higher risk of prostate events (odds ratio 1.78, 95% confidence interval 1.07 to 2.95), 6 and to date no long term placebo controlled trials have evaluated the risk of prostate cancer.Long term placebo controlled studies with hard endpoints are needed before this treatment is used. The increase in testosterone prescribing is probably due to marketing forces rather than evidence based arguments. Competing interests: None declared. 1 Hackett G, Kirby M, Jackson G, Wylie K; On behalf of the British Society for Sexual Medicine. Evidence based medicine inevitably increases testosterone prescribing. BMJ 2012;345:e6167. (24 September.) 2 Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:2536-59. 3 Wu FC. Caveat emptor: does testosterone treatment reduce mortality in men? J Clin Endocrinol Metab 2012;97:1884-6. 4 Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, et al. Adverse events associated with testosterone administration. N Engl J Med 2010;363:109-22. 5 Haddad RM, Kennedy CC, Caples SM, Tracz MJ, Boloña ER, Sideras K, et al. Testosterone and cardiovascular risk in men: a systematic review and metaanalysis of randomized placebo-controlled trials. Mayo Clin Proc 2007;82:29-39. 6Calof OM, Singh AB, Lee ML, Kenny AM, Urban RJ, Tenover JL, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials.
The so-called «testosterone deficiency syndrome» is a blend of nonspecific symptoms typical of the physiological process of aging. This syndrome has been the subject of intense promotional activity that has presented the phenomenon as highly prevalent and with a major public health impact. This strategy has been accompanied by the emergence of new and easy to administer testosterone devices into the pharmaceutical market and has generated significant sales for drug companies. The commercial promotion of testosterone deficiency syndrome and its remedies has exploited cultural stereotypes of aging and sexuality through awareness campaigns promoted by the laboratories involved and has been disseminated by media with the participation of numerous experts and with the support of scientific associations, representing a paradigmatic case of disease mongering. This example might be of use in the response to disease mongering activities from the clinical and public health fields.
Información editorial Folia Humanística publica artículos por encargo solicitados a especialistas, así como aquellas propuestas enviadas por los autores y aceptadas tras su evaluación por pares de académicos especializados. Los textos recibidos se publicaran en la lengua original (castellano, catalán, inglés y francés); los que se consideren de relevancia mayor serán traducidos al inglés y castellano. Los artículos deben ser originales y acompañados del documento "derechos de autor" que encontrarán en la web, junto a las normas de presentación a seguir. Cada artículo publicado al final tendrá especificado la referencia de citación, donde se incluirá el número DOI ®. Distribución La Revista Folia Humanística es de libre acceso a consultar online. http://www.fundacionletamendi.com/category/rev ista/ Folia Humanística es una revista internacional que tiene el doble objetivo de fomentar, por un lado, la reflexión y el debate público en el ámbito de la Salud, Ciencias Sociales y Humanidades, y por el otro, la colaboración entre distintos equipos de investigación nacionales e internacionales que dinamicen el diálogo entre la filosofía de la medicina, la salud pública y la justicia social. Dividida en "Tema del día", (artículos para el debate), "Pensamiento actual", (artículos críticos de novedades editoriales), y "Arte, Salud y Sociedad", la revista se esfuerza en fortalecer las conexiones entre la investigación académica, la práctica clínica, las experiencias de los pacientes y sus implicaciones éticas y estéticas en la sociedad. Todo ello con la intención de favorecer la reflexión entre diferentes disciplinas sobre temas de actualidad y las tendencias más novedosas en el campo de las Humanidades y la Salud. Folia Humanística is an International Journal, born with the dual aim of fuelling the discussion and public debate on issues of health, social sciences and humanities and on the hand, of fostering cooperation between various research groups, both national and International, to spur the dialogue between philosophy and medicine, public health and social justice. The Journal is divided into three different sections: "main focus" (article for debate), "Contemporary thought" (critical reviews of new Publications) and "Arts, Health and Society" which all contribute to strengthening the links between academic research, clinical practice, the experience of patients and their ethical and esthetical implications for society. Ultimately, the intention of the Journal is to promote reflection at the crossroads of several disciplines on topical issues and new trends in humanities and health.
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