Social science & medicine
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Social science & medicine · May 2003
Emplotting children's lives: developmental delay vs. disability.
While it is increasingly possible to envision "perfect" babies, it is not always the case that reproduction actually proceeds according to individual will; for example, there has been no recent reduction in rates of childhood disability. Nevertheless, in most studies of new reproductive technologies, the birth of those children whom few would actively choose-"defective" or disabled infants-is presented only in hypothetical terms. This paper argues for expanding the domain of reproduction to include research on the parenting of children with disabilities. ⋯ I suggest that American mothers' narratives, by utilizing the concept of developmental delay, can assert personhood, or rather, the potential for its future attainment; in doing so, they justify ongoing nurturance of a disabled child in spite of negative attitudes about disability. A particular case of one mother's emplotment of her child's life within a story of developmental delay, in competition with the physician's story of disability, is analyzed. The paper concludes with reflections on how stories of developmental delay told by mothers just encountering a diagnosis of disability may differ from the stories told by those who have experienced mothering a disabled child over time, and on the implications of these differences for the cultural construction of personhood in the United States.
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Social science & medicine · May 2003
Antiabortion positions and young women's life plans in contemporary Ireland.
At a critical time when Ireland's abortion ban faces legal challenges and the number of women obtaining abortions abroad each year continues to climb, some antiabortion advocates have turned their attention toward the social factors that influence women's abortion decision-making. Through an analysis of articles carried in the Irish mainstream and Catholic presses, this article examines how antiabortion advocates since the late 1990s have promoted an "antiabortion, pro-motherhood" message in response to trends that they identify as indicating that Irish reproduction has "gone awry". ⋯ These women are more likely than young women in past generations to postpone childbearing or opt for abortion in the face of an unwanted pregnancy, and thus, symbolize for antiabortion advocates the devaluation of a "traditional" Irish culture centered on the privileging of motherhood and married family life. This article examines antiabortion ideologies deployed around motherhood, work, and childcare, and argues that antiabortion advocates' "pro-motherhood" campaign fails to adequately respond to the changing realities of young, middle-class Irish women's life opportunities and expectations.
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Social science & medicine · Apr 2003
Primary health and social care services in the UK: progress towards partnership?
There has been a shift in the theoretical debates around the ways in which organisations deliver the state's objectives of providing health and social care services for its citizens, focusing on issues of welfare governance and the encouragement of partnership working between organisations. This article develops these theories by focusing on developments in primary health and social care policy in the UK, which have undergone a radical change recently. ⋯ This paper examines evidence from the first stage of a 3-year longitudinal quantitative and qualitative study of the development of partnership working between PCG/Ts and social services departments in England. It examines whether the evidence suggests that the integration of health and social care is feasible or desirable in older people's services.
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Social science & medicine · Mar 2003
Implementing participatory intervention and research in communities: lessons from the Kahnawake Schools Diabetes Prevention Project in Canada.
Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. ⋯ Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process.
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This study examined how patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient influenced whether patients with a depression diagnosis received an antidepressant prescription and whether they received a SSRI antidepressant, a non-SSRI antidepressant, or both. The 1998 National Ambulatory Medical Care Survey (NAMCS), in the USA, was used for the analysis. Logistic regression was used to examine what characteristics influenced whether a patient with a depression diagnosis received an antidepressant prescription. ⋯ Patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient all influenced antidepressant prescribing. An especially important finding was that insurance status influenced whether patients received an antidepressant. Health care providers need to take the time to help patients without insurance obtain antidepressant medication if it is needed.