Social science & medicine
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Social science & medicine · Jan 1991
The impact of family presence on the physician-cancer patient interaction.
Physician behaviors were studied in 473 interactions between oncologists and adult cancer outpatients. Ninety-nine of these interactions occurred when family members were present during the visit. Patients with family members present were likely to be sicker as demonstrated by a poorer performance status. ⋯ The results showed that, in general, physicians provide more information when patients are accompanied by family members, or if no family are present, when the patient has a worse performance status. Patient satisfaction and quality of life were rated lower for patients with a worse performance status and were not impacted by physician behaviors. Physicians' behavior was affected by both the presence of a family member, and the patient's performance status.
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Social science & medicine · Jan 1991
Comparative StudyPrimary health services in Ecuador: comparative costs, quality, and equity of care in Ministry of Health and rural social security facilities.
This study of costs, quality and financial equity of primary health services in Ecuador, based on 1985 data, examines three assumptions, common in international health, concerning Ministry of Health (MOH) and Social Security (SS) programs. The assumptions are that MOH services are less costly than SS services, that they are of lower quality than SS services, and that MOH programs are more equitable in terms of the distribution of funds available for PHC among different population groups. Full costs of a range of primary health services were estimated by standard accounting techniques for 15 typical health care establishments, 8 operated by the MOH and 7 by the rural SS program (RSSP), serving rural and peri-urban populations in the two major geographical regions of Ecuador. ⋯ Additional evidence of equity, using other indicators, would be helpful in future research. The paper's findings have policy implications not only for Ecuador's health sector but also for policy-makers in other countries at similar levels of socioeconomic development. These implications are spelled out in order to guide officials wrestling with issues of efficiency, quality, and equity as they search for the best use of scarce resources to promote health.
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In the early twentieth century in the United States and other Western countries, women were much less likely than men to smoke cigarettes, due in part to widespread social disapproval of women's smoking. During the mid-twentieth century, growing social acceptance of women's smoking contributed to increased smoking adoption by women. Increased social acceptance of women's smoking was part of a general liberalization of norms concerning women's behavior, reflecting increasing equality between the sexes. ⋯ Several other hypotheses concerning the causes of gender differences in smoking are not supported by the available evidence. For example, it appears that women's generally greater concern with health has not contributed significantly to gender differences in the prevalence of smoking. Similarly, it appears that sex differences in physiological responses to smoking have made only minor contributions to gender differences in smoking adoption or cessation.
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Social science & medicine · Jan 1991
Historical ArticleDiffusion and physiological responses to the influenza pandemic of 1918-19 in Nigeria.
Although virologists are not in agreement on the origins of the 1918-19 influenza pandemic, it has long been associated with the virulent type A virus. At least 21 million people died from the disease over a 12-month period, becoming one of the world's worst short-term demographic disasters. The disease was introduced into Nigeria by passengers and crews who arrived via ship from overseas. ⋯ The over-crowded urban centers were the hardest hit and, even though pandemic declined almost as suddenly as it began, morbidity, mortality, and panic adversely affected the productive capacity of the country. Since the 1930s, virologists have gained much knowledge about the agents responsible for influenza diffusion, but the disease remains one of the few plagues to be eradicated. This is partly because of the exceptional adaptability of influenza viruses, and partly because artificially and naturally-acquired immunity to influenza are temporary in duration, making reinfection possible even by the same type or subtype of influenza.
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Social science & medicine · Jan 1991
Charging for health care: evidence on the utilisation of NHS prescribed drugs.
The effects of regular and frequent increases in charges for health care on patient utilisation are analysed using monthly data on National Health Service (NHS) prescribed drugs in England for the period 1979-1985. Using a partial adjustment model a utilisation equation of prescribed drugs is estimated for the adult non-elderly population that is subject to the NHS prescription charge. ⋯ The short-run price elasticity of utilisation is -0.109 and the long-run elasticity is -0.09, while exempt utilisation is unaffected. Although the policy has generated a reduction in the central Government expenditure for prescribed drugs, on the basis of these estimates around 66% of these savings arise from the reduction in service use as opposed to the increased revenue per item of drugs.