Social science & medicine
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A paradoxical pattern has been suggested in the literature on doctors' strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctors' strikes. ⋯ Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.
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Social science & medicine · Nov 2008
Long-term effects of organized violence on young Middle Eastern refugees' mental health.
The pre- and post-displacement factors associated with psychological problems among young refugees are not clear. From the existing research it appears that refugee children and adolescents are vulnerable to the effects of pre-migration exposure to trauma, but the long-term effects of such exposure are mediated by certain risk and protective factors at the individual, family and community level. The aim of the present study was to assess the influence of traumatic experiences before emigration, as well as social life after immigration, on the mental health of young Middle Eastern refugees 8-9 years after immigration into Denmark. ⋯ Predictors of more internalizing behaviour were: numbers of types of traumatic events before arrival, numbers of types of stressful events after arrival, and numbers of types of experiences of discrimination, lower mother's education in the home country, fewer Danish friends, not Muslim or Christian religion, less Danish proficiency and female gender. It is concluded that aspects of social life in Denmark, including mother's education and indicators of adaptation, as well as a stressful life context in exile, including discrimination, predicted psychological problems 8-9 years after arrival, more than traumatic experiences before arrival. Thus, the prevention of psychopathology in young refugees depends to a large extent on the political will to make provision for the necessary changes regarding reception and treatment of refugees.
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Social science & medicine · Oct 2008
Review Meta AnalysisAssessing the effectiveness of interventions to promote advance directives among older adults: a systematic review and multi-level analysis.
Many studies have investigated the effectiveness of interventions in promoting advance directives (ADs) but there is uncertainty as to what works best, and in whom. We conducted a systematic review of the evidence in this regard, using both classical meta-analysis approaches and multi-level analyses. Eleven databases were searched for relevant reports published through March 2007. ⋯ Multi-variable analyses identified the provision of oral information over multiple sessions as the most successful intervention. This was true regardless of the target population. These findings support the effectiveness of educational interventions in increasing the formulation of ADs and provide practical advice on how best to achieve this goal.
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Social science & medicine · Oct 2008
Older people's views of a good death in heart failure: implications for palliative care provision.
Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77) with advanced heart failure and poor prognosis to explore the extent to which older people's views and concerns about dying are consistent with the prevalent model of the 'good death' underpinning palliative care delivery. ⋯ Similarly, concepts of autonomy and individuality appeared alien to most. Indeed, whilst there was evidence that palliative care could help improve the end of life experiences of older people, for example in initiating discussions around death and dying, the translation of other aspects of specialist palliative care philosophy appear more problematic. Ultimately, the study identified that improving the end of life experiences of older people must involve addressing the problematised nature of ageing and old age within contemporary society, whilst recognising the cohort and cultural effects that influence attitudes to death and dying.