Social science & medicine
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Social science & medicine · Nov 2013
Meta AnalysisEffectiveness and equity impacts of town-wide cycling initiatives in England: a longitudinal, controlled natural experimental study.
Cycling confers health and environmental benefits, but few robust studies have evaluated large-scale programmes to promote cycling. In England, recent years have seen substantial, town-wide cycling initiatives in six Cycling Demonstration Towns (funded 2005-2011) and 12 Cycling Cities and Towns (funded 2008-2011). The initiatives involved mixtures of capital investment (e.g. cycle lanes) and revenue investment (e.g. cycle training), tailored to each town. ⋯ We conclude that to date, cycling to work has increased (and driving to work decreased) in the intervention towns, in a relatively equitable manner. The variation in effects between towns indicates uncertainty regarding the likely impact of comparable investment in future towns. Nevertheless these results support the case for implementing and evaluating further town-wide cycling initiatives.
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Social science & medicine · Nov 2013
Randomized Controlled TrialEffectiveness of a parenting program in Bangladesh to address early childhood health, growth and development.
A stratified cluster design was used to evaluate a 10-month parenting program delivered to mothers of children in rural Bangladesh. Intervention mothers through a combination of group meetings and home visits received messages along with an illustrative card concerning hygiene, responsive feeding, play, communication, gentle discipline, and nutritious foods. Control mothers received the standard government care. ⋯ Age effects were found only for dietary diversity in that younger children in the program benefited more than older ones. However, all children became more stunted. Findings are discussed in terms of theories of behaviour change and parenting, critical ages for parenting programs, and implications for program delivery.
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Social science & medicine · Nov 2013
Randomized Controlled TrialThe seven Cs of the high acceptability of home-based VCT: results from a mixed methods approach in Zambia.
HIV testing and counselling is a critical gateway to prevention and treatment. Yet, coverage remains insufficient, few couples are tested together and gender differences in access exist. We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing (HB-VCT) in a pair-matched cluster-randomized trial in Zambia. ⋯ The high level of couple counselling within HB-VCT may contribute to closing the gender gap in HIV testing, and has benefits for both genders and potentially for prevention of HIV transmission. The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach. The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was crucial to fully understand the intervention and its consequences.
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Social science & medicine · Nov 2013
Malnutrition in early life and adult mental health: evidence from a natural experiment.
As natural experiments, famines provide a unique opportunity to test the health consequences of nutritional deprivation during the critical period of early life. Using data on 4972 Chinese born between 1956 and 1963 who participated in a large mental health epidemiology survey conducted between 2001 and 2005, we investigated the potential impact of exposure to the 1959-1961 Chinese Famine in utero and during the early postnatal life on adult mental illness. The risk of mental illness was assessed with the 12-item General Health Questionnaire (GHQ-12) and eight other risk factors, and the famine impact on adult mental illness was estimated by difference-in-difference models. ⋯ Compared to men in the 1963 birth cohort, men born during the famine had lower GHQ scores (decreased by 0.89 points; CI: -1.59, -0.20) and a nonsignificant decrease in the risk of mental illness (OR = 0.60; CI: 0.26, 1.40). We speculate that the long-term consequences of early-life famine exposure include both the selection of the hardiest and the enduring deleterious effects of famine on those who survive. The greater biological vulnerability and stronger natural selection in utero of male versus female fetuses during severe famine may result in a stronger selection effect among men than women, obscuring the deleterious impact of famine exposure on the risk of mental illness in men later in life.
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Social science & medicine · Nov 2013
Discretion or discretions? Delineating professional discretion: the case of English medical practice.
There has much debate about the extent to which professional discretion has been challenged by recent organisational changes such as through the new forms of governance associated with the introduction of the principles of the New Public Management (NPM) into health systems and other public sector services. What appears to be missing from these debates is a detailed analysis of the concept of professional discretion itself. This paper attempts to fill this gap by delineating the key concepts of professional discretion evident in the literature and exploring their significance in an empirical study of the influence of the 2004 new general medical services contract (nGMS) and the introduction of the Quality and Outcomes Framework (QOF), a prescriptive pay-for-performance system designed to standardise the quality of care provision in general medical practice in the United Kingdom. ⋯ A multi-dimensional conception of discretion was used to explore how GP discretion might have been influenced by contractual changes and in particular, QOF. The findings suggest that through a complex interplay of factors, a post-QOF reduction in GP discretion was identifiable, highlighting different potential sources of constraint such as in the social, organisational and economic dimensions of discretion. The evidence also suggested the emergence of a new form of organisational medical professionalism within general practice characterised by standardisation, bureaucracy and performance management.