Social science & medicine
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Social science & medicine · Oct 2013
Neighborhood context and racial/ethnic differences in young children's obesity: structural barriers to interventions.
Numerous studies in the last ten years have investigated racial/ethnic disparities in obesity for young children. Increasing attention is paid to the influence of neighborhood environments - social and physical-on a variety of young children's health outcomes. This work identifies resource-based and community-based mechanisms that impede on the maintenance of healthy weights for young children in socioeconomically depressed areas, and shows consistently higher rates of obesity in more deprived areas. ⋯ However, living in neighborhoods with higher levels of poverty, lower levels of education, and a higher proportion of black residents is associated with increased child obesity risk after considering a host of relevant individual level factors. In addition, living in neighborhoods with a higher proportion of foreign-born residents is associated with reduced child obesity risk. Although well-intentioned childhood obesity intervention programs aimed at changing individual-level behaviors are important, our results highlight the importance of considering neighborhood structural factors for child obesity prevention.
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Social science & medicine · Sep 2013
"So they believe that if the baby is sick you must give drugs…" The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa.
A mixed method approach was used to investigate the treatment of childhood illnesses in Johannesburg and Soweto. In 2004, in-depth interviews were held with caregivers (n = 5), providers of traditional (n = 6) and Western (n = 6) health care, as well as 5 focus groups with black caregivers of children under 6 years. An utilisation-based survey was conducted with 206 black caregivers of children under 6 years of age at 1 public clinic in Soweto (n = 50), 2 private clinics (n = 50) in Johannesburg, 2 public hospitals (n = 53) from Johannesburg and Soweto and 2 traditional healers (n = 53) from Johannesburg and Orange Farm, an informal settlement on the outskirts of Johannesburg. ⋯ Shortages of medicines at clinics and caregiver beliefs about the efficacy of medicines affect health-care seeking behaviour. Medicines are not always used as intended or according to instructions and some products such as household detergents may be used medicinally. As well as the need for improving facility-readiness for delivering IMCI (Integrated Management of Childhood Illnesses), the patient-provider relationship is instrumental in improving the treatment of childhood illnesses.
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Social science & medicine · Sep 2013
Competing and coexisting logics in the changing field of English general medical practice.
Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007-2009 and 2011-2012. ⋯ Although some aspects of organisational life are relatively untouched by the reforms, this is not due to 'resistance' on the part of staff within these organisations to attempts to 'control' them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics.
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Social science & medicine · Sep 2013
Women's autonomy and husbands' involvement in maternal health care in Nepal.
Both increasing women's autonomy and increasing husbands' involvement in maternal health care are promising strategies to enhance maternal health care utilization. However, these two may be at odds with each other insofar as autonomous women may not seek their husband's involvement, and involved husbands may limit women's autonomy. This study assessed the relationship between women's autonomy and husbands' involvement in maternal health care. ⋯ The magnitude and direction of association varied per autonomy dimension. These findings suggest that programs to improve the women's autonomy and at the same time increase the husband's involvement should be carefully planned. Despite the traditional cultural beliefs that go against the involvement of husbands, Nepalese husbands are increasingly entering into the area of maternal health which was traditionally considered 'women's business'.