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PubMed2000

[Perceptions, adaptation and health care strategies of the elderly family caregivers from the standpoint of the shift to ambulatory care].

This article presents the results of an exploratory study funded by the Social Sciences and Humanities Research Council of Canada. The objectives of this research were to explore (a) the perception by elderly women caregivers of the shift to ambulatory care; (b) their use of coping behaviours in the face of this major change within the health care system; and (c) their perceptions of health care services. In a theoretical framework of stress and coping, and using standardized questionnaires and open-ended questions, 40 home interviews were initially conducted with elderly women, each of whom was caring for her spouse after his discharge from hospital. Additional data were collected through focus groups. Quantitative and qualitative analyses revealed that elderly women caregivers perceive ambulatory care in a positive manner and as a change involving challenges only when they feel in control of the health care situation and when the care does not necessitate specialized abilities. When the care to be provided is complex and requires continued involvement and specific competence on the caregiver's part, the situation results in insecurity for elderly women. Caregivers use cognitive coping strategies to deal with their problems and are not inclined to use formal services in their social support network. Participants in this study wished to be better informed about the health care system in general ("how the system works") so that they could acquire a sense of predictability. Other expectations of elderly women caregivers concerned the importance of continuity in health services delivery, better preparation for the transition from hospital to home and availability of psychological support for themselves. These results suggest a critical analysis of the present paradigm guiding health care services, in which family caregivers are considered as resources or coworkers instead of coclients.

Aged↗
PubMed2006

[Current state of research on migration in Austria. A brief review].

Although Austria has been the aim of immigration for many years, research in the field of migration and integration is not yet established. Of the Austrian population, 9.6% have foreign citizenship and the proportion of the migrant population is highest in Vienna, where it is 18.0%. In 2002 a population register system was implemented in Austria which allows a more detailed description of migration processes and a differentiation of population by citizenship and country of birth. In social science and public health research as well as in official statistics and surveys the item of migration is not given sufficient consideration. On a political level, especially in Vienna, a comprehensive strategy of integration and diversity is being increasingly regarded as essential, and federal health policy has recently also focused on the health of migrants. In the future migration will hopefully be re-evaluated as the need for a humanitarian approach is recognized but also the benefits from migration in cultural, economic and demographic affairs are better appreciated and research is allowed to play an appropriate role in this process.

Acculturation↗
PubMedDate not supplied

[An approach to food consumption in an urban environment. The case of west Africa].

West Africa has undergone rapid economic and political changes during the last 20 years. After the failure of economic policies implemented since independence, programs for structural adjustment have strongly influenced the economy. Food problems affect each country differently. The Sahel has experienced food shortages and starvation whereas in forested countries the food supply has remained stable. Nevertheless, food policies have not succeeded in contributing to urban and rural development. The rate of urbanization in west Africa is generally low but the rate of urban population growth is particularly high, much more than the growth rates of industry and infrastructure. Although metropolitan areas are affected by poverty, they offer more hope and opportunities than rural areas. Urban markets have expanded and diversified as social differences have also increased and contributed to changes in consumption structure. Urban growth has contributed to the increase of imported food: this is indicated by both the strong dependency and the change of food habits towards western food patterns. Recently however, west African urban dwellers are still preferring local items if they are affordable. When imported products are used, they are integrated within a stable meal plan consisting of a single dish with a base and a sauce, which is typical of African food preparation. Surveys of consumption-budgets are still only available on a national scale. These can provide accurate information about food consumption patterns of families, particularly for significant trends. However, they do not provide information about the dynamics of food consumption, neither for urban areas or the individual. Now a significant proportion of individual food consumption occurs outside of the home, mainly with food provided by street vendors. This new consumption habit is a response to the urban food crisis. Consumption of street-vendor-food comprises one component but this cannot be dissociated from in-home food consumption. Despite the growing importance of street-vendor food consumption, it has still not been adequately documented. Theoretically, food consumption is an evolving concept. Single disciplines, such as economics or nutrition, first studied food consumption. More recently, social sciences developed new approaches with various interpretations, which were sometimes contradictory. The evolution of urban food consumption and the numerous related problems support the approach proposed by some authors suggesting a mixed analysis integrating both economics and cultural factors. Operationally, a global and dynamic approach to food styles must consider urban heterogeneity and diversity of situations. For example, food consumption by people maintaining their in-home food habits shows the pertinence of studies focusing on individuals. Therefore, the food course concept may be a useful method for the study of food consumption.

Africa, Western↗
PubMed1983

Social dimensions of healing: a longitudinal study of outcomes of medical management of headaches.

The social sciences have made few direct empirical contributions to the understanding of 'non-specific' benefits of treatment and generally the symbolic healing of indigenous non-Western medicine has received most attention in this field. This paper reports some results of a wider study of neurological clinics in England in which it is shown that a sample attending for headaches experienced considerable improvement in symptoms when followed up 1 year after attendance. Most of this improvement appeared not to be due to any intended treatments received at the clinics but could be attributed to the quality of patients' immediate responses to clinic attendance as assessed from reach interviews conducted after their consultations. This relationship between immediate 'satisfied' response and subsequent symptomatic improvement is interpreted in terms of the general levels of expectancy and sense of potential control achieved by obtaining referral to a specialist which directly enhanced recovery in those patients who felt the doctor's actions to be directly relevant to their personal concerns. Disappointment with the doctor reduced the 'non-specific' therapeutic benefits of the hospital referral. The intimate connections of patient satisfaction, treatment received and subsequent outcomes need more careful consideration in social studies of Western medicine.

Consumer Behavior↗
PubMed2003

Estimating implied rates of discount in healthcare decision-making.

OBJECTIVES: To consider whether implied rates of discounting from the perspectives of individual and society differ, and whether implied rates of discounting in health differ from those implied in choices involving finance or "goods". DESIGN: The study comprised first a review of economics, health economics and social science literature and then an empirical estimate of implied rates of discounting in four fields: personal financial, personal health, public financial and public health, in representative samples of the public and of healthcare professionals. SETTING AND PARTICIPANTS: Samples were drawn in the former county and health authority district of South Glamorgan, Wales. The public sample was a representative random sample of men and women, aged over 18 years and drawn from electoral registers. The health professional sample was drawn at random with the cooperation of professional leads to include doctors, nurses, professions allied to medicine, public health, planners and administrators. RESULTS: The literature review revealed few empirical studies in representative samples of the population, few direct comparisons of public with private decision-making and few direct comparisons of health with financial discounting. Implied rates of discounting varied widely and studies suggested that discount rates are higher the smaller the value of the outcome and the shorter the period considered. The relationship between implied discount rates and personal attributes was mixed, possibly reflecting the limited nature of the samples. Although there were few direct comparisons, some studies found that individuals apply different rates of discount to social compared with private comparisons and health compared with financial. The present study also found a wide range of implied discount rates, with little systematic effect of age, gender, educational level or long-term illness. There was evidence, in both samples, that people chose a lower rate of discount in comparisons made on behalf of society than in comparisons made for themselves. Both public and health professional samples tended to choose lower discount rates in health-related comparisons than in finance-related comparisons. It was also suggested that implied rates of discount, derived from responses to hypothetical questions, can be influenced by detail of question framing. CONCLUSIONS: The study suggested that both the lay public and healthcare professionals consider that the discount rate appropriate for public decisions is lower than that for private decisions. This finding suggests that lay people as well as healthcare professionals, used to making decisions on behalf of others, recognise that society is not simply an aggregate of individuals. It also implies a general appreciation that society is more stable and has a more predictable future than does the individual. There is fairly general support for this view in the theoretical literature and limited support in the few previous direct comparisons. Further research is indicated, possibly involving more in-depth interviewing and drawing inference on real, rather than hypothetical choices.

Adult↗
PubMed2002

The new middle level health workers training in the Amhara regional state of Ethiopia: students' perspective.

BACKGROUND: Following health sector reform, Ethiopia started training new categories of health workers. This study addresses students' perspectives regarding their training and career plans. METHODS: A cross sectional questionnaire was administered to 145 students in the three schools of the Amhara regional state of Ethiopia. RESULTS: The majority of students were male (62%) and originally from urban areas (76%). Job search was the most common reason for enrolling in the training for almost half (48%) of the respondents, followed by a desire to help the sick (46%). Once trained, the majority (98%) of graduates preferred to serve in the government sector and in rural health institutions (84%). Females were more willing to work in rural settings [chi2 (df 1)= 7.37; P = 0.007]. The majority (98%) of students felt the training period should be extended. 12% of graduates lacked confidence in their competencies after completing the training. A substantial proportion of the respondents (29%) did not feel the social science courses (Anthropology, Ecology and Psychology) were useful. CONCLUSIONS: This study demonstrates that mid-level health professional students are highly motivated, wish to address the health needs of rural communities, and are interested in professional development. However, students do not feel the training programs are fully addressing their needs. The students found that the duration of the training, the time for theory and practice, the availability of teaching materials, the course contents and their teachers were inadequate. This study suggests that the current training programs have serious inadequacies that need to be addressed.

Adult↗
PubMed2003

Brain death and organ transplantation: knowledge, attitudes, and practice among Japanese students.

OBJECTIVE: To investigate the knowledge, attitudes and practice of Japanese students regarding brain death and organ transplantation. METHODS: A 22-item questionnaire was handed out among 383 Japanese students during the 2002 academic year. The data was finally analyzed using a statistical package for social sciences, SPSS. RESULTS: Most students knew that organ transplantation can save a life 97%, while only 38% of the students were aware that there is no treatment for brain dead patients. Overall, 60% of the respondents believed brain death is equal to human death and 63% believed that organ removal from brain dead donors is mutilation of the body. There was a negative association between the students who reported positive attitudes toward the idea that removing an organ is mutilation of the body with their willingness to be a donor. Of the students 27% were opposed to the necessity of family agreement for organ donation. Although 66% expressed their wish to be a donor, less than half of them, 31% had a donor card; and 40% did not even know how to get a donor card. CONCLUSION: Granting a veto power to the family as well as the mistaken idea that there is recovery from brain death, can be considered as obstacles to organ procurement from the brain dead in Japan. The high value of life among Japanese society and the willingness to be a donor, bring hope that giving correct medical information and proper public education can increase social acceptance of organ transplantation from the brain dead in Japan.

Brain Death↗
PubMed2002

Overseeing organizations: configuring action and its environment.

Despite the widespread deployment of CCTV through most major cities and towns in great Britain, and the importance of surveillance to contemporary debates within the social sciences, there remains relatively little detailed research concerned with the practical use of these technologies in the workplace. In this paper, we examine how personnel in the operation rooms in London Underground use CCTV and related equipment to identify problems and events and to develop a co-ordinated response. In particular, we consider how personnel configure scenes to make sense of and interpret the conduct of the travelling public in organizationally relevant ways, and how they shape the ways in which both passengers and staff see and respond to each others' actions. In addressing how personnel constitute the sense and significance of CCTV images, we reflect on the development of information processing systems which are designed to automatically detect conduct and events.

Humans↗
PubMed2005

How to build an "active" patient? The work of AIDS associations in France.

"What is an "active" patient?" is a question that arises in most medicine and illness-related social science research. This article examines the normative work carried out by AIDS associations in France to define an "active" patient in healthcare and research. While the fight against AIDS is often presented as being homogenous, we look at the diversity of opinion between different associations (Aides, Act Up-Paris, Actions Traitements and Positifs). We find four different cases: the patient as manager of his illness, the empowerment of patients, the science-wise patient and the experimenter. Systematic comparison of these cases shows that these perceptions of the "active" patient, in terms of the same pathology, are based upon different ways of seeing: the nature of the relationships between the different types of knowledge of the illness (scientific knowledge, clinical knowledge, experience of the illness) and the distribution of roles and powers among the various actors in the healthcare system (the government, pharmaceutical companies, the medical profession, the patients). This article highlights the historical dynamics which allow us to have a better understanding of these differences, especially the major distinction between two generations of associations, which adopted different positions with regard to their public identity.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Retaining the meaning of the words religiousness and spirituality: a commentary on the WHOQOL SRPB group's "a cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life" (62: 6, 2005, 1486-1497).

Recent years have seen increasing recognition paid to the relation of religiousness/spirituality (R/S) to health care and research. This has led to the development of more inclusive and trans-culturally validated measurements of R/S. This paper comments on the WHOQOL SRPB Group's "A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life" (62: 6, 2005, 1486-1497), a recently published paper in Social Science & Medicine, and illustrates a possible problem in the measurement of R/S, especially as related to the study of mental health outcomes. Some scales have included questions about psychological well-being, satisfaction, connectedness with others, hopefulness, meaning and purpose in life, or altruistic values as part of their measure of R/S. These questions are really tapping indicators of mental health, and should not be included in the definition of R/S itself. Otherwise, tautology is the result, and it should not be surprising that such measures of R/S (defined by questions tapping mental health) are related to mental health outcomes.

Activities of Daily Living↗
PubMed2003

A method of moments technique for fitting interaction effects in structural equation models.

The desire to fit structural equation models containing an interaction term has received much methodological attention in the social science literature. This paper presents a technique for the cross-product structural model that utilizes factor score estimates and results in closed-form moments-type estimators. The technique, which does not require normality for the underlying factors, was originally introduced in a very general form by Wall and Amemiya (2000) for any polynomial structural model. In this paper, the practical implementation of this method, including standard error estimation, is presented specifically for the cross-product model. The procedure is applied to an example from social/behavioural epidemiology where the flexibility of the cross-product model provides a useful description of the underlying theory. A simulation study is also presented comparing the method of moments for the cross-product model with three other procedures.

Humans↗
PubMed1995

The quality of life in adult female patients with congenital adrenal hyperplasia: a comprehensive study of the impact of genital malformations and chronic disease on female patients life.

Female patients with congenital adrenal hyperplasia have been frequently studied in order to determine the impact of prenatal androgen exposure on various aspects of psychological, psychosocial and psychosexual development. There is no published study to evaluate the impact of the genital malformation, genital operations and chronic medication on the quality of life in adult females with congenital adrenal hyperplasia. We performed a quality-of-life evaluation in adult female patients with congenital adrenal hyperplasia due to a 21-hydroxylation defect. The patients were asked to fill out questionnaires covering the four domains of health-related quality of life, namely physical state, psychological well-being, social relationships and functional capacity as well as questionnaires covering the areas of psychosexual identification and psychosocial integration. In addition a semistructured interview was performed covering medical history as well as physical, emotional, social and psychosexual development. The results were evaluated using a computerized statistical program for social sciences. Forty-five patients agreed to participate (44 could be interviewed) and their medical data did not differ from the 20 patients (medical data were available from 16 patients) who refused to participate. Median age at diagnosis was below 1 year in 54.8 of the participating patients; range was from 0 to 30 years. Of the participants, 48.6%, 34.2% and 17.2% suffered from the simple-virilizing-, salt-wasting-, and late-onset-form of congenital adrenal hyperplasia, respectively. The mean adult height was 157.8 cm, and mean weight was 56.8 kg. In 35.7% the degree of genital virilization was classified as Prader stage 3 or 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Hyperplasia, Congenital↗
PubMed1997

Gender, race, class, and aging: advances and opportunities.

Key debates in social science and health research have centered on how to increase the inclusiveness of such research and hence its relevance for understanding the intersections of race, class, gender, and aging. This article uses gerontology as a case in point, examining the challenges of inclusivity and interlocking oppressions/intersectionality for better apprehending how broad structural factors shape and determine the experience of aging and growing old. The authors discuss alternative hypotheses being used to explore inequalities in the aging experience and the limitations of current concepts and methods. Promising new developments in sociology, epidemiology, and other fields are described in terms of their relevance for better understanding the dynamic interplay of race, class, gender, and aging.

Adaptation, Psychological↗
PubMed2005

Impact of the media on adolescent sexual attitudes and behaviors.

BACKGROUND: Adolescents in the United States are engaging in sexual activity at early ages and with multiple partners. The mass media have been shown to affect a broad range of adolescent health-related attitudes and behaviors including violence, eating disorders, and tobacco and alcohol use. One largely unexplored factor that may contribute to adolescents' sexual activity is their exposure to mass media. OBJECTIVE: We sought to determine of what is and is not known on a scientific basis of the effects of mass media on adolescent sexual attitudes and behaviors. Method. We performed an extensive, systematic review of the relevant biomedical and social science literature and other sources on the sexual content of various mass media, the exposure of adolescents to that media, the effects of that exposure on the adolescents' sexual attitudes and behaviors, and ways to mitigate those effects. Inclusion criteria were: published in 1983-2004, inclusive; published in English; peer-reviewed (for effects) or otherwise authoritative (for content and exposure); and a study population of American adolescents 11 to 19 years old or comparable groups in other postindustrial English-speaking countries. Excluded from the study were populations drawn from college students. RESULTS: Although television is subject to ongoing tracking of its sexual content, other media are terra incognita. Data regarding adolescent exposure to various media are, for the most part, severely dated. Few studies have examined the effects of mass media on adolescent sexual attitudes and behaviors: only 12 of 2522 research-related documents (<1%) involving media and youth addressed effects, 10 of which were peer reviewed. None can serve as the grounding for evidence-based public policy. These studies are limited in their generalizability by their cross-sectional study designs, limited sampling designs, and small sample sizes. In addition, we do not know the long-term effectiveness of various social-cultural, technologic, and media approaches to minimizing that exposure (eg, V-Chips on television, Internet-filtering-software, parental supervision, rating systems) or minimizing the effects of that exposure (eg, media-literacy programs). CONCLUSIONS: Research needs to include development of well-specified and robust research measures and methodologies; ongoing national surveillance of the sexual content of media and the exposure of various demographic subgroups of adolescents to that content; and longitudinal studies of the effects of that exposure on the sexual decision-making, attitudes, and behaviors of those subgroups. Additional specific research foci involve the success of various types of controls in limiting exposure and the mitigative effects of, for example, parental influence and best-practice media-literacy programs.

Adolescent↗
PubMed2002

Environmental policies to reduce college drinking: options and research findings.

OBJECTIVE: The goal of this article is to provide an overview of environmental strategies that may reduce college drinking. Drinking behavior is influenced by many environmental factors, including messages in the media, community norms and attitudes, public and institutional policies and practices and economic factors. College student drinking may be influenced by environmental factors on and off campus. METHOD: A comprehensive search of MEDLINE, ETOH, Current Contents and Social Science Abstracts databases was conducted to identify research studies evaluating effects of environmental strategies on college and general populations. RESULTS: The identified environmental strategies fall into four categories: (1) increasing compliance with minimum legal drinking age laws, (2) reducing consumption and risky alcohol use, (3) decreasing specific types of alcohol-related problems and (4) de-emphasizing the role of alcohol on campus and promoting academics and citizenship. Although the extant research indicates that many environmental strategies are promising for reducing alcohol-related problems among the general population, few of these strategies have been evaluated for effects on the college population. CONCLUSIONS: Further research is needed to evaluate effects of alcohol control policies on alcohol consumption and its related problems among college students.

Alcohol Drinking↗
PubMed1985

The Primary Health Care Project in Belgium: a survey on the utilization of health services.

The article consists of two major parts. In the Introduction a general overview is given of the Primary Health Care Project, carried out in Belgium from 1975 to 1978 in the broader framework of a large National Project in the Social Sciences. An explanation is given of the scope of the study, its method and sampling. Since the very broad study design, it was decided to make a selection of interesting results. An overview is given of the most relevant data with respect to the utilization of health care services and of medicines. After a short clarification of the concept of utilization behaviour, some data are presented in order to describe the use of medical services and the consumption of medicines. Secondly an attempt is made to explain utilization behaviour. For the explanatory model used in this project, the WHO-model functioned as an important source of inspiration. In this way it surmounted the limitations of much previous research. This model included variables on the level of the individual-perceived morbidity, predisposing factors and enabling factors-as well as system variables--such as degree of urbanization, proximity and the way of functioning of the medical supply. The research results have successfully shown that: there is a strong relationship between perceived presence and perceived seriousness of morbidity on the one hand, utilization behaviour on the other hand; the health perspective (including medical knowledge, values and attitudes) seems to have a differential influence on utilization behaviour, depending on age and social background of the respondent; the inclusion of socio-structural variables is an innovation in the Belgian health care research. The hypothetical character of the relationships found here is largely supported by the research simultaneously conducted in the French-speaking region of Belgium; accessibility and socialization are factors having a clear influence on the use of general practice services. The importance of the presence and the organization of the supply in the explanation of utilization behaviour is partly confirmed.

Attitude to Health↗
PubMed1998

Explaining women's employment patterns: 'orientations to work' revisited.

Explanations of the persisting differences in the structure of men's and women's employment have long been debated in the social sciences. Sociological explanations have tended to stress the continuing significance of structural constraints on women's employment opportunities, which persist despite the removal of formal barriers. Neo-classical economists, in contrast, have emphasized the significance of individual choice, an argument which has been recently endorsed by Hakim who suggests that patterns of occupational segregation reflect the outcome of the choices made by different 'types' of women. In this paper, a previous debate relating to the explanatory utility of men's 'orientations to work' is used to argue that employment structures are the outcome of both choice and constraint, and that this is the case for women, as well as men. The argument is illustrated with evidence from cross-nationally comparative biographical interviews carried out in five countries.

Career Choice↗
PubMed2001

Dissociative identity disorder and the nurse-patient relationship in the acute care setting: an action research study.

This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

Acute Disease↗