Social science & medicine
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Social science & medicine · Apr 2007
Material and social deprivation and health and social services utilisation in Québec: a local-scale evaluation system.
Very few studies have employed local-scale analyses to evaluate how well primary health care and social services reach the most socially and economically deprived individuals. This paper describes a project, conducted in close partnership with decision-makers and practitioners at selected local community service centres (in French, CLSCs) in Quebec, Canada, that developed a system for assessing primary care and social services utilisation by applying deprivation levels defined at the local scale (i.e., according to the distribution of deprivation in individual CLSC service areas). ⋯ The evaluation system presented in this article is built on deprivation profiles for each CLSC service area and comprises maps, relative indices of service utilisation, and an interpretation framework that facilitates the integration of new data into the decision-making and services planning processes. Study results show that deprivation levels, when defined using local perspectives, correspond more closely to decision-makers' perceptions, that relative indices are sensitive to key determinants of services provision and utilisation, and that the interpretation framework is useful for reassessing intervention strategies.
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Social science & medicine · Apr 2007
Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study.
This paper investigates the relationship between institutional trust in the health-care system, i.e. an institutional aspect of social capital, and self-rated health, and whether the strength of this association is affected by access to health-care services. The 2004 public health survey in the Scania region of Sweden is a cross-sectional study; a total of 27,963 respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. Logistic regression model was used to investigate the association between institutional trust and self-rated health. ⋯ In conclusion, low trust in the health-care system is associated with poor self-rated health. This association may be partly mediated by "not seeking health care when needed". However, this is a cross-sectional exploratory study and the causality may go in both directions.
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Social science & medicine · Apr 2007
Relieving suffering at the end of life: practitioners' perspectives on palliative sedation from three European countries.
This paper reports findings from visits to palliative care settings and research units in the UK, Belgium and the Netherlands. The aim was to learn about clinicians' (both nurses and doctors) and academic researchers' understandings and experiences of palliative sedation for managing suffering at the end of life, and their views regarding its clinical, ethical and social implications. The project was linked to two larger studies of technologies used in palliative care. ⋯ We report respondents' views under four headings: understanding and responding to suffering; the relationship between palliative sedation and euthanasia; palliative sedation and artificial hydration; and risks and uncertainties in the clinician-patient/family relationship. We conclude that the three countries can learn from one another about the difficult issues involved in giving compassionate care to those who are suffering immediately before death. Future research should be directed at enabling dialogue between countries: this has already been shown to open the door to the development of improved palliative care and to enhance respect for the different values and histories in each.
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Social science & medicine · Apr 2007
Deciding to resuscitate extremely premature babies: how do parents and neonatologists engage in the decision?
Parents at risk of delivering a baby at the threshold of viability are faced with a critical decision. When a child is born between 23 and 25 weeks of gestation, parents are asked to decide whether or not to resuscitate their child. In essence, they are faced with a choice between life and death. ⋯ Parents express the need to receive more than just factual information from neonatologists. They also require support and engagement from caregivers to manage the uncertainty. This brings into question the traditional concept of neutral informed consent and suggests the necessity of a shared decision-making model to ensure that the decision to resuscitate extremely premature babies, at the limits of viability, becomes a truly ethical task.
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Social science & medicine · Apr 2007
Constructions of sexuality and intimacy after cancer: patient and health professional perspectives.
With an increasing emphasis on the provision of psychosocial support for patients in cancer and palliative care, an emerging body of literature has highlighted the importance of providing the opportunity for patients to discuss issues of intimacy and sexuality with their health professionals. Very little is known about why health professionals struggle with this level of communication in clinical practice. The aim of this paper is to discuss constructions of intimacy and sexuality in cancer and palliative care from patient and health professional perspectives. ⋯ Key findings from this project reveal incongruence between the way patients and health professionals constructed sexuality and intimacy. Structures which govern cancer and palliative care settings perpetrated the disparity and made it difficult for health professionals to regard patients as people with sexual and intimate needs or to express their own vulnerability when communicating about these issues in the clinical practice setting. A degree of reflexivity about personal and professional constructions of sexuality and intimacy was required for health professionals to confidently challenge these dominant forces and engage in the type of communication patients were seeking.