Social science & medicine
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Social science & medicine · Dec 2010
Comparative StudyEconomic fluctuations and suicide: a comparison of Taiwan and Hong Kong.
This study examines the impact of unemployment on suicide rates in Taiwan and Hong Kong during the period of rising unemployment (1997-2003) and its subsequent decline (2003-2007), with 2003 as the turning point. During these initial years of high unemployment, suicide rates increased markedly in Hong Kong and Taiwan; however, as employment conditions improved, suicide rates fell in Hong Kong but continued to increase in Taiwan. ARMAX time-series models with appropriate time lags were used to assess the impact of unemployment on suicide rates for both periods. ⋯ In conclusion, lower unemployment was not necessarily associated with lower suicide rates. Exogenous factors other than economic ones have been suggested to be important for understanding differences in suicide patterns in Hong Kong and Taiwan. The impact of employment conditions on suicide across different countries deserves further investigation.
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Social science & medicine · Dec 2010
Metropolitan isolation segregation and Black-White disparities in very preterm birth: a test of mediating pathways and variance explained.
Residential isolation segregation (a measure of residential inter-racial exposure) has been associated with rates of preterm birth (<37 weeks gestation) experienced by Black women. Epidemiologic differences between very preterm (<32 weeks gestation) and moderately preterm births (32-36 weeks) raise questions about whether this association is similar across gestational ages, and through what pathways it might be mediated. Hierarchical Bayesian models were fit to answer three questions: is the isolation-prematurity association similar for very and moderately preterm birth; is this association mediated by maternal chronic disease, socioeconomic status, or metropolitan area crime and poverty rates; and how much of the geographic variation in Black-White very preterm birth disparities is explained by isolation segregation? Singleton births to Black and White women in 231 U. ⋯ There is no association between segregation and prematurity among White women. Isolation segregation explains 28% of the geographic variation in Black-White very preterm birth disparities. Our findings highlight the importance of isolation segregation for the high-burden outcome of very preterm birth, but unexplained excess risk for prematurity among Black women is substantial.
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Social science & medicine · Dec 2010
Precarious spaces: risk, responsibility and uncertainty in school-based suicide prevention programs.
We report on findings from an in-depth qualitative case study designed to closely examine the social practices of planning and implementing a four-part (six hour) classroom-based suicide prevention program within two classrooms in one secondary school in Vancouver, British Columbia. Representing a departure from traditional evaluation research studies in suicidology, we examine how school-based youth suicide prevention programs get brought into being in "real world" contexts. ⋯ Based on our analysis, we suggest that suicide (and its prevention), in all its complex and culturally situated forms, simply cannot be conceptualized through singular, stable or universalizing terms that transcend time and context. Implications for (re)- conceptualizing suicide prevention education are discussed.
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Social science & medicine · Dec 2010
Integrated care in the emergency department: a complex adaptive systems perspective.
Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. ⋯ We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.
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Social science & medicine · Dec 2010
Are local health department expenditures related to racial disparities in mortality?
This study estimated whether 1990-1997 changes in expenditures per capita of local health departments (LHDs) and percentage share of local public revenue allocated to LHDs were associated inversely with 1990-1997 changes in mortality rates for Black and White racial/ethnic groups in the US. Population was 883 local jurisdictions with 1990 and 1997 mortality rates for Black and White racial populations from the Centers for Disease Control and Prevention Wonder Compressed Mortality File and LHD expenditures from the National Association of County and City Health Officials. ⋯ LHD expenditures or percentage share were related to absolute reductions in mortality for infants, Blacks, and White females but did not close Black-White mortality differences for these groups. Therefore, disparities in Black and White mortality rates for subgroups with the greatest mortality gaps may be more likely to be reduced by public investment in local health departments than disparities in Black and White total, all-cause mortality rates.