Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China.

BACKGROUND: The Eleventh Revision of International Classification of Diseases (ICD-11) newly listed gaming disorder, including internet gaming disorder (IGD), as a disease. The level of awareness and potential positive and negative impacts of this medicalization among adolescents were unknown. OBJECTIVE: This study investigated the levels, associated factors, and potential positive and negative impacts of awareness of the medicalization of IGD among adolescents in China. METHODS: In a cross-sectional survey, 1343 middle school students in Guangzhou, China, self-administered an anonymous questionnaire in classrooms (October to December 2019). Three risk subgroups were identified: those who scored ≥5 items in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition checklist (IGD-S), those who self-perceived having IGD currently (IGD-PC), and those who self-perceived having IGD within 12 months (IGD-P12M). RESULTS: Of the internet gamers, 48.3% (460/952) were aware of the medicalization of IGD; they were more likely to belong to the IGD-P12M/IGD-S risk subgroups. Within the IGD-PC/IGD-P12M (but not IGD-S) risk subgroups, IGD medicalization awareness was positively associated with favorable outcomes (reduced internet gaming time in the past 12 months, seeking help from professionals if having IGD, and fewer maladaptive cognitions). After being briefed about the ICD-11 inclusion of IGD, 54.2% (516/952) and 32.8% (312/952) expressed that it would lead to the reduction of gaming time and help-seeking behaviors, respectively; however, 17.9% (170/952), 21.5% (205/952), 15.9% (151/952), and 14.5% (138/952) perceived self-doubt for being diseased, stronger pressure from family members, negative emotional responses, and labeling effect, respectively. With a few exceptions, such perceived positive or negative impacts were stronger among the IGD-S, IGD-PC, and IGD-P12M risk subgroups. CONCLUSIONS: The exploratory study shows that the medicalization of IGD may have benefits that need maximization and potentially harmful effects that need minimization. Future studies should test the efficacies of health promotion that increases IGD medicalization awareness.

[Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic.] / La medicalización de residencias como alternativa real a la hospitalización durante la pandemia de COVID-19.

OBJECTIVE: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease. METHODS: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency. RESULTS: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission. CONCLUSIONS: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes.

OBJETIVO: Las residencias de ancianos son entornos de alto riesgo para la transmisión del coronavirus SARS-CoV-2, por tratarse de ambientes cerrados, con personas que muestran manifestaciones atípicas de la enfermedad, con altas posibilidades de evolucionar desfavorablemente y con personal que frecuentemente presenta una elevada movilidad en relación a los puestos de trabajo. Por otro lado, en una situación de pandemia, numerosos centros hospitalarios han soportado periodos de gran presión asistencial. El objetivo de este trabajo fue presentar una experiencia de medicalización de una residencia donde casi el 50% de los residentes contrajo la enfermedad. METODOS: Se llevó a cabo una intervención multidisciplinar en una residencia de ancianos de titularidad pública con 99 residentes. Trabajaron de forma conjunta especialistas de Medicina Interna, Atención Primaria y técnicos de salud, en estrecha colaboración con los trabajadores de la residencia. Se habilitó la presencia de personal de Enfermería las 24 horas y personal médico con visita diaria. Se dotó al centro de los medios necesarios para la administración de la medicación (oral e intravenosa) y la oxigenoterapia necesaria para atender a los pacientes con la enfermedad. Los resultados analíticos estaban disponibles en 24 horas. Para el análisis de los datos se calcularon los porcentajes y se empleó la media como medida de tendencia central. RESULTADOS: Cuarenta y ocho residentes (48,5%) y quince trabajadores contrajeron la enfermedad. El número total de fallecimientos durante ese periodo fue de trece (13,1%), siete de ellos con diagnóstico de COVID-19 (edad media de 84,4 años), siendo la tasa de letalidad del 14,6%. Once pacientes (22%) con diagnóstico de COVID-19 fueron hospitalizados, falleciendo dos durante el ingreso. CONCLUSIONES: La medicalización de las residencias puede contribuir a disminuir la presión asistencial en los centros hospitalarios, así como a optimizar los cuidados a estas personas vulnerables con una asistencia más humanizada, lo que puede redundar, finalmente, en mejores resultados en salud.

Medical diagnosis of dyslexia in a Swedish elite school: A case of "consecrating medicalization".

Based on qualitative data of an upper-secondary school in Sweden's primary elite community, Djursholm, I propose how medical diagnosis of students as dyslexics contributes to consecrating them by offering a short cut to successful performance, while at the same time reproducing differences between social classes. The study suggests how students that do not score top can be labeled dyslexic and the social and moral consequences of that. I introduce the concept of "consecrating medicalization" in order to discriminate between the effects of medical diagnosis of members of different social classes. In this way, this paper contributes to further examining some key problems in medical sociology and the sociology of elites, by offering a framework of synthesis and integration.

[Machines and artisanal health workers]. / Máquinas y arte-sanos.

This work discusses the dominant models and tensions within the health field regarding the conceptualization of the human body (as a machine), the process of health work (industrial and artisanal models), institutions (hospitals and health centers) and primary agents (the medical corporation and the medical industrial complex). The context of analysis is the United States from the end of the 19th century to the present. Economic-political, ideological-cultural, and scientific-technical dimensions are discussed, which permeate the historicity of the field. The purpose is to illustrate how the health field has transformed over time, as well as the role instrumental reason and financial capital has played in this process, to the detriment of relational aspects.

Este trabajo discute los modelos dominantes y las tensiones, al interior del campo de la salud, entre la concepción del cuerpo humano (máquina); el proceso de trabajo médico (modelos industriales o artesanales); las institucionalidades (hospitales y centros de salud) y los principales agentes (corporación médica y complejo médico industrial). El análisis se contextualiza en EEUU desde fines del siglo XIX a la actualidad. Se discuten dimensiones económico-políticas, ideológico-culturales y científico-técnicas, que atraviesan la historicidad del campo. El propósito es elucidar cómo se viene transformando el campo de la salud, y qué peso tiene la razón instrumental y el capital financiero en ese proceso, en detrimento de lo relacional.

Rebirth of childbirth: reflections on medicalization of the Brazilian obstetric care.

OBJECTIVE: to reflect on the medicalization process of childbirth and birth and its consequences based on a Brazilian audiovisual media artifact. METHOD: reflective and interpretive analysis of the documentary O Renascimento do Parto (The Rebirth of Childbirth) based on Critical Discourse Analysis. RESULTS: c-section emerges as an alternative to adverse conditions of pregnancy. However, it has become a routine and abusive practice of a medicalized obstetric care, thus becoming a social problem. In order to the incidence of c-sections decrease, women's protagonism must be restored, in addition to considering psychological, affective, emotional, spiritual, cultural, and contextual aspects in childbirth. CONCLUSION: childbirth is established as a material element and a mental phenomenon of social practices. We must interrupt the predominant model, allowing the body to express itself through the release of oxytocin, and decrease the segregation that c-section causes, thus enabling affective bonds.

Rebirth of childbirth: reflections on medicalization of the Brazilian obstetric care / Renacimiento del parto: reflexiones sobre la medicalización de la atención obstétrica en Brasil / Renascimento do parto: reflexões sobre a medicalização da atenção obstétrica no Brasil

ABSTRACT Objective: to reflect on the medicalization process of childbirth and birth and its consequences based on a Brazilian audiovisual media artifact. Method: reflective and interpretive analysis of the documentary O Renascimento do Parto (The Rebirth of Childbirth) based on Critical Discourse Analysis. Results: c-section emerges as an alternative to adverse conditions of pregnancy. However, it has become a routine and abusive practice of a medicalized obstetric care, thus becoming a social problem. In order to the incidence of c-sections decrease, women's protagonism must be restored, in addition to considering psychological, affective, emotional, spiritual, cultural, and contextual aspects in childbirth. Conclusion: childbirth is established as a material element and a mental phenomenon of social practices. We must interrupt the predominant model, allowing the body to express itself through the release of oxytocin, and decrease the segregation that c-section causes, thus enabling affective bonds.

RESUMEN Objetivo: reflexionar sobre el proceso de medicalización al parto y nacimiento y sus consecuencias, a partir de un artefacto mediático audiovisual brasileño. Método: análisis reflexivo e interpretativo del documental "O Renascimento do Parto", basado en el Análisis Crítico del Discurso. Resultados: la cesárea se configura como alternativa a condiciones adversas en la gestación. Sin embargo, se convirtió en una práctica rutinaria y abusiva, de una atención obstétrica medicalizada, pasando a ser un problema social. Para que la incidencia de cesáreas disminuya es necesario que sea restituido el protagonismo de la mujer, además de considerar aspectos psicológicos, afectivos, emocionales, espirituales, culturales y contextuales en el parto. Conclusión: el parto se configura como elemento material y fenómeno mental de las prácticas sociales. Es necesario romper con el modelo predominante, permitir que el cuerpo se exprese por medio de la liberación de oxitocina y disminuir la segregación que la cesárea provoca, proporcionando la formación de vínculos afectivos.

RESUMO Objetivo: refletir sobre o processo de medicalização ao parto e nascimento e suas consequências, a partir de um artefato midiático audiovisual brasileiro. Método: análise reflexiva e interpretativa do documentário "O Renascimento do Parto", baseada na Análise do Discurso Crítica. Resultados: a cesariana configura-se como alternativa para condições adversas gestacionais. Entretanto, tornou-se uma prática rotineira e abusiva, de uma atenção obstétrica medicalizada, passando a ser um problema social. Para que a incidência de cesarianas diminua é necessário que seja restituído o protagonismo da mulher, além de considerar aspectos psicológicos, afetivos, emocionais, espirituais, culturais e contextuais no parto. Conclusão: o parto configura-se como elemento material e fenômeno mental das práticas sociais. É necessário romper com o modelo predominante, permitir que o corpo se expresse por meio da liberação de ocitocina e diminuir a segregação que a cesariana provoca, proporcionando a formação de vínculos afetivos.

Heroic struggles, criminals and scientific breakthroughs: ADHD and the medicalization of child behaviour in Australian newsprint media 1999-2009.

There is a dearth of scholarly analysis and critique of the Australian newsprint media's role in the medicalization of child behaviour. To begin to redress this lack this paper analyses newsprint media's use of metaphors that re/describe and construct realities of ADHD with a medicalizing effect. The interdisciplinary team used the FactivaTM database to locate and review 453 articles published in Australian national and metropolitan newspapers during the decade 1999-2009. Data analysis involved generating statistical descriptions of the dataset according to attributes such as: date, state, newspaper titles and author names. This was followed by inductive analysis of article content. Content analysis revealed pervasive and striking use of metaphor in newsprint media reporting of ADHD content, especially when describing health professionals, educators, parents and children. This collection of metaphors was striking, and while the metaphors deployed were varied, this diversity seemed underscored by a common functionality that increased the risk that child behaviour was explained using medicalized knowledge. We contend that these metaphors collectively and coherently functioned to simplify and delimit meanings of children's health and behaviour to favour depictions that medicalize problems of children and childhood.

Finger Pricks and Blood Vials: How doctors medicalize 'cultural' solutions to demedicalize the 'broken' hymen in the Netherlands.

This paper provides new perspectives on the scholarship on medicalization and demedicalization, building on an ethnography of hymenoplasty consultations in the Netherlands. By examining how doctors can play an active role in demedicalization, this paper presents novel insights into Dutch physicians' attempt to demedicalize the "broken" hymen. In their consultations, Dutch doctors persuade hymenoplasty patients to abandon the assumed medical definition of the "broken" hymen and offer nonmedical solutions to patients' problems. Drawing from unique ethnographical access from 2012 to 2015 to 70 hymenoplasty consultations in the Netherlands, this paper's original contribution comes from closely examining how demedicalization can be achieved through the process of medicalization. It investigates how Dutch physicians go even further in their efforts to demedicalize by medicalizing "cultural" solutions as an alternative course of action to surgery.

Medicalization in psychiatry: the medical model, descriptive diagnosis, and lost knowledge.

Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the "atheoretical" approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry's over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry.  As a result,  the field has suffered a loss of knowledge that may be difficult to recover.

Early start renal replacement therapy for acute kidney injury-Universal panacea or another case of over medicalization?

Despite advances in medical practice and renal replacement therapy, the mortality of patients who develop acute kidney injury remains high. In the field of cardiology, the management of myocardial infarction has evolved from one of conservative bed rest to primary coronary intervention. As renal replacement therapy is now generally available, the question arises whether earlier intervention could lead to improved patient outcomes. The evidence to date is primarily centered on retrospective observational reports, with the majority reporting increased patient survival for earlier intervention. However, these reports are typically based on small numbers of patients and differ in the etiology of acute kidney injury, patient comorbidity, and definitions of what constitutes "early" start. To date, there is less than a handful of prospective randomized studies published in the modern era. Again these are small studies, with differing patient populations, and definitions of "early" start, but generally do not show any significant advantage for an "early" start approach. As such until adequately powered prospective trial data become available, the decision to initiate renal replacement therapy should be made by the traditional review of patient history, repeated clinical assessments, and trends in biochemical data.

The context of empowerment and self-care within the field of diabetes.

There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu's concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically 'policed' field of diabetes is explored using empirical data from a study of diabetes health-care professionals' understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.

The sexualization of the medical.

The medicalization of sex is part of an already-in-place discursive problem that can be illuminated by looking at efforts to sexualize the medical. "Erectile dysfunction," "female sexual dysfunction," and their real and imagined pharmacopia, do not constitute the medicalization of sex; they are effects of sex already having been-to borrow a term from Peter Conrad ( 1992 )-healthicized. The equation of sex and health, as cultural common sense, has made health seem like the natural discourse for thinking about sex in the first place. Reversing the terms of this special issue, and using the methodology of rhetorical analysis, this article looks at the person with cancer as a sexualized subject-someone whose health is represented as intimately tied to his or her sex life. It suggests that, in public discourse-and notably in movies and on television-sex is the comic ending of the illness narrative. In light of this narrative move, the ability to have good sex joins the ability to be positive and cheerful as a (Western) cultural imperative of illness experience, in general, and cancer experience, in particular. Public representations of illness virtues often fail, then, to answer realistically the compelling question, "How shall I be ill?"