Social science & medicine
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Social science & medicine · Aug 2002
Understanding household demand for indoor air pollution control in developing countries.
More than 2 billion people rely on solid fuels and traditional stoves or open fires for cooking, lighting, and/or heating. Exposure to emissions caused by burning these fuels is believed to be responsible for a significant share of the global burden of disease. To achieve widespread health improvements, interventions that reduce exposures to indoor air pollution will need to be adopted and consistently used by large numbers of households in the developing world. ⋯ Based on such existing information, it might be concluded that household demand should seemingly be strong given that willingness to pay, based on existing information, is seemingly large compared to costs for common interventions like improved stoves. Given that household demand is not strong for existing interventions, this analysis shows that more clearly focused research on household demand for interventions is needed if such interventions are going to be demanded (i.e. adopted and used) by large numbers of households throughout the developing world. Four priority areas for future research are: (1) improving information on dose-response relationships between indoor air pollution and various health effects (e.g. increased mortality and morbidity risks); (2) improving information on impacts from interventions in terms of air pollution reductions and also cooking times, fuel use, and heat intensities; (3) improving information on household shadow values for improved health, with separate information for adult and child health; and (4) considering more directly household information, and its adequacy, for their ability to evaluate the relationships between fuel use and health.
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Social science & medicine · May 2002
Meanings of immediate: the practical use of the Patient's Charter in the accident and emergency department.
The publication of the Patient's Charter in Britain enabled patients to have access to a series of documented standards relating to health care provision in a variety of situations. However since its introduction much discussion has taken place as to its application in clinical practice. An initial interest in the accomplishment of routine accident and emergency (A& E) nursing work led to the identification of issues associated with the use of the Patient's Charter standards; particularly those associated with immediate assessment in the A & E department. ⋯ Firstly, the meanings of immediate assessment continue to remain open to interpretation and therefore difficult to capture and manage. Secondly, the Patient's Charter standards, associated with immediate assessment, deal with one aspect of the work only and yet the accomplishment of A & E work is dependent upon maintaining a perception of order and shape throughout the whole department. Ultimately both issues have an impact on nurses' recognition and management of what they know to be the normal appearances and shape of routine work.
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Social science & medicine · May 2002
Dynamics of change in local physician supply: an ecological perspective.
The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified: generalists, medical specialists, surgical specialists, and hospital-based specialists. ⋯ For example, both hospital consolidation and managed care penetration showed significant positive eflects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size of that specialty population between 1985 and 1994, suggesting the existence of competition. Overall, the findings of this study facilitate a better understanding of the complexity of physician workforce supply.
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Social science & medicine · Apr 2002
"Women enjoy punishment": attitudes and experiences of gender-based violence among PHC nurses in rural South Africa.
Violence against women is pervasive in South Africa where, as in many other countries, cultural values and norms serve to condone and reinforce abusive practices against women. Primary health care nurses, who are widely distributed throughout the rural areas, may appear to be an ideal network for addressing this issue in resource-poor settings. However, based on a qualitative and quantitative study of a class of 38 PHC nurses, this paper emphasises that the nurses are women and men first--and as such, experience the same cultural values, and indeed, similar or higher levels of violence, as the clients they are expected to counsel and treat. ⋯ Only then did the intervention turn to their roles as professional nurses. Clearly, there is a need for further research to explore these issues in more depth and to inform the development of appropriate training strategies for health care workers, particularly in developing countries. Moreover, such research may well have implications for the design and implementation of training interventions aimed at raising awareness and capacity within other sectors such as the welfare, police and judicial systems.
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Social science & medicine · Mar 2002
Comparative StudyThe importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class?
In this study we consider both a gender model, a model that focuses on the stress associated with social roles and conditions in the home environment, and a job model, which addresses the stressful characteristics of the work environment, to investigate patterns of women's and men's psychological morbidity across different social positions. Using data from the Whitehall II Study, a longitudinal study of British civil servants, we hypothesise that a lack of control in the home and work environments affects depression and anxiety differently for women and men and across three social class groups. Both women and men with low control either at work or at home had an increased risk of developing depression and anxiety. ⋯ Men in the middle grade with low work control were at risk for depression while those in the lowest grade were at risk for anxiety. Men in the middle and highest grades, however, were at greatest risk for both outcomes if they reported low control at home. We conclude that, in addition to social roles and characteristics of the work environment, future investigations of gender inequalities in health incorporate variables associated with control at home and social position.