Social science & medicine
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Social science & medicine · Apr 1997
Effects of socioeconomic disadvantage and women's status on women's health in Cameroon.
Research on the effects of socioeconomic disadvantage and women's status on women's health is important for policy makers in developing countries, where limited resources make it crucial to use existing maternal and child health care resources to the best advantage. Using a community-based data set collected prospectively in Cameroon, this study attempts to understand the extent to which socioeconomic factors and women's status have influences on women's health. The most important finding is that the burden of illness rests disproportionately on the economically disadvantaged women and on those with low social status. ⋯ From a theoretical perspective, this study has demonstrated the importance of the "intermediate" framework for the study of women's health: the operations of effects of a number of background characteristics are mediated by more proximate determinants of women's health. These results remain robust even after controlling for other measured factors and after correcting for unmeasured heterogeneity and sample selection; this helps to dismiss the potential influence of some artifacts. While this study suggests that there are opportunities within the existing health care system for meeting many of the health care needs of the socially disadvantaged, further biobehavioral and psychosocial research is needed to determine how women's status and social disadvantage influence the demand for health care services, in order to ensure equitable as well as a more effective delivery of health care services and to break the vicious circle of disadvantage.
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Social science & medicine · Mar 1997
Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).
Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. ⋯ We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.
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Using the method first presented by Sullivan, the article presents results on health expectancy by level of education and gender in the late 1980s in Finland. The life tables by level of education cover the years 1986-90. Indicators of disability and poor health were based on three variables from the nationwide 1986 Survey on Living Conditions (N = 12,057): limiting long-standing illness, functional disability or poor self-perceived health. ⋯ The differences between educational categories in disability-free life expectancy were markedly larger than in total life expectancy. Life expectancy with disability was shortest among the more educated and longest among the less educated. Due to the higher life expectancy and the higher prevalence of disability among women, life expectancy with disability was longer among women than men according to all indicators.
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Social science & medicine · Mar 1997
The role of decision analysis in informed consent: choosing between intuition and systematicity.
An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients' values, and it eliminates the burden of integrating these values with probabilistic information. ⋯ We point out that there is no gold standard for optimal decision making in decisions that hinge on patient values. We also point out that in some such situations it is too early to assume that the benefits of systematicity outweigh the benefits of intuition. Research is needed to address the question of which situations favor the use of intuitive approaches of decision making and which call for a more systematic approach.
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There has been little research to date on the factor which predict high anxiety in family members or carers before bereavement. Our study used data on 302 patients for whom the family's anxiety had been recorded by cancer palliative care teams in the last weeks of the patient's life. Variables known at the time of the patient's referral to the teams were entered into a discriminant analysis. ⋯ Important predictors were: whether the family member was a spouse, a diagnosis of breast cancer, young age, the time from diagnosis and low patient mobility. There was a small significant correlation between a longer time in palliative care and lower family anxiety. The predictive model could be used oncologists to identify cases where greater psychological support will be needed.