Social science & medicine
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Social science & medicine · Jan 1986
ReviewUnemployment, health and health services in German-speaking countries.
The links between unemployment and health are manifold: Employment may lead to illness: health problems (that may lead to unemployment) often result from unfavourable working conditions of the (previous) employment. Another factor is job insecurity: fear of job loss increases the incidence of disease, and this applies not only to people who are emotionally unstable. Illness may lead to unemployment: in many cases, unemployment is caused by previous health impairments, which, to a considerable extent, also explain the duration of unemployment. ⋯ Individual prevention and rehabilitation measures are of great importance to problem groups suffering from cumulative or indirect unemployment, i.e. to unemployed elderly as well as to children of unemployed parents. Since the unemployed tend to isolate themselves, extramural services are useful. Specific services for the unemployed only are certainly not as helpful as multi-functional social services, such as those being already rendered by some self-help organizations, churches and trade-unions.(ABSTRACT TRUNCATED AT 400 WORDS)
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Social science & medicine · Jan 1986
Divided loyalties: a physician's responsibilities in an information age.
Increasing demands are being placed on medical care providers for the disclosure of identifiable patient information for use in the medical treatment and payment system as well as for unrelated uses. The legal and ethical principles that are supposed to guide physicians with respect to confidentiality of medical records are neither consistent nor complete. Physicians are required to make decisions regarding the disclosure of patient information without clearly defined, up-to-date legal or ethical guidance and in circumstances in which the physician and the patient may have different interests.
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Social science & medicine · Jan 1985
Difficulties involved in taking health services to the people: the example of a public health care center in a Caracas barrio.
This paper discusses the difficulties faced by a typical Ministry of Health and Social Welfare maternal and infant health care services center. These service modules are usually located in the lower income barrios of Venezuela's urban centers. Recent experiences as seen by supervisors of the regional and district offices of the Ministry and the center's staff were evaluated following in-depth interviews, direct observation and scanning of clinical records over a three month period. The study concludes that the major problem areas influence the Ministry's primary goal of extending coverage to a greater proportion of the needy population and maintain the quality of the services: inadequate administrative structure leading to logistics difficulties; and the clinic location and the characteristics of the barrio itself and of the client population.
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Social science & medicine · Jan 1985
Comparative Study Clinical TrialInformed consent in psychiatric research: preliminary findings from an ongoing investigation.
Preliminary findings from an investigation of informed consent processes in four psychiatric research projects (two being carried out at a university medical center and two at a public psychiatric hospital) are reported. Study methods include the systematic observation of investigator/subject information disclosure sessions using audio and videotape, as well as the use of standardized interaction rating forms and subject understanding interviews. In an attempt to determine if subjects' understanding of research can be improved through increased subject education, several modes of information disclosure are compared. ⋯ Subjects' problematic understanding of research purposes and methodology was compounded by investigator disclosures which often emphasized the therapeutic, personalistic and nonresearch-oriented aspects of the project. Nevertheless, even when information disclosures were significantly improved, subject understanding in many cases continued to be low--suggesting that additional factors aside from the quality of investigator disclosure are involved in psychiatric subjects' comprehension and understanding of research. The implication of these findings for informed consent, regulation of biomedical research and the protection of human subjects are discussed.
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Social science & medicine · Jan 1985
Hospital care utilization in a 17,000 population sample: 5-year follow-up.
The growing utilization of hospital care, especially of the services of Emergency Departments (ED), has been of great concern for many Western countries. The purpose of this study was to relate the amount of hospital care utilization to the frequency of ED visits. The study, based on a computerized medical information system, was carried out at Huddinge hospital which serves a suburban area of Stockholm, Sweden. ⋯ The difference increased gradually with increasing number of ED visits and was also evident in each age group. The mortality was also significantly increased for those with several ED visits. Higher migration in the latter group may besides indicate social instability.(ABSTRACT TRUNCATED AT 250 WORDS)