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Social science & medicine 20건

  1. [해외논문]   Trade liberalization and social determinants of health: A state of the literature review  

    McNamara, C.
    Social science & medicine v.176 ,pp. 1 - 13 , 2017 , 0277-9536 ,

    초록

    The health impacts of trade liberalization are often described in relation to access to medicines, changing dietary patterns, tobacco use and alcohol consumption. The impacts of trade liberalization on the social determinants of health (SDH), are by contrast, less well known. Missing is an account of how liberalizing processes identified across different research areas relate to each other and how the association between trade liberalization and health is conceptualized within each of them, especially with reference to SDH. This paper presents a systematic review which provides a more complete picture of the pathways between trade liberalization and health, with special attention to SDH pathways. This picture captures the interrelationships between different areas of investigation, along with current limitations of our understanding and recommendations for future research.

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  2. [해외논문]   Guilt without fault: A qualitative study into the ethics of forgiveness after traumatic childbirth  

    Schroder, K. ; la Cour, K. ; Jorgensen, J.S. ; Lamont, R.F. ; Hvidt, N.C.
    Social science & medicine v.176 ,pp. 14 - 20 , 2017 , 0277-9536 ,

    초록

    When a life is lost or severely impaired during childbirth, the midwife and obstetrician involved may experience feelings of guilt in the aftermath. Through three empirical cases, the paper examines the sense of guilt in the context of the current patient safety culture in healthcare where a blame-free approach is promoted in the aftermath of adverse events. The purpose is to illustrate how healthcare professionals may experience guilt without being at fault after adverse events, and Gamlund's theory on forgiveness without blame is used as the theoretical framework for this analysis. Philosophical insight has proven to be a useful resource in dealing with psychological issues of guilt and Gamlund's view on error and forgiveness elucidates an interesting dilemma in the field of traumatic events and medical harm in healthcare, where healthcare professionals experience that well-intended actions may cause injury, harm or even death to their patients. Failing to recognise and acknowledge guilt or guilty feelings may preclude self-forgiveness, which could have a negative impact on the recovery of midwives and obstetricians after adverse events. Developing and improving support systems for healthcare professionals is a multi-factorial task, and the authors suggest that the narrow focus on medico-legal and patient safety perspectives is complemented with moral philosophical perspectives to promote non-judgemental recognition and acknowledgement of guilt and of the fallible nature of medicine.

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  3. [해외논문]   Son-biased sex ratios in 2010 US Census and 2011-2013 US natality data  

    Almond, D. ; Sun, Y.
    Social science & medicine v.176 ,pp. 21 - 24 , 2017 , 0277-9536 ,

    초록

    If gender bias is receding, demographic manifestations of son preference should also tend to decrease. The sex composition of US children provides a key barometer of gender preference. In the 2010 US Population Census, Chinese and Asian-Indian families are more likely to have a son after a daughter, consistent with previous research. Korean-American families, by contrast, do not show this same pattern, paralleling recent declines in sex selection observed for South Korea. Non-Hispanic White families have sex ratios within the range of the biologically norm regardless of the sex composition of previous children. We corroborate the 2010 Census data with 2011-2013 birth certificate microdata, which likewise show elevated sex ratios for Chinese and Asian Indians at higher birth orders.

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  4. [해외논문]   Conceptualisation of the 'good' self-manager: A qualitative investigation of stakeholder views on the self-management of long-term health conditions  

    Ellis, J. ; Boger, E. ; Latter, S. ; Kennedy, A. ; Jones, F. ; Foster, C. ; Demain, S.
    Social science & medicine v.176 ,pp. 25 - 33 , 2017 , 0277-9536 ,

    초록

    Healthcare policy in developed countries has, in recent years, promoted self-management among people with long-term conditions. Such policies are underpinned by neoliberal philosophy, as seen in the promotion of greater individual responsibility for health through increased support for self-management. Yet still little is known about how self-management is understood by commissioners of healthcare services, healthcare professionals, people with long-term conditions and family care-givers. The evidence presented here is drawn from a two-year study, which investigated how self-management is conceptualised by these stakeholder groups. Conducted in the UK between 2013 and 2015, this study focused on three exemplar long-term conditions, stroke, diabetes and colorectal cancer, to explore the issue. Semi-structured interviews and focus groups were carried out with 174 participants (97 patients, 35 family care-givers, 20 healthcare professionals and 22 commissioners). The data is used to demonstrate how self-management is framed in terms of what it means to be a 'good' self-manager. The 'good' self-manager is an individual who is remoralised; thus taking responsibility for their health; is knowledgeable and uses this to manage risks; and, is 'active' in using information to make informed decisions regarding health and social wellbeing. This paper examines the conceptualisation of the 'good' self-manager. It demonstrates how the remoralised, knowledgeable and active elements are inextricably linked, that is, how action is knowledge applied and how morality underlies all action of the 'good' self-manager. Through unpicking the 'good' self-manager the problems of neoliberalism are also revealed and addressed here.

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  5. [해외논문]   Predictors of decline in IADL functioning among older survivors following the Great East Japan earthquake: A prospective study  

    Tsuboya, T. ; Aida, J. ; Hikichi, H. ; Subramanian, S.V. ; Kondo, K. ; Osaka, K. ; Kawachi, I.
    Social science & medicine v.176 ,pp. 34 - 41 , 2017 , 0277-9536 ,

    초록

    Introduction: We described associations between the type of disaster experience and change in instrumental activities of daily living among older adult survivors before-after a terrible disaster. Methods: The study took advantage of a ''natural experiment'' afforded by the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study established in 2010, seven months prior to the earthquake and tsunami. A follow-up survey was conducted in 2013. This study was conducted in Iwanuma, which was directly struck by tsunami. Our sample comprised community-dwelling aged survivors in Iwanuma who responded to questions about personal circumstances and functional status both before and after the disaster (N = 3547). Personal experiences of earthquake and tsunami damage was used as an exposure variable. The outcome was changes in self-reported 13-item instrumental activities of daily living (IADL), which was assessed both before and after the disaster. Results: Among the participants, 931 reported losing family member(s) to the disaster, while a further 549 reported losing friend(s). More than half of the participants reported any damage to their houses while approximately 1 in 8 lost their car(s). The multivariable OLS regression revealed that complete house loss and disruption of internal medicine were associated with significantly worse IADL: -0.67 points (95%CI: -0.99, -0.34) for entirely destroyed homes; -0.40 points (95% CI: -0.71, -0.092) for disruption of internal medicine. By contrast, loss of family/friends/pets/cars and disruption to the other medical service were not associated with decline in IADL. Conclusion: Complete house loss and disruption of access to internal medicine after a disaster were associated with significant adverse impact on decline in physical and cognitive functions 2.5 years after the disaster, while loss of family/friends was not.

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  6. [해외논문]   Hour-glass ceilings: Work-hour thresholds, gendered health inequities  

    Dinh, H. ; Strazdins, L. ; Welsh, J.
    Social science & medicine v.176 ,pp. 42 - 51 , 2017 , 0277-9536 ,

    초록

    Long workhours erode health, which the setting of maximum weekly hours aims to avert. This 48-h limit, and the evidence base to support it, has evolved from a workforce that was largely male, whose time in the labour force was enabled by women's domestic work and care giving. The gender composition of the workforce has now changed, and many women (as well as some men) combine care-giving with paid work, a change viewed as fundamental for gender equality. However, it raises questions on the suitability of the work time limit and the extent it is protective of health. We estimate workhour-mental health thresholds, testing if they vary for men and women due to gendered workloads and constraints on and off the job. Using six waves of data from a nationally representative sample of Australian adults (24-65 years), surveyed in the Household Income Labour Dynamics of Australia Survey (N = 3828 men; 4062 women), our study uses a longitudinal, simultaneous equation approach to address endogeneity. Averaging over the sample, we find an overall threshold of 39 h per week beyond which mental health declines. Separate curves then estimate thresholds for men and women, by high or low care and domestic time constraints, using stratified and pooled samples. We find gendered workhour-health limits (43.5 for men, 38 for women) which widen further once differences in resources on and off the job are considered. Only when time is 'unencumbered' and similar time constraints and contexts are assumed, do gender gaps narrow and thresholds approximate the 48-h limit. Our study reveals limits to contemporary workhour regulation which may be systematically disadvantaging women's health.

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  7. [해외논문]   ''Life is so easy on ART, once you accept it'': Acceptance, denial and linkage to HIV care in Shiselweni, Swaziland  

    Horter, S. ; Thabede, Z. ; Dlamini, V. ; Bernays, S. ; Stringer, B. ; Mazibuko, S. ; Dube, L. ; Rusch, B. ; Jobanputra, K.
    Social science & medicine v.176 ,pp. 52 - 59 , 2017 , 0277-9536 ,

    초록

    Background: Timely uptake of antiretroviral therapy, adherence and retention in care for people living with HIV (PLHIV) can improve health outcomes and reduce transmission. Medecins Sans Frontieres and the Swaziland Ministry of Health provide community-based HIV testing services (HTS) in Shiselweni, Swaziland, with high HTS coverage but sub-optimal linkage to HIV care. This qualitative study examined factors influencing linkage to HIV care for PLHIV diagnosed by community-based HTS. Methods: Participants were sampled purposively, exploring linkage experiences among both genders and different age groups. Interviews were conducted with 28 PLHIV (linked and not linked) and 11 health practitioners. Data were thematically analysed to identify emergent patterns and categories using NVivo 10. Principles of grounded theory were applied, including constant comparison of findings, raising codes to a conceptual level, and inductively generating theory from participant accounts. Results: The process of HIV status acceptance or denial influenced the accounts of patients' health seeking and linkage to care. This process was non-linear and varied temporally, with some experiencing non-acceptance for an extended period of time. Non-acceptance was linked to perceptions of HIV risk, with those not identifying as at risk less likely to expect and therefore be prepared for a positive result. Status disclosure was seen to support linkage, reportedly occurring after the acceptance of HIV status. HIV status acceptance motivated health seeking and tended to be accompanied by a perceived need for, and positive value placed on, HIV health care. Conclusions: The manner in which PLHIV process a positive result can influence their engagement with HIV treatment and care. Thus, there is a need for individually tailored approaches to HTS, including the potential for counselling over multiple sessions if required, supporting status acceptance, and disclosure. This is particularly relevant considering 90-90-90 targets and the need to better support PLHIV to engage with HIV treatment and care following diagnosis.

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  8. [해외논문]   The productive techniques and constitutive effects of 'evidence-based policy' and 'consumer participation' discourses in health policy processes  

    Lancaster, K. ; Seear, K. ; Treloar, C. ; Ritter, A.
    Social science & medicine v.176 ,pp. 60 - 68 , 2017 , 0277-9536 ,

    초록

    For over twenty years there have been calls for greater 'consumer' participation in health decision-making. While it is recognised by governments and other stakeholders that 'consumer' participation is desirable, barriers to meaningful involvement nonetheless remain. It has been suggested that the reifying of 'evidence-based policy' may be limiting opportunities for participation, through the way this discourse legitimates particular voices to the exclusion of others. Others have suggested that assumptions underpinning the very notion of the 'affected community' or 'consumers' as fixed and bounded 'policy publics' need to be problematised. In this paper, drawing on interviews (n = 41) with individuals closely involved in Australian drug policy discussions, we critically interrogate the productive techniques and constitutive effects of 'evidence-based policy' and 'consumer participation' discourses in the context of drug policy processes. To inform our analysis, we draw on and combine a number of critical perspectives including Foucault's concept of subjugated knowledges, the work of feminist theorists, as well as recent work regarding conceptualisations of emergent policy publics. First, we explore how the subject position of 'consumer' might be seen as enacted in the material-discursive practices of 'evidence-based policy' and 'consumer participation' in drug policy processes. Secondly, we consider the centralising power-effects of the dominant 'evidence-based policy' paradigm, and how resistance may be thought about in this context. We suggest that such interrogation has potential to recast the call for 'consumer' participation in health policy decision-making and drug policy processes.

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  9. [해외논문]   From wanting to willing - controlled drug use as a treatment goal  

    Jarvinen, M.
    Social science & medicine v.176 ,pp. 69 - 76 , 2017 , 0277-9536 ,

    초록

    This paper uses rational choice theory to analyse a new - and controversial - treatment approach to drug problems: services aimed at making clients capable of controlled use of illegal drugs. The paper highlights three mechanisms used in control-focused treatment: attempts to move drug use from the sphere of ''wanting'' to the sphere of ''willing''; temporal framing of illegal drug use; and a therapeutic focus on clients' resources rather than their problems. Furthermore, the paper identifies some of the main challenges associated with this kind of treatment. The paper is based on 30 qualitative interviews with young people (aged 18-25) enrolled in drug treatment in Copenhagen, Denmark.

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  10. [해외논문]   ''Too much medicine'': Insights and explanations from economic theory and research  

    Hensher, M. ; Tisdell, J. ; Zimitat, C.
    Social science & medicine v.176 ,pp. 77 - 84 , 2017 , 0277-9536 ,

    초록

    Increasing attention has been paid in recent years to the problem of ''too much medicine'', whereby patients receive unnecessary investigations and treatments providing them with little or no benefit, but which expose them to risks of harm. Despite this phenomenon potentially constituting an inefficient use of health care resources, it has received limited direct attention from health economists. This paper considers ''too much medicine'' as a form of overconsumption, drawing on research from health economics, behavioural economics and ecological economics to identify possible explanations for and drivers of overconsumption. We define overconsumption of health care as a situation in which individuals consume in a way that undermines their own well-being. Extensive health economics research since the 1960s has provided clear evidence that physicians do not act as perfect agents for patients, and there are perverse incentives for them to provide unnecessary services under various circumstances. There is strong evidence of the existence of supplier-induced demand, and of the impact of various forms of financial incentives on clinical practice. The behavioural economics evidence provides rich insights on why clinical practice may depart from an ''evidence-based'' approach. Moreover, behavioural findings on health professionals' strategies for dealing with uncertainty, and for avoiding potential regret, provide powerful explanations of why overuse and overtreatment may frequently appear to be the ''rational'' choice in clinical decision-making, even when they cause harm. The ecological economics literature suggests that status or positional competition can, via the principal-agent relationship in health care, provide a further force driving overconsumption. This novel synthesis of economic perspectives suggests important scope for interdisciplinary collaboration; signals potentially important issues for health technology assessment and health technology management policies; and suggests that cultural change might be required to achieve significant shifts in clinical behaviour.

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