Social Science & Medicine最新文献

{"title":"Difficult decisions and possible choices: Rare diseases, genetic inheritance and reproduction of the family.","authors":"Waleska Aureliano","doi":"10.1016/j.socscimed.2024.117380","DOIUrl":"https://doi.org/10.1016/j.socscimed.2024.117380","url":null,"abstract":"<p><p>This article sets out to explore the dilemmas present in the reproductive practices of people affected by rare hereditary diseases, focusing on the use of diagnostic tests and the practice of genetic counselling in Brazil. The development of technologies capable of mapping 'genetic flaws' prior to conception or in prenatal consultations has led researchers to consider how these technologies may be shaping contemporary subjectivities related to kinship and guiding reproductive decisions based on knowledge of our 'genetic heritage.' Genetic counselling has emerged in this setting as a modality of health knowledge and information capable of assisting people, especially women, in their reproductive choices. In Brazil, access to these technologies and their use has proven to be unequal and heterogeneous. I argue that the idea of 'choice' that permeates genetic counselling needs to be problematized by considering the social, cultural, economic, affective and moral frameworks in which women are inserted and that inform and/or determine their reproductive decisions. Based on this premise, I analyse how families 'at risk' of rare hereditary diseases deal with the idea of 'genetic inheritance' in relation to the 'wish to have children', and the impasses surrounding the idea of 'informed choice' when we evaluate this rhetoric in the context of the shortfalls in access to healthcare and the limits to reproductive justice in Brazil.</p>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"117380"},"PeriodicalIF":4.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The liminal experience of awaiting for a cadaveric kidney donation: “I would not wish it on even my enemy!”","authors":"Hicran Karataş ,&nbsp;Şener Balas","doi":"10.1016/j.socscimed.2024.117466","DOIUrl":"10.1016/j.socscimed.2024.117466","url":null,"abstract":"<div><div>This study aims to explore the concept of liminality in the lives of chronic kidney disease (CKD) patients in Turkiye who are undergoing dialysis while awaiting kidney transplants. The research focuses on how patients experience this transitional state, being between life stages, and how they cope with the uncertainty of their condition while aspiring for a transplant. The research involved in-depth, semi-structured interviews and participant observations of 34 dialysis patients who had been registered on the national organ waiting list for over five years. The research was conducted between August 16, 2022, and November 11, 2022. The principal findings reveal that these patients experience profound uncertainty and hope, viewing potential transplants as a \"second birthday\" and symbolic rebirth. The study also highlights significant cultural and familial dynamics influencing the organ donation process, with many patients facing disappointment when relatives are unwilling or unable to donate. Additionally, patients report various physical and psychological challenges, including social isolation, strict dietary restrictions, and the emotional toll of dependence on hemodialysis. The significant conclusions indicate that the anticipation of receiving a cadaveric organ donation provides both hope and anxiety, motivating patients to adhere strictly to medical advice while coping with the emotional burden of uncertainty. The research underscores the complex interplay between cultural beliefs, medical practices, and the lived experiences of CKD patients. This paper contributes to knowledge by comprehensively understanding the cultural and emotional dimensions of the dialysis experience in Turkey. It offers valuable insights for healthcare providers and policymakers to improve patient care and support systems.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"Article 117466"},"PeriodicalIF":4.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who is helping students? A qualitative analysis of task-shifting and on-campus mental health services in China's university settings.","authors":"Rui Hou, Isabella Huang, Kenneth Po-Lun Fung, Alan Li, Cunxian Jia, Shengli Cheng, Jianguo Gao, Jingxuan Zhang, Josephine Pui-Hing Wong","doi":"10.1016/j.socscimed.2024.117527","DOIUrl":"https://doi.org/10.1016/j.socscimed.2024.117527","url":null,"abstract":"<p><p>The mental health of university students is a major concern worldwide. Current literature has highlighted workforce shortage as one of the main barriers for delivering mental health care in China and elsewhere. A common strategy to tackle this shortage involves engaging non-specialist health workers and professionals from non-medical backgrounds in mental health promotion within university settings. Yet, there remains limited understanding of how this approach operates in practice and its effectiveness in delivering essential on-campus services to students. This study contributes to narrowing this knowledge gap through the engagement with interdisciplinary mental health service providers (n = 141) at six universities in Shandong, China. We used focus group interviews to explore how task-shift practices operate in the Chinese university context and analyze the main barriers in the practitioners' delivery of mental health care practices. According to our analysis, (1) competing roles of non-health actors create a trust-privacy dilemma in the delivery of mental health service; (2) knowledge gap and workload issues become new barriers for effective mental health promotion; and (3) the lack of structured intersectoral collaboration creates barriers to establish effective mental health care networks to meet the needs of university students. These results highlight the importance of using a settings approach in designing and assessing mental health interventions based on task-shifting within the contexts of Chinese universities. The study also helps to map out the unique features of the workforce situation in the mental health support system of Chinese universities, offering researchers and practitioners insights on how to better localize their assessment and programming.</p>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"117527"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From affordable to accessible: How the pharmaceutical industry transformed patient consumers into charity recipients.","authors":"Laura Halcomb","doi":"10.1016/j.socscimed.2024.117524","DOIUrl":"https://doi.org/10.1016/j.socscimed.2024.117524","url":null,"abstract":"<p><p>Recent changes in healthcare pricing and financing have resulted in patients paying more out of pocket for their healthcare. As a result, more patients with insurance are being priced out of essential or desired medications. Pharmaceutical companies have responded by offering financial assistance programs for patients. Medical sociologists have productively used the concept of consumerism to describe the effects of markets on the provision of healthcare. But in this current context where financial assistance programs are increasingly important for patients seeking prescription drugs, what are the implications for medical sociological theories of patient consumerism? I use medical and economic sociology theories to analyze pharmaceutical executive testimonies in 34 federal US Congressional hearing transcripts prices from 1959 to 2020. Congressional testimony offers an ideal window into how these executives justify their prices and describe the implications for patients downstream in the healthcare system. I find that executives initially justified prices as fair and drugs as cost-effective because medications were an affordable form of healthcare. However, as drug prices rose, executives abandoned affordability arguments and instead argued drugs were accessible to patients though pharmaceutical company run financial assistance programs. Findings contribute to medical sociology by theorizing a system of corporate charity as the next phase of the capitalist US healthcare system and demonstrates how elite market actors (re)define downstream categories of consumers.</p>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"117524"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An analysis of intersectional disparities in alcohol consumption in the US.","authors":"Sophie Bright, Charlotte Buckley, Daniel Holman, George Leckie, Andrew Bell, Nina Mulia, Carolin Kilian, Robin Purshouse","doi":"10.1016/j.socscimed.2024.117514","DOIUrl":"https://doi.org/10.1016/j.socscimed.2024.117514","url":null,"abstract":"<p><p>Alcohol is one of the leading causes of preventable deaths in the United States (US). Prior research has demonstrated that alcohol consumption and related mortality are socially patterned; however, no study has investigated intersectional disparities in alcohol consumption, i.e., attending to how social positions overlap and interact. In this study, we used an innovative intersectional approach (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, MAIHDA) and data from a large nationally representative survey (the National Health Interview Survey, 2000-2018) to quantify inter-categorical disparities in alcohol consumption in the US (proportion of current drinkers, and average consumption amongst drinkers), along dimensions of sex, race and ethnicity, age, and level of education. Our analysis revealed significant intersectional disparities in both the prevalence of drinking and the average consumption by drinkers. Young, highly educated White men were the most likely to be current drinkers and consumed the highest amounts of alcohol on average, whilst racially and ethnically minoritized women with lower education were the least likely to drink and had the lowest levels of alcohol consumption, across all age categories. Notably, we found significant interaction effects for many intersectional strata, with much higher consumption estimated for some groups than traditional additive approaches would suggest. By identifying specific understudied groups with high consumption, such as young American Indian or Alaska Native (AI/AN) men, adult Black men with low education, and older White women with high education, this analysis has important implications for future research, policy, and praxis. This is the first known application of MAIHDA to account for a skewed outcome, highlighting and addressing critical methodological considerations.</p>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"117514"},"PeriodicalIF":4.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and the risk of social isolation and loneliness in older Chinese adults: Do gender, age, and education make a difference?","authors":"Dan Zhang","doi":"10.1016/j.socscimed.2024.117486","DOIUrl":"10.1016/j.socscimed.2024.117486","url":null,"abstract":"<div><h3>Objective</h3><div>Pain has long been known to affect the health and well-being of older adults. However, no longitudinal study has examined the associations between pain, social isolation, and loneliness among older adults in China. This study aims to explore the relationships between pain and older Chinese adults’ social isolation (family isolation and friend isolation) and loneliness, and whether these associations are moderated by gender, age, and education groups.</div></div><div><h3>Method</h3><div>Data derived from the four waves of the China Longitudinal Aging Social Survey (CLASS, 2014–2020). The sample included 18,692 respondents (aged 60 years and older), and mixed-effects logistic models were used.</div></div><div><h3>Results</h3><div>Pain is not significantly associated with family isolation. In contrast, pain increases the risk of friend isolation and loneliness. Regarding the moderating roles of gender, age, and education, the results show that the relationship between pain and friend isolation is stronger among older women compared to their male counterparts. The association between pain and the risk of friend isolation is stronger among young-old adults (60–69 years) than among their older counterparts (70 years and older). Conversely, the oldest old adults (80+ years) are more likely to experience loneliness combined with pain than their younger counterparts. In addition, the negative effect of pain on the risk of loneliness is stronger among the more educated than among the less educated older adults.</div></div><div><h3>Conclusions</h3><div>The findings underscore the pivotal role of pain in shaping the social well-being of older adults, and highlight the need to consider sociodemographics and socioeconomic status when developing pain prevention and management strategies.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"Article 117486"},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering the COVID-19 density puzzle: A meta-analysis approach.","authors":"Pratik Kumar Singh, Alok Kumar Mishra","doi":"10.1016/j.socscimed.2024.117485","DOIUrl":"https://doi.org/10.1016/j.socscimed.2024.117485","url":null,"abstract":"<p><p>The COVID-19 pandemic has sparked widespread efforts to mitigate its transmission, raising questions about the role of urban density in the spread of the virus. Understanding how city density affects the severity of communicable diseases like COVID-19 is crucial for designing sustainable, pandemic-resilient cities. However, recent studies on this issue have yielded inconsistent and conflicting results. This study addresses this gap by employing a comprehensive meta-analytic approach, synthesizing data across diverse regions and urban contexts to offer a broader, more nuanced perspective on the impact of city density. A systematic meta-analysis was conducted, initially screening 2,452 studies from Google Scholar, Scopus, and Avery Index databases (up to August 31, 2023), and narrowing down to 63 eligible studies. Using the restricted maximum likelihood (REML) method with a random effects model, the study accounted for variations across different studies. Statistical tests, file drawer analysis, and influence measure analysis were performed, along with assessments of heterogeneity and publication bias through forest and funnel plots. Despite this extensive analysis, the findings indicate that city density has a negligible effect on the severity of COVID-19, challenging the prevailing assumptions in the literature.</p>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"117485"},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dilemmas of care: Healthcare seeking behaviours and antibiotic use among women in rural communities in Nam Dinh Province, Vietnam","authors":"Yen Hong Thi Nguyen ,&nbsp;Rogier van Doorn ,&nbsp;Jennifer Ilo Van Nuil ,&nbsp;Sonia Lewycka","doi":"10.1016/j.socscimed.2024.117483","DOIUrl":"10.1016/j.socscimed.2024.117483","url":null,"abstract":"<div><div>Antimicrobial resistance is a silent pandemic to cause an estimated ten million deaths by 2050. Self-medication with antibiotics in low- and middle-income countries has been identified as a driver of antibiotic resistance. Interventions targeting solely individual behaviour change around antibiotic practices are often unsuccessful as they fail to address socio-cultural and structural causes of the problem. Understanding the context of antibiotic use in communities will better inform interventions addressing the misuse and overuse of antibiotics. Vietnam faces a growing threat of antimicrobial resistance due to inappropriate use of antibiotics in the healthcare system, farming and food production, and in the community. To understand the roots of this problem, we conducted qualitative research in 2020, with one component focusing on the community. This included fifteen in-depth interviews with women and four months of participant observation in three districts in Nam Dinh Province to explore the healthcare seeking practices and perceptions of medicine and antibiotic use. We argue that even when participants understood antibiotic resistance and were willing to adjust their care practices with antibiotics, there were cultural and structural challenges demotivating changes. The participants faced what we term “dilemmas of care”. For example, while public health messaging promoted appropriate antibiotic practices, the healthcare system did not provide a suitable environment to support appropriate use. Besides, the introduction of biomedicines into the long-standing traditional medical system caused confusions in community health practices, leading to issues such as poor adherence to treatment. At an individual level, participants faced challenges in accessing healthcare knowledge, adhering to social expectations surrounding care, and financial issues. We argue that the misuse of medicines and antibiotics in communities are responses to a deficient healthcare system and unequal access to quality healthcare.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"Article 117483"},"PeriodicalIF":4.9,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual & joint associations of sexual stigma and mental distress with PrEP uptake, adherence and persistence among US gay and bisexual men","authors":"Udodirim N. Onwubiko ,&nbsp;Sarah M. Murray ,&nbsp;Amrita Rao ,&nbsp;Allison T. Chamberlain ,&nbsp;Travis H. Sanchez ,&nbsp;David Benkeser ,&nbsp;David P. Holland ,&nbsp;Samuel M. Jenness ,&nbsp;Stefan D. Baral","doi":"10.1016/j.socscimed.2024.117493","DOIUrl":"10.1016/j.socscimed.2024.117493","url":null,"abstract":"<div><h3>Background</h3><div>Sexual stigma, mental health disorders, and socioeconomic disparities present important yet incompletely understood barriers to PrEP adoption among gay men and other men who have sex with men (MSM). This study examines how these factors interact and affect PrEP uptake, adherence, and persistence among MSM.</div></div><div><h3>Methods</h3><div>Data from the 2018 and 2019 American Men's Internet Survey cycles, involving 6907 adult MSM eligible for PrEP, were analyzed. We assessed sexual stigma heterogeneity among this group using latent class analysis and investigated individual relationships between i) stigma class membership, ii) mental distress, and PrEP engagement (past-year use, adherence, and persistence) using Poisson regression with a robust error variance, considering potential variations based on poverty status. The combined associations of sexual stigma and mental distress with PrEP engagement was evaluated using inverse probability weighting.</div></div><div><h3>Results</h3><div>Four distinct sexual stigma classes were identified, each exhibiting varied associations with PrEP engagement. Associations with mental distress lost statistical significance after adjusting for confounders. However, having both mental distress and sexual stigma was associated with lower past-year PrEP use, with the strongest association observed for those with anticipated healthcare stigma class membership and mental distress (aPR 0.53 [95% CI: 0.37, 0.76]). Sexual stigma accompanied by mental distress was also associated with significantly increased poor PrEP adherence, particularly among those with family and general social stigma class membership (aPR 2.31 [95% CI: 1.08, 4.97]).</div></div><div><h3>Conclusions</h3><div>Psychosocial factors exert synergistic impacts on PrEP engagement among MSM. Tailored interventions addressing these subtleties may effectively optimize PrEP uptake and improve consistency of use among MSM.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"Article 117493"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing disease self-management in multi-ethnic patients with chronic conditions and evaluating psychometric properties of the Partners in Health scale","authors":"Yiyun Shou ,&nbsp;David Smith ,&nbsp;Jun Xuan Ng ,&nbsp;Malcolm Battersby ,&nbsp;Cynthia Chen ,&nbsp;Ngan Phoon Fong","doi":"10.1016/j.socscimed.2024.117490","DOIUrl":"10.1016/j.socscimed.2024.117490","url":null,"abstract":"<div><div>The increasing prevalence of chronic diseases globally has resulted in increased healthcare utilization. Patients’ self-management of chronic diseases is important for efficient healthcare and improving patient health outcomes. This study aims to evaluate the psychometric properties of the Partners in Health (PIH) scale in a representative, multi-ethnic sample of patients with chronic diseases in Singapore and examine factors that can contribute to chronic disease self-management. A cross-sectional household survey included the PIH scale administered to 502 patients aged 40 and above who reported having at least one chronic condition. Bayesian Confirmatory Factor Analysis was applied to evaluate the factor structure and gender measurement invariance of PIH. The results suggested that a four-factor structure fit the Singaporean sample and had approximate measurement equivalence between males and females for most of the PIH items. The PIH scale and subscales also demonstrated criterion validity by having expected correlations with conceptually relevant constructs. Finally, sociodemographic characteristics and satisfaction with healthcare are significantly related to self-management based on the PIH scale. Satisfaction with healthcare also attenuated the reduction of self-management in patients from minority ethnic groups or those with lower education. This suggested that those groups can benefit from high satisfaction towards care providers in enhancing their disease management. In conclusion, this study demonstrated that PIH can be a promising tool for assessing patient self-management in the Singaporean population.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"363 ","pages":"Article 117490"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}