Social Science & Medicine最新文献

{"title":"Repairing with a warm heart: How medical practitioners cultivate affective relationships with clients","authors":"","doi":"10.1016/j.socscimed.2024.117449","DOIUrl":"10.1016/j.socscimed.2024.117449","url":null,"abstract":"<div><div>Healthcare providers are often advised to manage emotions to adhere to professional feeling rules and avoid deep affection for clients, but there are situations where this would not apply. We offer an atypical case of a cleft lip and palate (CLP) treatment program where affectionate medical provider-patient relationships are encouraged. Participant observation in a CLP department, in-depth interviews with the medical team, and public online content from the official WeChat account of the department showed that a meaningful bond was formed through a contextual concordance of moral consideration and professionalism across the organization. Medical practitioners have developed and justified such emotional work at the individual, professional, and organizational levels through three concordant micro-processes: developing the moral deservingness of the patient, instilling moral fulfillment into professionalism, and establishing moral consensus among medical professionals. This study enhances our current understanding of emotional work in healthcare by recognizing the moral consideration of patients and its influence on medical practices and by highlighting the complexities and dynamics of different feeling rules.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570113","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":"Social and policy characteristics associated with injurious shootings by police in US counties: A multilevel analysis, 2015–2020","authors":"","doi":"10.1016/j.socscimed.2024.117460","DOIUrl":"10.1016/j.socscimed.2024.117460","url":null,"abstract":"<div><div>From 2015 to 2020, shootings by police injured or killed 1769 people annually in the United States, disproportionately harming members of minoritized groups. Prior studies of the structural determinants of these inequities have largely examined state-level aggregations and fatal outcomes. This study aimed to: 1) describe state and county variation in fatal and nonfatal injurious shootings by police, and 2) analyze the relationship between state and county context and differences in county rates of injurious shootings by police. Injury data were developed from manual review of incidents listed in the Gun Violence Archive, then aggregated by county-year. Covariate selection was informed by theories of police use of force and the Social Basis of Disparities in Health conceptual framework. Fixed effects negative binomial regression models were estimated, nesting years within counties and states. Analyses controlled for county population, local reporting presence, and multiple measures of social conflict and community violence. From 2015 to 2020, 56% of counties experienced injurious shootings by police. Higher county rates of victimization were associated with greater state spending on police relative to health, county income inequality, prevalence of unmet substance use disorder needs, higher county firearm availability, and permitless concealed carry statutes. Firearm purchaser licensing polices were associated with lower incidence of injurious shootings by police. To prevent patterns of injurious shootings by police, policymakers should consider addressing undermanaged substance use disorder through crisis fund allocation and use, adopting stronger firearm licensing systems, and evaluating local strategies to combat inequities and strengthen non-policing responses to social needs.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565211","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":"Mind the glass ceiling: The gender gap in how depressive symptoms after age 55 relate to earlier career mobility in CONSTANCES","authors":"","doi":"10.1016/j.socscimed.2024.117446","DOIUrl":"10.1016/j.socscimed.2024.117446","url":null,"abstract":"<div><div>A substantial body of research has shown an association between career mobility and mental health in later life through health selection and causal processes, with favourable health outcomes associated with upward mobility. However, gender differences in these associations have been largely overlooked, despite evidence of gender inequalities in career opportunities.</div><div>We use data on individuals aged 55–69 from the CONSTANCES cohort. We examine their current mental health and career trajectories between ages 20–55, reconstructed through a retrospective questionnaire. Using sequence analysis, we identify 11 types of past occupational mobility (upward, downward, stagnant) across a gradient from unskilled to high-skilled occupations. We use nested logistic regression to assess their association with depressive symptoms (CES-D) in men and women separately, controlling for socio-demographic variables and occupational hazards.</div><div>For both men and women, depressive symptoms are strongly associated with careers involving unskilled jobs, with no difference between directions of mobility. For men, upward mobility into skilled or high-skilled jobs is associated with fewer depressive symptoms compared to a stagnant career. This is not the case for women, for whom upward career mobility to high-skilled jobs is associated with more depressive symptoms compared to stagnation at origin.</div><div>Our findings show a gendered relationship between mental health in later life and past career mobility and highlight the mental health issues faced by women who break through the glass ceiling. They call for further research into the circumstances of women's careers that challenge their mental health in later life.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570109","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":"Context dependent preferences in prestige bias learning about vaccination in rural Namibian pastoralists","authors":"","doi":"10.1016/j.socscimed.2024.117461","DOIUrl":"10.1016/j.socscimed.2024.117461","url":null,"abstract":"<div><div>Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565195","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":"Hierarchy, class, race and PPE in an American hospital in the early days of COVID-19: What the pandemic stress test can teach us about building equitable health systems","authors":"","doi":"10.1016/j.socscimed.2024.117463","DOIUrl":"10.1016/j.socscimed.2024.117463","url":null,"abstract":"<div><div>Because hospitals are spaces where life and death are routinely at stake, social hierarchies, pressures, and cultural norms are heightened. This was particularly true in the early days of the COVID-19 pandemic. Examining the dynamics in that era can provide insight into the nature of race and hierarchy in hospital structures.</div><div>In the large literature on the experiences of hospital staff in the COVID-19 era, class and racial dynamics in hospitals are often sidestepped. In addition, the experiences of service staff such as environmental service workers and food service workers are severely under-represented.</div><div>Here, we explore hierarchy, class, race and risk in two hospitals in the city of Baltimore in the first months of the pandemic in 2020, through the lens of availability of PPE. We draw on a survey of 403 staff in two Baltimore hospitals, and semi-structured interviews with 57 of those staff. Respondents worked in a variety of roles, from administration to clinical to service staff.</div><div>A large majority of non-clinical service staff identified as Black, in contrast to a small minority of clinical staff with advanced degrees. The experience of access to PPE in the early pandemic differed across cadres of workers. Everyone in the hospital had to ration PPE, but many service staff felt that they were not prioritized in the same ways as clinical staff. PPE availability took on powerful symbolic resonance as a demonstration of how different cadres of workers were valued.</div><div>The COVID-19 pandemic threw social and class dynamics within the hospital into relief, shedding light on what so often ran below the surface. Thus, it could also potentially be an impetus to examine these fault lines, and to push hospital structures a bit more in the direction of justice.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565208","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":"Do discrepancies between subjective and objective health shift over time in later life? A markov transition model","authors":"","doi":"10.1016/j.socscimed.2024.117441","DOIUrl":"10.1016/j.socscimed.2024.117441","url":null,"abstract":"<div><div>Subjective health (SH) deteriorates less rapidly than objective health (OH) in older adults. However, scant evidence exists regarding if discrepancies between SH and OH shift in the same individuals over time. We explore whether such discrepancies change over time in a sample of older adults living in England, through a prospective, observational cohort study design. Using data from the English Longitudinal Study of Ageing, we followed a sample of 6803 older adults, aged 60+ years at baseline, over three waves of data collection (2002–2007), yielding two wave transitions. A ‘health asymmetry’ metric classified older adults into four categories at each wave, based on the level of agreement between their SH and OH scores (‘health pessimist’, ‘health optimist’, ‘good health realist’ and ‘poor health realist’). First-order Markov transition and generalised logit models yielded estimated transition probabilities and odds ratios for health asymmetry transitions over time. At baseline, 36.84% of the sample were ‘good health realists’, 33% were ‘poor health realists’, 14.54% were ‘health optimists’, and 15.62% were ‘health pessimists’. Good and poor health realists were likely to remain health realistic over time. Good health realists who did transition however, were likely to become health optimists. Subsequently, the proportion of health optimists in the sample increased over time. Health pessimists had a high probability of being lost to study attrition. In conclusion, health optimism (i.e. where SH is rated better than OH) becomes more prevalent over time, in later life. Future research should investigate if promoting positive SH appraisals among health pessimists and poor health realists can optimise health and survival outcomes.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570060","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":"Easing caregiver strain: The power of health check-ups","authors":"","doi":"10.1016/j.socscimed.2024.117445","DOIUrl":"10.1016/j.socscimed.2024.117445","url":null,"abstract":"<div><div>Against the backdrop of global aging and escalating pressures on family caregiving, this study delves into the impact of health check-ups for the elderly on alleviating the objective burden of family caregiving by analyzing China's Free Health Check-up Program (FHCP). Using an unbalanced panel dataset spanning 2011, 2013, 2015, 2018, and 2020, comprising approximately 35,000 observations of the elderly population aged 65 and above, the research employs the Difference-in-Differences method. The research reveals a significant 9.18% reduction in family caregiving time following the implementation of FHCP, primarily attributed to the enhancement of the elderly's self-care abilities and health awareness. This study elucidates, for the first time, the efficacy and mechanisms of health check-ups in alleviating caregiving objective burdens, providing evidence for the formulation of pertinent policies. It underscores the significance of routine health check-ups as a public health intervention in supporting family caregivers and addressing the challenges of aging.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555026","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 public health to political repression: COVID-19 lockdown measure in Hong Kong's opposition districts","authors":"","doi":"10.1016/j.socscimed.2024.117440","DOIUrl":"10.1016/j.socscimed.2024.117440","url":null,"abstract":"<div><div>Repression comes with costs, such as reducing regime legitimacy and citizen conformity. The COVID-19 pandemic was an opportunity and a pretext for authoritarian regimes to repress their populations at a low cost. This paper examines the case of Hong Kong, where restriction-testing declarations (RTDs) were used as a lockdown measure to facilitate mandatory testing for the virus from January 2021 to September 2022. Despite the government's claim that RTDs were implemented for public health reasons, statistical analyses showed that Hong Kong districts that opposed the regime or those with a mobilization legacy were more likely to be subject to RTDs, with the opposition district effect present only when COVID-19 infections were low. These RTDs highlight the authoritarian regime's tradeoff in using a nonpolitical measure to achieve its political aims and illustrates the enduring impact of past election and mobilization activities on the choice of selective repression sites in Hong Kong.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548493","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":"Person-first and identity-first disability language: Informing client centred care","authors":"","doi":"10.1016/j.socscimed.2024.117444","DOIUrl":"10.1016/j.socscimed.2024.117444","url":null,"abstract":"<div><h3>Background</h3><div>Addressing individuals with a disability can entail the use of person-first (person with a disability) or identity-first language (disabled person). However, there has been debate about use of these terms, yet there is a lack of evidence to inform preference across people with a broad range of health conditions, demographics, or health related factors.</div></div><div><h3>Methods</h3><div>A 42-item survey measuring demographic and health condition factors, implicit and explicit preference for person-first and identity-first language use was open for completion by individuals with a self-reported health condition between July 7, 2021 and November 30, 2021. Recruitment was undertaken via posts on relevant social media sites and through community support and advocacy organisations.</div></div><div><h3>Results</h3><div>Data analysis included responses from 875 valid surveys. Mean age of participants was 39.7 (SD: 13.7) years. There were 89 (10.2%) male, 637 female (72.8%) and 149 (17.0%) non-binary/other participants. When referring to themselves, participants most often reported use of identity first language (n = 335, 42.2%), followed by person-first language (n = 272, 34.1%), then both interchangeably (118, 23.7%). When referring to others, participants most often used person first language (n = 312, 39.4%), followed by both interchangeably (269, 34.0%), then identity-first language (n = 211, 26.6%). Disability language preference varied across health conditions, with participants with neurodevelopmental conditions most likely to use identity-first language and participants with digestive conditions most often preferencing person-first language. Participants who were younger and of non-binary gender preferred use of identity-first language. Appropriate use of identity-first language was rated significantly higher for people with a disability/health condition and family/friends than for third-party representatives, including healthcare professionals, educators, media and the general public.</div></div><div><h3>Conclusion</h3><div>Findings highlight the need to understand health condition and disability language preference in a more nuanced way to promote respectful language use when addressing people in the context of their disability/health condition.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523398","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":"Self-rated health predicts mortality -- but it depends on your age","authors":"","doi":"10.1016/j.socscimed.2024.117439","DOIUrl":"10.1016/j.socscimed.2024.117439","url":null,"abstract":"<div><div>While self-rated health (SRH) has long been known to predict mortality in adult populations, the age of respondents plays an interesting and complex role in both explaining and modifying the association. The objective of this study is to test for differences by age in the association of SRH with all-cause mortality. Because much of the research has been conducted with older samples, a wider age range of adults may show that some age groups have more predictive SRH than others. We estimated Cox proportional hazards models to determine if SRH in 1999 predicted survival to 2021 differently based on age, using data from the Panel Study of Income Dynamics. The sample consisted of 5843 respondents aged 25 to 97 who were interviewed in 1999 and followed for survival until 2021. We included demographic and socioeconomic factors, physical health and mental health indicators, and health risk behaviors as covariates to assess their potential mediating role in the predictive ability of SRH. The results showed a significant interaction between SRH and age, with larger and more significant hazards for those aged 40–54 and 55–74. There were no significant effects at all for the youngest group and virtually none for the oldest group. For example, for individuals aged 40–54, there were significant HRs for poor health (2.49, 95% CI 1.05, 5.89) and fair health (1.95, 95% CI 1.11, 3.42) compared to excellent health in the fully adjusted models. Our findings suggest that age group differences in the predictiveness of SRH may reflect an absence of health knowledge and experience for younger respondents, and a survivor bias for the oldest age group due to the lifetime elimination of those with poor health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548494","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}