Social science & medicine
-
Social science & medicine · Dec 2004
Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model.
Latinos, who constitute the fastest growing ethnically distinct US group, experience disproportionately high rates of type 2 diabetes. At the same time, linguistic and economic barriers, differing cultural expectations between patients and physicians, provider reactions based on stereotypes, and managed healthcare shortfalls limit diabetes care. Such trends highlight physicians' need to consider culture in the delivery of effective services. ⋯ Diverse educational experiences appear particularly helpful in this process. Community clinic settings also help practitioners gain cultural knowledge. While Latino ethnicity predicted cultural awareness, results also suggest that all physicians can take steps towards increasing their cultural competence.
-
Social science & medicine · Nov 2004
Changes in authorship patterns in prestigious US medical journals.
To improve identification of contributors to manuscripts, editors of medical journals have developed authorship responsibility criteria. Some have specified an acceptable number of authors per manuscript. We wanted to examine changes in patterns of authorship in the context of the development of these specifications. ⋯ Group authorship was most prevalent in journals that limited the acceptable number of authors per manuscript. These findings suggest that the number of authors per manuscript continues to grow. The growth in the number of authors on bylines and the proportion of group-authored manuscripts is likely to reflect the increasing complexity of medical research.
-
Social science & medicine · Nov 2004
Characteristics of online and offline health information seekers and factors that discriminate between them.
Increasing number of individuals are using the internet to meet their health information needs; however, little is known about the characteristics of online health information seekers and whether they differ from individuals who search for health information from offline sources. Researchers must examine the primary characteristics of online and offline health information seekers in order to better recognize their needs, highlight improvements that may be made in the arena of internet health information quality and availability, and understand factors that discriminate between those who seek online vs. offline health information. This study examines factors that differentiate between online and offline health information seekers in the United States. ⋯ This study is unique in that the results illustrate that there are several key factors (age, income, and education) that discriminate between US online and offline health information seekers; this suggests that general "digital divide" characteristics influence where health information is sought. In addition to traditional digital divide factors, those who are healthier and happier are less likely to look exclusively offline for health information. Implications of these findings are discussed in terms of the digital divide and the patient-provider relationship.
-
Social science & medicine · Oct 2004
Comparative StudyThe effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries.
In Europe, the reduction of acute care hospital beds has been one of the measures implemented to restrict hospital expenditure. The aim of this study is to gain insight into the effect bed reductions have on the use of the remaining beds within different healthcare systems. We concentrated on two healthcare system elements: hospital financing system (per diem and global budget systems) and physician remuneration system (fee-for-service and salary systems). ⋯ We found some indication that the different financial incentives of hospital financing systems do indeed influence hospital bed use in the case of reductions in acute care hospital bed supply in different ways. However, we found significant effects only for the hospital bed use indicators "occupancy rate" and "admission rate". For physician financing systems, no significant effects were found.
-
Social science & medicine · Oct 2004
Denial of impending death: a discourse analysis of the palliative care literature.
Terminally ill patients and their families are often referred to as being "in denial" of impending death. This study uses the qualitative method of discourse analysis to investigate the usage of the term "denial" in the contemporary hospice and palliative care literature. A Medline search (1970-2001) was performed combining the text words "deny" and "denial" with the subject headings "terminal care", "palliative care" and "hospice care," and restricted to English articles discussing death denial in adults. ⋯ Elements of the psychoanalytic definition of denial as an unconscious defence mechanism are retained in the literature but are interwoven with new themes on patient choice. The result is an overall discourse that is conflictual and at times self-contradictory but overall consistent with the biomedical model of illness. I suggest that the representation of death denial elaborated in these articles may be related to a larger discourse on dying in contemporary Western society, which both invites patients to participate in the planning of their death and labels those who do not comply.