Social science & medicine
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Social science & medicine · Jan 1989
ReviewWar-related changes in health and health services in Nicaragua.
The low-intensity war against Nicaragua from 1983 to 1987 has had a wide reaching impact on health, health services, and health economics in that country. Beyond the death of individuals and destruction of facilities, economic embargo and contra destruction have cost the health system about 200 billion cordobas between 1981 and 1987. This is approximately equal to the value of 2 years of the entire health budget. ⋯ Nonetheless, the indirect effects of the war have been detrimental to the system. Negative effect include the loss to the system of health professionals and rampant inflation. These forces contribute to the weakening of primary health programs and the reorientation of the national system into hospital based, curative medical services.
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The MCH/FP services for women in Africa offer today limited services that do not cater to the multiple and complex problems that women face during their long productive lives. Many women are infertile, many suffer and die from abortions, many cannot get access to safe contraceptive technology or safe and sterile delivery services. ⋯ The health needs of women have thus intensified and become increasingly shaped by their growing role in production and in the social reproduction of the household. The paper examines the changing health needs of women in East Africa, why MCH/FP health services have failed to meet these needs, and identifies the types of services that women increasingly require.
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Social science & medicine · Jan 1989
Patient involvement in decision-making in surgical and orthopaedic practice: the Project Perioperative Risk.
As part of the Project Perioperative Risk (PROPER), which is a clinical and epidemiological study of surgical complications, patient involvement in the decision to operate was evaluated by means of a questionnaire. The sample of 666 patients, on the waiting list for an operation, received a questionnaire on a broad range of issues concerning their involvement in the decision-making process one week before the operation. The results show that 41% regarded the decision to have an operation as a joint patient-doctor decision, in 29% of the cases the doctor advocated an operation and in 8% the patient asked to be operated. ⋯ In the discussion, it is argued that the comparatively high degree of patient satisfaction with involvement in the decision-making process cannot be taken as evidence of a high level of influence in an absolute sense. In a normative perspective--and considering the fact that the increased responsibility of the health sector is aimed at involving patients in decision-making in health matters--patient satisfaction can just as well be understood as resulting from low expectations with respect to one's own influence. The results also indicate that patient's information needs when facing surgery relate to three issues; possible complications, precise nature of the operation as such, and nature and consequences of anaesthetic procedures.
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Social science & medicine · Jan 1989
Drug use among Puerto Rican youth: an exploration of generational status differences.
An analysis of the relationship between generational status, or a migrational experience, and adolescent drug use takes advantage of a natural experiment--the migration of Puerto Ricans to the continental United States and their immigration back to the island. Although researchers have studied different sources of variation in adolescent drug use behavior, few have examined the drug use experience of the same ethnic group in varying sociocultural settings. The present study focused on the drug use involvement of four generational status groups of Puerto Rican adolescents in two different settings--New York City and San Juan, Puerto Rico. ⋯ Two important conditional relationships were documented. First, the impact of length of time living in New York City varied with the adolescent's gender, with higher risk of drug involvement observed for female migrants. Second, socioeconomic status was associated with Puerto Rican adolescents' drug use involvement in the New York City subgroups, but not among the students in Puerto Rico.
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Social science & medicine · Jan 1989
Privacy between physicians and patients: more than a matter of confidentiality.
This study examined patients' perceptions (N = 427) of the meaning of privacy within the physician-patient dyad. The recognition of the importance of privacy, the norms that govern privacy, and the specific behaviors that may be considered to violate privacy in relationships has most often received only general attention by researchers. ⋯ Thus, in contrast to the usual conception of patient confidentiality as an issue focused on information, confidentiality is cast as a topic within both the informational and psychological realms of privacy. Implications for current medical interviewing practices, especially with regard to questions that concern patients' sexual behavior, are discussed.