Social Science & Medicine最新文献

{"title":"Whole personhood in medical education: Visual thinking strategy, close reading, and creative practice with a diversity and equity lens","authors":"Elizabeth Lahti ,&nbsp;Natalie Lanocha ,&nbsp;Cirila Estela Vasquez Guzman ,&nbsp;Pamela Pierce ,&nbsp;Candace Chan ,&nbsp;Andrew Lee Breidenbach ,&nbsp;Lisa Abia-Smith","doi":"10.1016/j.socscimed.2024.117645","DOIUrl":"10.1016/j.socscimed.2024.117645","url":null,"abstract":"<div><h3>Purpose</h3><div>To create and implement a Whole Personhood in Medical Education curriculum including Visual Thinking Strategies (VTS), close reading, and creative practice that features creative works by BIPOC, persons with disability, and/or LGBTQ + individuals that aligns with educational competencies.</div></div><div><h3>Materials and methods</h3><div>Curriculum design by an interdisciplinary team made up of physician educators, medical sociologist, digital collection librarian, and art museum educators. Prospective single arm intervention study at a single site academic teaching hospital. Utilized pre-post surveys using the Interpersonal Reflexivity Index (IRI) scale on perspective taking, an internally developed ordinal scale survey on arts integration and bias recognition, and open-ended questions for qualitative analysis.</div></div><div><h3>Results</h3><div>A total of 161 participants responded and showed statistically significant increases in their mean scores in perspective-taking (4.7%), empathic concern (1.8%), the perceived value of art in medical education (15.8%) and recognizing bias (6.1%). In all subscales, non-white students saw bigger increases than white students, and in three of four subscales, females showed higher increases than males. Qualitative analysis of free text responses (n = 308) showed three emergent themes: (1) increased community; (2) recognition of bias in personal, interpersonal, and system levels; and (3) increased awareness of application of empathy and perspective taking in health settings.</div></div><div><h3>Conclusions</h3><div>Incorporating a required curriculum that features art and written narratives by minoritized groups and utilizes close observation/reading and reflective/creative practice, leads to an enhanced medical education experience. The curriculum leads to statistically significant increase in individuals’ ability to identify bias, recognize perspectives different than their own, and be empathetic toward others.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117645"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928435","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":"Does women empowerment impact child well-being? Evidence from India","authors":"Sunetra Nath,&nbsp;Gurudas Das","doi":"10.1016/j.socscimed.2025.117686","DOIUrl":"10.1016/j.socscimed.2025.117686","url":null,"abstract":"<div><div>This study intends to examine how women's empowerment directly or indirectly impacts their children's well-being. Since prior research primarily focussed on the effects of maternal empowerment on specific domains of child well-being, such as healthcare or education, this study seeks to explore a more comprehensive understanding of child well-being, where child well-being is quantified using four domains, viz., physical well-being, psycho-social well-being, educational well-being and awareness of safety. For the study, a primary sample of 416 married women who have a child aged between 6 and 18 years was collected using a multistage purposive sampling method from the Barak Valley of Assam, India. Then, exploratory factor analysis is employed to construct two indices, one on women empowerment and the other on child well-being. The index of child well-being was then used as the regressand, and the women empowerment index, along with other children, mother and household characteristics, were used as the regressors in multiple linear regressions. Besides, the moderating role of women's empowerment on child well-being is also studied by creating interactions between the women's empowerment index and other mothers, children, and household characteristics. The study finds that women's empowerment has a strong and positive direct impact on the well-being of children aged 6 to 18. The study also reveals that women's empowerment indirectly impacts child well-being as it moderates between child well-being and other attributes, viz., the mother's working status, child's age, place of residence, and standard of living. A key implication of our study is that maternal empowerment is essential for enhancing child well-being during the early developmental years. We also find that maternal empowerment, when interacted with paid employment, profoundly uplifts their child's well-being.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117686"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042949","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":"Between ‘fetal viability’ and the ‘viability of families’: Decision-making for extremely premature infants in Spain","authors":"Paula Martone ,&nbsp;Anna Molas ,&nbsp;Diana Marre","doi":"10.1016/j.socscimed.2025.117760","DOIUrl":"10.1016/j.socscimed.2025.117760","url":null,"abstract":"<div><div>Neonatal expertise and technologies have been perfected over the last decades, improving preterm infants' survival rates and allowing a gradual reduction in the gestational age limits of fetal viability. Using the concept of viability as a starting point, we analyze decision-making processes regarding extremely preterm newborns at the limits of viability. Drawing on extensive ethnographic fieldwork in a public hospital in Barcelona between March and November 2023, we examine the knowledge forms, rationalities and values that healthcare workers employ when guiding families in decisions about infants' viability. In this respect, we thoroughly analyze the actors involved and the extent of their agency. The findings point out that although neonatal decisions in Spain are embedded in an ethos of “individual responsible choice,” they are in practice collectively produced and shaped by two main (sometimes conflicting) drivers: the perceived means of families to face the challenges posed by infants with high chances of severe sequelae (the ‘viability of families’), and the preterm patients' perceived “will to live” (‘fetal viability’). The study highlights how viability in this context needs to be understood within the structural socioeconomic constraints and struggles to make and raise families in Spain.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117760"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069036","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 tragedy of promising happiness through overcoming disability","authors":"Olivia Dahl ,&nbsp;Merete Monrad","doi":"10.1016/j.socscimed.2025.117769","DOIUrl":"10.1016/j.socscimed.2025.117769","url":null,"abstract":"<div><div>This article explores the often-overlooked tragedy of promising happiness through overcoming disability. It draws on qualitative interviews and focus groups with 36 adults with cerebral palsy to explore how medical discourse shapes the ways in which individuals are encouraged to pursue a good life, leading to unintended consequences. Sara Ahmed's theory of happiness is used to understand the dialectics of pursuing a good life through overcoming disability, revealing how medical interventions and discourse during childhood inadvertently contribute to feelings of inferiority and social alienation. The article highlights the need to reconsider how individuals with disabilities are encouraged to pursue a good life, emphasizing the paradox of disabling effects arising from attempts to minimize and overcome disability.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117769"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069116","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":"Impact of COVID-19 on medical utilization for psychiatric conditions in Japan","authors":"Kazuhiro Abe ,&nbsp;Kouta Suzuki ,&nbsp;Atsushi Miyawaki ,&nbsp;Ichiro Kawachi","doi":"10.1016/j.socscimed.2025.117763","DOIUrl":"10.1016/j.socscimed.2025.117763","url":null,"abstract":"<div><h3>Background</h3><div>During COVID-19, Japan experienced an increase in suicides, in contrast to many other countries. We sought to examine whether access to outpatient and inpatient care for psychiatric conditions was maintained in Japan during the pandemic.</div></div><div><h3>Methods</h3><div>Difference-in-differences analysis with Poisson regression comparing psychiatric patient admissions during the pre-pandemic period (January 2015–December 2019) versus the pandemic period (January 2020–December 2020) was performed, using the data from 242 acute-care hospitals in Japan. The Japanese government's emergency declaration in April 2020 was considered an exogenous shock. Primary outcomes included the number of inpatient and outpatient admissions for schizophrenia, mood disorders, anxiety disorders, dementia, and alcohol-related disorders.</div></div><div><h3>Results</h3><div>During the study period, 79,867 outpatient cases and 2600 hospitalizations were observed. The difference-in-differences analysis showed a decline in the number of outpatient and inpatient admissions except for anxiety disorders after April 2020: incidence-rate ratios (95% confidence intervals), 0·92 (0·83 - 1·02) and 0·71 (0·46 - 1·09) for outpatients and inpatients with schizophrenia, 0·92 (0·85 - 0·99) and 0·87 (0·50 - 1·49) for mood disorders, 1·02 (0·92 - 1·13) and 1·07 (0·69 - 1·65) for anxiety disorders, 0·88 (0·80 - 0·96) and 0·68 (0·38 - 1·22) for dementia, and 0·77 (0·54 - 1·11) and 0·63 (0·43 - 0·90) for alcohol-related disorders.</div></div><div><h3>Conclusion</h3><div>In Japan, psychiatric admissions decreased overall following the start of the COVID-19 pandemic, with the exception of anxiety disorder cases. The decrease in psychiatric care utilization contrasted with rising suicide rates in the nation, underscoring the need for enhanced psychiatric access during crises.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117763"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076212","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":"Navigating bodily disruptions within biolegitimizing institutions: Mastectomy, femininity, and race","authors":"Jessica Poling","doi":"10.1016/j.socscimed.2025.117730","DOIUrl":"10.1016/j.socscimed.2025.117730","url":null,"abstract":"<div><div>There are times when our bodies suddenly change in unexpected or undesirable ways, challenging our sense of self. I posit a framework to study bodily disruptions which attends to the triadic relationship between personal culture, public culture, and the body. First, I explore how public forms of culture shape individuals' experiences of sudden bodily changes. How do these external expectations exacerbate (or alleviate) experiences of disruptions? Moreover, how do these public expectations <em>interact</em> with individuals' own schemas, and in what ways do embodied differences mediate this interaction? Drawing from interviews with therapeutic mastectomy patients and content analysis of online testimonies, I find that healthcare providers' expectations of femininity informed their patient care. Moreover, the compatibility between patients' schematic orientations and these external expectations shaped the extent to which patients' cancer disrupted their sense of self. Patients with hegemonic schemas mostly resonated with these expectations and subsequently felt more at ease with doctors who could realign them with their gendered goals. But not all patients' schemas were so aligned. In these cases, doctors' enforcement of biolegitimacy exacerbated disruptions. Moreover, I argue that the raced and sexualized notions of biolegitimacy posed additional incongruence for patients who felt unable to conform to white, cis-heterosexual norms. These findings expand upon medical sociology's long exploration of “biographical disruptions” and are significant for sociology's continued endeavors to bring the body into cultural studies.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117730"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081803","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":"Carceral heat exposure as harmful design: An integrative model for understanding the health impacts of heat on incarcerated people in the United States","authors":"Karina Brunn,&nbsp;Olivia Toledo,&nbsp;Chelsea Chau Tran,&nbsp;Ashwin Vasudevan,&nbsp;Bharat Jayram Venkat","doi":"10.1016/j.socscimed.2025.117679","DOIUrl":"10.1016/j.socscimed.2025.117679","url":null,"abstract":"<div><div>In an era of climate change-driven weather events, extreme heat has become the most lethal form of “natural disaster” in the United States. However, its negative consequences are unequally distributed. Incarceration exacerbates vulnerability to heat-related illnesses and deaths. This article reviews and synthesizes a range of literature related to carceral heat exposure to characterize the complex biological, social, infrastructural, financial, and legal mechanisms through which incarcerated people experience heat-related illnesses and deaths. These mechanisms include the location, design, and construction of carceral facilities; structural racism and poverty that lead to the overrepresentation of specific populations within the carceral system; comorbid conditions amongst incarcerated people; the use of medication as a form of control; barriers to medical care; institutional neglect; and the weaponization of heat as a tactic of retaliation. This article also reviews the patchwork regulatory apparatus related to carceral heat exposure, legal efforts to improve protections for incarcerated people, and obstacles to implementing those protections.</div><div>In reviewing the literature, we find that there is no singular factor that explains how and why incarcerated people are especially vulnerable to the deleterious effects of heat. We offer instead an integrative model for understanding how multiple mechanisms are consolidated by the carceral system, magnifying the vulnerability of incarcerated people to the effects of heat. As social scientists have demonstrated in other contexts, no one dies from a heat wave alone; instead, they experience illness and death as a result of social and infrastructural arrangements that render them vulnerable to the effects of heat. Our aim is to elucidate the specific arrangements through which the carceral system makes people vulnerable to heat. We argue that exposure to debilitating heat and its attendant consequences represent more than a failure of the carceral system – rather, they reveal its fundamentally harmful design.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117679"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145978","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":"“He was not interested in pain”: The experience of pain in child sexual abuse as conveyed by adult survivors","authors":"Noga Tsur,&nbsp;Bella Klebanov,&nbsp;Ada Talmon,&nbsp;Carmit Katz","doi":"10.1016/j.socscimed.2025.117796","DOIUrl":"10.1016/j.socscimed.2025.117796","url":null,"abstract":"<div><div>Although extensive efforts have been dedicated to uncovering the close link between trauma and chronic pain, very few research efforts have investigated the lived experience of pain during and following trauma. This study delves into the complex and multifaceted experiences of physical pain among adults who experienced child sexual abuse (CSA), examining 29 detailed testimonies provided to the Israeli Independent Public Inquiry into CSA. Using qualitative thematic analysis, the research identifies and elaborates on three pivotal themes: pain as a distress signal, the internalization of pain, and the intermingling of physical and mental pain. Thus, the study findings capture the immediate physical pain experienced during abusive incidents, which serves as an involuntary alert to the self and, at times, to the broader environment about the trauma being experienced. The findings also explore how this acute response transforms into a chronic state, becoming an embedded part of survivors' daily lives, influencing personal and relational dynamics, often without visible scars but with profound internal implications. Lastly, the findings reveal the blurred lines between the participant's physical and psychological pain, illustrating how they express psychological distress through physical pain symptoms and how this affects their coping mechanisms. The study underscores the necessity of recognizing pain as a complex, enduring component of the CSA survivor's experience, highlighting the need for integrated therapeutic approaches that address the intertwined nature of posttraumatic mental symptoms and physical pain. This study advocates for a more nuanced understanding and acknowledgment of pain in CSA survivors, urging further research and adapted clinical practices to better support their recovery and well-being.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"369 ","pages":"Article 117796"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143430091","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":"Understanding vaccine scepticism among complementary and alternative medicine users: A comprehensive mixed-methods investigation","authors":"Ivan Souček ,&nbsp;Roman Hofreiter ,&nbsp;Kamila Koza Beňová","doi":"10.1016/j.socscimed.2025.117808","DOIUrl":"10.1016/j.socscimed.2025.117808","url":null,"abstract":"<div><div>The use of complementary and alternative medicine (CAM) has been widely recognized as a potential contributor to the emergence of vaccine scepticism and refusal. However, a direct correlation between trust in CAM and vaccine scepticism is still a matter of discussion. The objective of this study is to explore the multidimensional factors that explain the association between CAM usage and vaccine scepticism. Qualitative and quantitative research designs were adopted to examine whether visiting CAM practitioners directly contributes to vaccine scepticism and to identify whether antivaccination attitudes are caused by other social, and cultural factors. These findings support the idea that CAM users tend to exhibit more vaccine scepticism compared to non-users. However, preferring a holistic health model, individual autonomy, and a negative perception of biomedicine representatives emerged as more influential factors in understanding the connection between the prevalence of CAM utilization and vaccine scepticism. Taken together, these results suggest that CAM itself is not the direct predictor of vaccine scepticism. To build trust between the population and vaccines, this information can be used to develop targeted interventions aimed at strategies to improve healthcare services and develop the soft skills of medical doctors.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117808"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143207931","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":"Converging perspectives on the processes exacerbating adolescent obesity: An integrative systems approach","authors":"Anaely Aguiar ,&nbsp;Jefferson K. Rajah ,&nbsp;Kaitlin Conway-Moore ,&nbsp;Natalie Savona ,&nbsp;Cécile Knai ,&nbsp;Ioana Vlad ,&nbsp;Oddrun Samdal ,&nbsp;Harry Rutter ,&nbsp;Nanna Lien ,&nbsp;Birgit Kopainsky","doi":"10.1016/j.socscimed.2025.117706","DOIUrl":"10.1016/j.socscimed.2025.117706","url":null,"abstract":"<div><div>Adolescent obesity is a complex public health challenge with steadily increasing and variable prevalence among countries. This paper synthesises the driving feedback mechanisms of adolescent obesity studied in the CO-CREATE project, furthering our understanding of the complexity of this issue. Using systems thinking principles and causal loop diagramming, we integrated the following knowledge and perspectives derived from diverse sources into a causal loop diagram (CLD): a systems map generated by adolescents through participatory modelling workshops, a comprehensive literature review, and input from subject-matter experts during validation workshops. We used a structured and iterative approach to include drivers and to identify feedback loops exacerbating adolescent obesity. The CLD identified 27 key feedback loops across four themes: twelve related to the commercial food environment, six to the physical activity environment, four to mental wellbeing and five to social norms. These loops indicate not only diet and physical activity as drivers of obesity but also stress and other emotional and social pressures. Recognising the imperative need to integrate the perspectives and experiences of adolescents into our analysis, this work advocates for the synthesis of experiential insights with empirical research. The integrated CLD can be used as a visual tool that fosters collaboration among stakeholders and engenders a more comprehensive and inclusive system understanding that can provide holistic intervention considerations to tackle adolescent obesity. Additionally, the CLD lays a foundation for subsequent quantitative modelling works to further address this issue and develop context-based approaches to prevention and evaluation of adolescent obesity.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117706"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145684","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}