Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervized weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) (...) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervized weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization. (shrink)

When the original Dutch version of this book was presented in 1971 to the University of Leiden as a thesis for the Doctorate in philosophy, I was prevented by the academic mores of that university from expressing my sincere thanks to three members of the Philosophical Faculty for their support of and interest in my pursuits. I take the liberty of doing so now, two and a half years later. First and foremost I want to thank Professor G. Nuchelmans warmly (...) for his expert guidance of my research. A number of my most im portant sources were brought to my attention by him. During the whole process of composing this book his criticism and encouragement were carried out in a truly academic spirit. He thereby provided working conditions that are a sine qua non for every author who is attempting to approach controversial matters in a scientific manner, conditions which, however, were not easily available at that time. In a later phase I also came into contact with Professors L. M. de Rijk and J. B. Ubbink, with both of whom I had highly stimulating discussions and exchanges of ideas. The present edition contains some entirely new sections, viz. 1-9, IV-29, V-9, V-20, VII-14 (iii), (iv), VII-17 (i), VIII-22, IX-17, IX-19, X-9 and XI-8. Section X-9 was inspired by a remark made by Professor A. (shrink)

The contributions in the first part Re-modelling logic of this volume take account of formal logic in the theory of rational argumentation.

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Else Margarete Barth (1928-2015) was een Noors-Nederlandse filosoof.0Else Barth vond dat filosofie in dienst zou moeten staan van de combinatie van medemenselijkheid en helder, geïnformeerd denken en discussiëren. Barth was ervan overtuigd dat zorgvuldig redeneren en debatteren noodzakelijk is voor het verbeteren van menselijke relaties. Met logica als wapen bestreed ze vaagheid en vooroordelen. Om logica van betekenis te maken voor het praktische leven, verbond ze het met analytisch onderzoek naar ideeën die rondwaren in wetenschap en politieke cultuur. Haar (...) bijzondere belangstelling ging daarbij uit naar anti-argumentatieve en anti-parlementaire houdingen en denksystemen die, vaak ten faveure van een hoger doel, minachting voor (groepen) individuen legitimeren of zelfs aanmoedigen. Met haar pleidooi voor een 'empirische logica' leverde Barth een originele bijdrage aan de Europese wijsbegeerte, die ook voor de huidige tijd relevant is.0'Empirische logica' is een selectie uit Barths werk. De bundel bevat voorbeelden van toegepast empirisch-logisch onderzoek, naar de logische grondslagen van het Duitse idealisme bijvoorbeeld, die volgens Barth dezelfde zijn als die van de klassieke homeopathie, naar het denken van de Noorse nazi Quisling, maar ook naar de onevenredige aandacht voor 'gemiddelden' in de sociale wetenschappen, die tot stigmatisering leidt. In beschouwende stukken reflecteert de auteur onder meer op het belang van cultuur-georiënteerd logica-onderwijs en zoekt ze een verklaring voor de kloof tussen logica en politiek. Ten slotte zijn essays0opgenomen die Barth schreef over filosofen die haar inspireerden: Bertrand Russell, Evert Willem Beth en Arne Naess. (shrink)

This book is a guide to the poetics of the two Greek fountainheads of Western literary theory. Part I traces the development of Plato's great themes of inspiration and imitation but makes no attempt to reduce his disparate statements to a system. Part II demonstrates that Aristotle's Poetics embodies a powerful theory of literature that answers Plato's objections to poetry as an emotionally powerful, and therefore dangerous, communication of false opinion. Originally published in 1987. A UNC Press Enduring Edition -- (...) UNC Press Enduring Editions use the latest in digital technology to make available again books from our distinguished backlist that were previously out of print. These editions are published unaltered from the original, and are presented in affordable paperback formats, bringing readers both historical and cultural value. (shrink)

The evidence-based practice movement fails to pay attention to and to respect sufficiently the fundamental differences that exist between clinical practice and the kind of research that is modeled on the natural sciences. According to M. Polanyi knowledge, will always have a tacit dimension that is not possible to operationally define. This paper argues that the tacit dimension is especially important in clinical knowledge. This represents a challenge to the dominance of positivism and to the evidence-based practice movement. As psychiatrists, (...) we must be able to attend to the patient's perspective, his subjective experience and context. Clinical practice is a careful balance between dialogue and technique. Evidence-based psychiatry might tilt this balance toward a more technical attitude. This could pose problems, considering the importance of the so-called nonspecific factors in psychotherapy. (shrink)

Beliefs have the potential to obscure and legitimate, or to challenge, inequalities of gender and race. Through an analysis of the association between education and beliefs about racial and gender inequality, this article explores for whom education is most likely to foster beliefs that challenge social inequality. Data from the 1996 General Social Survey suggest that education tends to have a greater positive impact on rejection of group segregation and rejection of victim-blaming explanations for inequality than it does on recognition (...) of discrimination or endorsement of group-based remedies for inequality. This pattern is consistent with the view that education reproduces rather than challenges inequality, and it is evident for white men, white women, and African American men. African American women present an exception, which is considered in terms of the unique structural location and historical legacy surrounding African American women's relationship to education. (shrink)

Public debate about who or what is to blame for the rising rates of obesity and overweight shifts between two extreme opinions. The first posits overweight as the result of a lack of individual will, the second as the outcome of bodily drives, potentially triggered by the environment. Even though apparently clashing, these positions are in fact two faces of the same liberal coin. When combined, drives figure as a complication on the road to health, while a strong will should (...) be able to counter obesity. Either way, the body’s propensity to eat is to be put under control. Drawing on fieldwork in several obesity clinics and prevention sites in the Netherlands, this paper first traces how this ‘logic of control’ presents itself in clinical practices targeted at overweight people, and then goes on to explore how these practices move beyond that logic. Using the concepts of ‘will’ and ‘drives’ as analytical tools, I sketch several modes of ordering reality in which bodies, subjects, food and the environment are configured in different ways. In this way it appears that in clinical practices the terms found in public discourse take on different meanings and may even lose all relevance. The analysis reveals a richness of practiced ideals. The paper argues, finally, that making visible these alternative modes of ordering opens up a space for normative engagements with obesity care that move beyond the logic of control and its critiques. (shrink)