Social science & medicine
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This paper assesses how the relationship between health and educational attainment has changed over the last three decades. We examine trends in disease prevalence and self-reported health using the US National Health Interview Survey for five chronic conditions-arthritis, diabetes, heart disease, hypertension, and lung diseases. The sample is limited to non-Hispanic Whites ages 40-64 to focus on the value of education and not changing representation of minority populations. ⋯ The value of education in achieving better health has increased over the last 25 years; both in protecting against onset of disease and promoting better health outcomes amongst those with a disease. Besides better access to health insurance, the more educated increasingly adapted better health behaviors, particularly not smoking and engaging in vigorous exercise, and reaped the benefits of improving medical technology. Rising health disparities by education are an important social concern which may require targeted interventions.
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Social science & medicine · Apr 2011
Neighborhood walkability, physical activity, and walking behavior: the Swedish Neighborhood and Physical Activity (SNAP) study.
More knowledge concerning the association between physical activity and objectively measured attributes of the built environment is needed. Previous studies on the association between objectively measured neighborhood walkability, physical activity, and walking have been conducted in the U. S. or Australia and research findings are available from only one country in Europe - Belgium. ⋯ The statistically significant and "adjusted" results for individuals living in highly walkable neighborhoods, as compared to those living in less walkable neighborhoods, were: (1) 77% and 28% higher odds for walking for active transportation and walking for leisure, respectively, (2) 50 min more walking for active transportation/week, and (3) 3.1 min more MVPA/day. The proportion of the total variance at the neighborhood level was low and ranged between 0.0% and 2.1% in the adjusted models. The findings of the present study stress that future policies concerning the built environment must be based on context-specific evidence, particularly in the light of the fact that neighborhood redevelopments are time-consuming and expensive.
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Social science & medicine · Apr 2011
Journal peer review in context: A qualitative study of the social and subjective dimensions of manuscript review in biomedical publishing.
Peer- and editorial review of research submitted to biomedical journals ('manuscript review') is frequently argued to be essential for ensuring scientific quality and the dissemination of important ideas, but there is also broad agreement that manuscript review is often unsuccessful in achieving its goals. Problems with manuscript review are frequently attributed to the social and subjective dimensions of the process (e.g., bias and conflict of interest). While there have been numerous efforts to improve the process, these have had limited success. ⋯ Importantly, these social and subjective influences were often viewed positively and were seen as expressions of, rather than threats to, editors' and reviewers' epistemic authority and expertise. From this we conclude that the social and subjective dimensions of biomedical manuscript review should be made more explicit, accommodated and even encouraged, not only because these dimensions of human relationships and judgements are unavoidable, but because their explicit presence is likely to enrich, rather than threaten the manuscript review process. We suggest a 'dialectical' model which can simultaneously accommodate, and embrace, all dimensions of the manuscript review process.
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Social science & medicine · Apr 2011
Established users and the making of telecare work in long term condition management: implications for health policy.
Increasingly policy for long term condition management is focussing on new technologies. Telecare is viewed as a means of making services more responsive, equitable, cost and clinically-effective and able to play a central part in mediating between service users, professionals, and service providers. It has also been identified as helping to establish patient self-management for long term conditions. ⋯ However, the nature of patient work involved is 'low level' rather than requiring higher level interpretation of readings and decision making commensurate with realising a policy vision of more independent and responsible self -managers. Indeed a paradox of the reliance and acceptance of telecare is the creation of new relationships and dependencies rather than the diminution of reliance envisaged by policy. The illumination of practices around telecare provides evidence for policy makers and others to adjust the predictions and presumptions about how telecare might enable and promote more effective long term condition management.
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Social science & medicine · Mar 2011
Liberating the NHS? A commentary on the Lansley White Paper, "Equity and Excellence".
In July 2010, the new Coalition Government unveiled its plans to make major changes to the English National Health Service (NHS). This paper, which provides a commentary on the NHS White Paper, Equity and Excellence: Liberating the NHS, casts doubt upon the extent to which the proposals will bring about the fundamental reform that the Government intends, not least because both the British public and GP commissioners (who are expected to play a central role in transforming the NHS) appear to have a limited appetite for radical market reform. The paper also identifies a number of unintended risks, including the large transitional costs and organisational turbulence resulting from further NHS reorganisation; and the fact that key aspects of the White Paper proposals could result in significant financial instability. Given the real world limitations to translating a rhetoric of localism and democratic legitimacy into reality and a lack of hard evidence about the benefits of market reform, the Government would be well advised to take a more cautious approach to health policy formulation and implementation and to ensure that any further changes to the NHS are based on evidence, piloting and evaluation.