Social science & medicine
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Social science & medicine · Dec 2010
Precarious spaces: risk, responsibility and uncertainty in school-based suicide prevention programs.
We report on findings from an in-depth qualitative case study designed to closely examine the social practices of planning and implementing a four-part (six hour) classroom-based suicide prevention program within two classrooms in one secondary school in Vancouver, British Columbia. Representing a departure from traditional evaluation research studies in suicidology, we examine how school-based youth suicide prevention programs get brought into being in "real world" contexts. ⋯ Based on our analysis, we suggest that suicide (and its prevention), in all its complex and culturally situated forms, simply cannot be conceptualized through singular, stable or universalizing terms that transcend time and context. Implications for (re)- conceptualizing suicide prevention education are discussed.
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Social science & medicine · Dec 2010
Integrated care in the emergency department: a complex adaptive systems perspective.
Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. ⋯ We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.
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Social science & medicine · Dec 2010
Are local health department expenditures related to racial disparities in mortality?
This study estimated whether 1990-1997 changes in expenditures per capita of local health departments (LHDs) and percentage share of local public revenue allocated to LHDs were associated inversely with 1990-1997 changes in mortality rates for Black and White racial/ethnic groups in the US. Population was 883 local jurisdictions with 1990 and 1997 mortality rates for Black and White racial populations from the Centers for Disease Control and Prevention Wonder Compressed Mortality File and LHD expenditures from the National Association of County and City Health Officials. ⋯ LHD expenditures or percentage share were related to absolute reductions in mortality for infants, Blacks, and White females but did not close Black-White mortality differences for these groups. Therefore, disparities in Black and White mortality rates for subgroups with the greatest mortality gaps may be more likely to be reduced by public investment in local health departments than disparities in Black and White total, all-cause mortality rates.
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Social science & medicine · Nov 2010
Measurement challenges of informal caregiving: a novel measurement method applied to a cohort of palliative care patients.
Informal caregiving is a complex concept, and inconsistencies are found in the literature regarding how to measure it. The differences in tasks included in the definition of caregiving, as well as the different methods used to measure caregiving time may explain the huge variations in results found in the literature. The current paper aimed to lay out the challenges of how to calculate the time spent by informal caregivers on providing care and assistance to an ill person at home. ⋯ The proposed measurement method is then applied to a cohort of informal caregivers of palliative care patients. The illustration study revealed that this method brought advantages comparatively to other methods, and that persisting challenges remain in measuring informal caregiving time. We conclude that, the estimate of time spent caregiving for palliative care patients may be useful in guiding support programs for the families taking care of a loved one at home during the palliative phase of care.