Social science & medicine
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Social science & medicine · Feb 2010
Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa.
The study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18-44 years in one urban (n=606) and one rural (n=412) site. The women were interviewed using a structured questionnaire. ⋯ Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency.
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Social science & medicine · Feb 2010
Physicians' psychosocial barriers to different modes of withdrawal of life support in critical care: A qualitative study in Japan.
Despite a number of guidelines issued in Anglo-American countries over the past few decades for forgoing treatment stating that there is no ethically relevant difference between withholding and withdrawing life-sustaining treatments (LST), it is recognized that many healthcare professionals in Japan as well as some of their western counterparts do not agree with this statement. This research was conducted to investigate the barriers that prevent physicians from withdrawing specific LST in critical care settings, focusing mainly on the modes of withdrawal of LST, in what the authors believe was the first study of its kind anywhere in the world. In 2006-2007, in-depth, face-to-face, semistructured interviews were conducted with 35 physicians working at emergency and critical care facilities across Japan. ⋯ The findings suggest what the Japanese physicians avoid is not what they call a life-shortening act but an act that would not lead to a soft landing, or a slow death that looks 'natural' in the eyes of those surrounding the patient. The purpose of constructing such a final scene is believed to fulfill the psychosocial needs of the patient's family and the physicians, who emphasize on how death feels to those surrounding the patient. Unless withdrawing LST would lead to a soft landing, Japanese clinicians, who recognize that the results of withdrawing LST affect not only the patient but those around the patient, are likely to feel that there is an ethically relevant difference between withholding and withdrawing LST.
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Social science & medicine · Feb 2010
Perceptions of the gift relationship in organ and tissue donation: Views of intensivists and donor and recipient coordinators.
The international literature on organ donation and transplantation has drawn attention to the popularity of "gift of life" discourse among pro-donation advocates, transplantation specialists, and within organisations lobbying for improved donation rates to promote the benefits of organ donation among members of the general public. In Aotearoa/New Zealand, gift of life discourse is robust. Aside from attempts to elicit altruism by promoting tissue donation in the public domain, gift terminology separates the act of donation from that of commerce and the commodification of body tissues. ⋯ The data indicate several problems with gift rhetoric to describe the situations health professionals encounter. In sum, gift terminology tends to downplay the sacrifice involved in tissue donation generally, as well as depoliticising the exchange relations of tissue transfer in contemporary consumer culture and in the global context. This raises questions about the underlying ethics of language choice and what, if anything, empirical accounts of tissue transfer can contribute to ethical debates.
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Social science & medicine · Feb 2010
Using economic levers to change behaviour: the case of Thailand's universal coverage health care reforms.
Thailand's universal coverage health care policy has been presented as a knowledge-based reform involving substantial pre-planning, including expert economic analysis of the financing mechanism. This paper describes the new financing system introduced from 2001 in which the Ministry of Public Health allocated monies to local Contracted Units for Primary Care (CUPs) on the basis of population. It discusses the policy intention to use capitation funding to change incentive structures and engineer a transfer of professional staff from over-served urban areas to under-served rural areas. ⋯ In many CUPs, the hospital directors controlling resource allocation channelled funds more towards curative services than community facilities. Taken together the macro and micro problems led to the dilution of capitation funding and reduced the re-distributive effects of the reforms. This strand of policy foundered in the face of structural and institutional barriers to change.
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Social science & medicine · Feb 2010
The dynamic interaction of quality and efficiency in the emergency department: Squaring the circle?
This paper examines the relationship between clinical quality and organizational efficiency in emergency departments (EDs). Previous studies have often emphasized the incompatibility of quality and efficiency, or have neglected to account for their inter-relationships. Policy perspectives reflect normative prescriptions for throughput and reduced waiting times which do not always align with clinicians' foci or day-to-day practices. ⋯ The relationship between clinical quality and organizational efficiency can be understood through a sociological lens that highlights the roles of interdependent clinicians in a clinical pecking order, working to provide care, and balancing the two. The paper is novel in expanding "value-assimilation" into the clinical domain, and strives to reconcile policy with everyday practice in emergency settings. It moves the debate about quality versus efficiency to one that emphasizes interdependence.