Social science & medicine
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Social science & medicine · Nov 2002
Change in determinants of use of physician services in Finland between 1987 and 1996.
The determinants of use of physician services in Finland in 1987 and 1996 were studied to evaluate how the utilisation altered over this period, which saw fairly radical changes in Finnish health care and the entire economy. We used econometric methods to describe the changes in structure and level of utilisation. The study was based on the Finnish Health Care Surveys of 1987 and 1996, which were nationally representative cross-sectional samples of the total non-institutionalised population. ⋯ Among adults aged 18-64, the most important structural change was an increase of the effect of self-rated health status variables on utilisation. Inequity in utilisation of services persisted with respect to income. In conclusion it can be stated that Finland's tax-based and locally decentralised health care system adapted quite well to the radical changes experienced during the study period.
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Social science & medicine · Oct 2002
The epidemiology of rape and sexual coercion in South Africa: an overview.
During 1999 the issue of rape in South Africa was debated at the highest levels. The epidemiology of rape has become an issue of considerable political importance and sensitivity, with President Mbeki demanding an answer to the question: how much rape is there in South Africa? The purpose of this paper is both to summarise and synthesise the findings of research to provide an overview of the epidemiology of rape of women in South Africa and to show how difficult it is to answer the President's question. The review begins by considering why rape is so difficult to research. ⋯ Knowledge of causal and contributory factors influencing the high levels of rape are also discussed. We conclude that the rape statistic for the country is currently elusive but levels of non-consensual and coerced sex are clearly very high. International comparison needs to be approached with caution because most developing countries lack the infrastructure for accurate crime reporting and do not have such a substantial body of survey data.
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Social science & medicine · Sep 2002
Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents.
This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. ⋯ The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.
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Social science & medicine · Sep 2002
Predictors of Canadian legislators' support for tobacco control policies.
It is clear that regulatory strategies can be effective in reducing tobacco use. Because legislators ultimately determine whether many of these policies are enacted, they are a key focus for tobacco policy research. This study identifies political and personal predictors of Canadian legislators' support for tobacco control policies. ⋯ It also appears that legislators who oppose tobacco control measures may not be opposed to tobacco control per se, but are more generally opposed to a government role in health promotion. Thus, public health professionals and tobacco control advocates need to be more attentive to the way tobacco control issues are framed for particular legislators. Further, meetings with health groups about tobacco issues would be welcomed by many legislators; non-governmental organizations and other health advocates could work to increase tobacco knowledge among legislators.
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Social science & medicine · Aug 2002
Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries.
The World Health Organization estimates that 58% of pregnant women in developing countries are anemic. In spite of the fact that most ministries of health in developing countries have policies to provide pregnant women with iron in a supplement form, maternal anemia prevalence has not declined significantly where large-scale programs have been evaluated. During the period 1991-98, the MotherCare Project and its partners conducted qualitative research to determine the major barriers and facilitators of iron supplementation programs for pregnant women in eight developing countries. ⋯ The major barrier to effective supplementation programs is inadequate supply. Additional barriers include inadequate counseling and distribution of iron tablets, difficult access and poor utilization of prenatal health care services, beliefs against consuming medications during pregnancy, and in most countries, fears that taking too much iron may cause too much blood or a big baby, making delivery more difficult. Facilitators include women's recognition of improved physical well being with the alleviation of symptoms of anemia, particularly fatigue, a better appetite, increased appreciation of benefits for the fetus, and subsequent increased demand for prevention and treatment of iron deficiency and anemia.