社区社会经济环境对健康结局的影响

社区社会经济环境可能是人群健康状况和疾病的最重要的影响因素,但直到近10年来才成为研究热点。本文对有关社会经济环境因素对健康结局影响的研究结果进行了综述,并对研究中所涉及的几个问题进行了评述。结果表明,尽管存在研究设计的异质性、地区测量代替社区测量和测量误差等问题,社区社会经济环境对健康结局有较小的影响。社区社会经济环境应该受到重视,社区水平的干预措施应该建立。     

Contextual influences on chronic illness: A multi-level analysis in the twin cities of Ramallah and Al Bireh in the occupied Palestinian Territory

The features of the urban environment can support human health as well as harm it, but less is known about such influences in the context of middle eastern countries. The association between green space and the political classifications of the urban environment and the risk of chronic illness was investigated in a novel setting, the twin cities of Ramallah and Albireh in the occupied Palestinian territory. We used a generalised multi-level regression analysis to link the 2017 census data with Geographic Information System data. We modelled individuals at level one (n = 54693) and areas of residence at level two (n = 228), adjusting for individual demographic and socio-economic characteristics.The proportions of ‘mixed’ trees in residential areas had a significant inverse association with the risk of chronic illness. On the political dimension, only living in a refugee camp had a significant positive association with chronic illness; however, this was largely explained and rendered non-significant when green space variables were entered into the models. Our ability to differentiate between several types of green space was important, as findings demonstrated that not all types were associated with reduced risk of chronic illness. Our results from a middle eastern setting add to the largely Western existing evidence, that trees in urban settings are important and beneficial to human health. Researchers and policymakers should pay more attention to the health consequences of refugee camps but also the role of trees in benefiting individuals' health in such a disadvantaged context.     

The Context of Caregiving,Kinship Tie and Health: A Comparative Study of Caregivers and Non-Caregivers

ABSTRACT

The present study aimed to compare caregiving appraisal and psychological and physical health between caregivers and non-caregivers and between wives or daughters, and to examine the associations of caregiving context variables (intensity, duration, and co-residence) with health. The sample included 201 individually matched pairs of caregivers and non-caregivers, wives and daughters of older patients discharged from the three Internal Medicine wards at Hadassah Medical Centre in Jerusalem, Israel, during 2003. Caregivers reported significantly more negative appraisal and poorer health compared with non-caregivers, wives differed from daughters in burden appraisal and had significantly poorer health. Almost no significant interactions of care-giving status by kinship tie were observed, suggesting that caregivers differed from non-caregivers irrespective of kinship tie. The multi-variate analyses of health measures by caregiving context revealed that high-intensity caregivers and co-residing daughter caregivers were most vulnerable to poor health. Health services providers need to develop ways for early identification of vulnerable caregivers, providing support and care programs and targeting resources.     

The determinants of health: structure, context and agency

Abstract The concept of social structure is one of the main building blocks of the social sciences, but it lacks any precise technical definition within general sociological theory. This paper reviews the way in which the concept has been deployed within medical sociology, arguing that in recent times it has been used primarily as a frame for the sociological interpretation of health inequalities and their social determinants. It goes on to examine the contribution that medical sociologists have made to the debate over health inequalities, giving particular attention to contributions to Sociology of Health and Illness. These have often provided a focus for discussions outside or critical of the mainstream debates that have been driven primarily by epidemiologists. The paper reviews some of the main points of criticism of epidemiological approaches, focusing in particular on the methodological constraints that limit the capacity of epidemiologists to develop more theoretically satisfactory accounts of the inter‐relationships of social structure, context and agency in their impact on health and well being. Some recent examples from the Journal of more theoretically innovative and analytically fine‐grained approaches to understanding the impact of social structure on health are then explored. The paper concludes with an argument for a more historically‐informed analysis of the relationships between social structure and health, using the knowledgeable narratives of people in places as a window onto those relationships.     

Treatment Decision Making and Its Discontents

Patient participation in treatment decision making is held as a virtue in clinical contexts, and has much to recommend it. Yet important questions have been raised about the assumptions underlying models of patient participation. Debates have arisen about the significance of medically defined risks and outcomes of treatment; the adequacy and relevance across social groups of the concept of autonomy; and the emphasis on the professional–patient dyad. This article contributes to the debate about treatment decision making with reference to a study focused on older women with cancer. Interviews with patients and cancer care professionals highlighted the salience to patients' treatment choices of experiential knowledge, social roles and responsibilities, and the health policy context. It appears that prevailing models of decision making may obscure patients' more typical decision processes as well as the social determinants of those choices.     

Impact of water supply and sanitation on diarrheal morbidity among young children in the socioeconomic and cultural context of Rwanda (Africa)

This project studied the frequency and intensity of water contamination at the source, during transportation, and at home to determine the causes of contamination and its impact on the health of children aged 0 to 5 years. The methods used were construction of the infrastructure for three sources of potable water, administration of a questionnaire about socioeconomic status and sanitation behavior, anthropometric measurement of children, and analysis of water and feces. The contamination, first thought to be only a function of rainfall, turned out to be a very complex phenomenon. Water in homes was contaminated (43.4%) with more than 1100 total coliforms/100 ml due to the use of unclean utensils to transport and store water. This socioeconomic and cultural problem should be addressed with health education about sanitation. The latrines (found in 43.8% of families) presented a double-edged problem. The extremely high population density reduced the surface area of land per family, which resulted in a severe nutritional deficit (15% of the children) affecting mainly young children, rendering them more susceptible to diarrhea (three episodes/child/year).     

The impact of the integrative perceptual approach on the teaching of Chinese characters in a Hong Kong kindergarten

This study investigated the effectiveness of the integrative perceptual approach (IPA) to enhancing Hong Kong kindergarten children’s Chinese character learning. The study applied the IPA to an experimental group of 29 lower form (K2) children. A group of 30 upper form children taught via traditional methods the year before, served as the control group. Quantitative data consisted of pre‐ and post‐test scores, analysed using dependent and independent t‐testing. It was found that the pupils in the experimental group had significantly improved their ability between pre‐ and post‐testing in three aspects of Chinese character mastery: shape, sound and meaning recognition. The progress made was significantly superior to that made by control group counterparts. Qualitative data gathered through teacher and parent interviews indicated that the pupils in the experimental group displayed increased awareness of the composition of several components and structures of Chinese characters.     

A Search for Synergy: The Child and Youth Care Educated Child Protection Worker

The field of child protection has a longstanding familiarity with the field of Social Work. However, in British Columbias Ministry for Children and Family Development the ranks of Child Protection Workers are swelling with professionals who have been educated in Child and Youth Care. Using the authors personal experience, this article outlines the differences between Social Work and Child and Youth Care perspectives and further explores two of the many roles MCFD workers can assume within the MCFD. The article then offers insight to which role is accommodating of CYC hallmarks and which is not. The discussion then concludes with an examination of how CYC workers in the MCFD can advocate for the CYC perspective and profession within a Social Work dominated environment.     

Ageisms

In this paper some very fundamental attitudes we have and assumptions we make in the US about persons, what they owe and what they are owed, are scrutinized and found to be indefensibly ageist. It is argued that these assumptions and the attitudes they engender are supported by logically and ethically suspect methods and conclusions. These errors are summarized and some remedial steps by which we might better protect against such illicit and unwarranted methods and conclusions in the future are suggested.