Social science & medicine
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Social science & medicine · Nov 2015
Who is on the medical team?: Shifting the boundaries of belonging on the ICU.
Medical teamwork promises to improve communication and collaboration in the healthcare industry, yet critics argue teamwork is little more than a new managerial discourse to obscure traditional workplace hierarchies. Based on 300 h of participant-observation and 35 interviews with staff of a medical intensive care unit at an academic medical center, this article argues that teamwork is neither a panacea for coordinating complex care nor is it simply a discourse to control workers; rather, it is an ongoing social activity characterized by boundary-work, negotiation, and resistance over the terms of membership. This study identifies three processual and temporal phases of families' participation in medical teams: (1) Constructing Teamwork, (2) Deflection and Resistance, and (3) Reintegration. ⋯ Families participated on the team at admission, but their involvement narrowed considerably as staff implemented diagnostic and treatment plans. When staff determined a patient was appropriate for palliation, families were reintegrated back into a leading role on the team as surrogate decision-makers. This study advances current understandings of medical teamwork, staff-family interactions, and it highlights the value of qualitative methods in social-science research about medicine.
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Social science & medicine · Nov 2015
Does disability status modify the association between psychosocial job quality and mental health? A longitudinal fixed-effects analysis.
People with disabilities have difficulties in obtaining work. However, evidence suggests that those with disabilities derive substantial mental health benefits from employment. This paper assesses how the relationship between work and mental health is influenced by psychosocial job quality for people working with a disability. ⋯ Efforts to improve psychosocial job quality may have significant mental health benefits for people with disabilities. This will contribute to the economic viability of disability employment insurance schemes in Australia and other high-income countries.
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Social science & medicine · Nov 2015
Household income and adolescent blood pressure in a Chinese birth cohort: "Children of 1997".
The inconsistent relation of national income with population blood pressure raises questions as to whether social comparisons of relative income at individual or neighbourhood level may be more relevant than absolute income. We examined the associations of absolute household income (income per se), absolute neighbourhood median income (average income among geographically-proximate households), relative household income [deprivation using Yitzhaki index, or rank by position] (differences in income or rank compared with others) and relative neighbourhood income inequality [Gini coefficient] (income gap within a neighbourhood) with blood pressure z-score, prehypertension or hypertension at ∼13 years using a fixed effects multilevel linear or logistic model in a Chinese birth cohort (n = 5063, 61% of follow-up). Absolute household or neighbourhood income was not associated with adolescent blood pressure. ⋯ Income measures were not associated with prehypertension or hypertension. Relative household income (greater deprivation or lower rank) were positively associated with adolescent blood pressure independent of absolute household income while absolute or relative neighbourhood income had little contribution, suggesting social comparisons at a key developmental stage could be relevant. Clarifying specific effects of socioeconomic position across the life-course could inform interventions.
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Social science & medicine · Nov 2015
The impact of fiscal austerity on suicide mortality: Evidence across the 'Eurozone periphery'.
While linkages between some macroeconomic phenomena and suicides in some countries have been explored, only two studies, hitherto, have established a causal relationship between fiscal austerity and suicide, albeit in a single country. The aim of this study is to provide the first systematic multiple-country evidence of a causal relationship of fiscal austerity on time-, gender-, and age-specific suicide mortality across five Eurozone peripheral countries, namely Greece, Ireland, Italy, Portugal and Spain over the period 1968-2012, while controlling for various socioeconomic differences. The impact of fiscal adjustments is found to be gender-, age- and time-specific. ⋯ A 1% reduction in government spending is associated with a 1.38%, 2.42% and 3.32% increase in the short-, medium- and long-run, respectively, of male suicides rates in the 65-89 age group in the Eurozone periphery. These results are highly robust to alternative measures of fiscal austerity. Improved labour market institutions help mitigate the negative effects of fiscal austerity on suicide mortality.
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Daily physical symptoms play a critical role in health and illness experiences. Despite their daily prevalence, the ability of these symptoms to predict future health status is debated. ⋯ Findings suggest that daily physical symptoms are unique indicators of future health status.