Social science & medicine
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Social science & medicine · Feb 2004
Is going to church good or bad for you? Denomination, attendance and mental health of children in West Scotland.
Religiosity is often associated with mental health in adult populations, but not in a consistent direction. Conflicting results reflect the multidimensional nature of both concepts. Few studies have addressed the relationship between religiosity and mental health among children. ⋯ Self-esteem, anxiety and depression all demonstrated an interaction, such that weekly church attendance was associated either with advantage for Catholics, disadvantage for children with a Church of Scotland affiliation, or both. Teasing/bullying acted in a small way as a mediating factor in these relationships. In an education system with separate Catholic and 'non-denominational' schools, we hypothesise that the relationship between church attendance and mental health may be contingent on whether church attendance is normative within the peer group.
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Social science & medicine · Jan 2004
Developing ethical strategies to assist oncologists in seeking informed consent to cancer clinical trials.
Randomised clinical trials have come to be regarded as the gold standard in treatment evaluation. However, many doctors see the discussion of a clinical trial as an intrusion into the doctor-patient relationship and find these discussions difficult to initiate. Detailed informed consent is now a requirement of patient participation in trials; however, it is known that patients commonly fail to understand and recall the information conveyed. ⋯ Detailed strategies were developed to assist doctors to communicate in these areas. We have developed a set of ethical strategies which may assist health professionals in this difficult area. A training package based on these strategies is currently being evaluated in a multi-centre randomised controlled trial.
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Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. ⋯ Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening.
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Social science & medicine · Jan 2004
What is important to continuity in home care?. Perspectives of key stakeholders.
In Canada, home care is growing rapidly. Each province takes a somewhat different approach to its delivery. Ontario uses a competitive bidding model to award contracts to community agencies that bid for service delivery rights. ⋯ Clients included consistency of timing of service delivery while rarely mentioning care management issues. They emphasized the importance of consistent knowledge and skills in the workers and trusting relationships as important to experiencing care continuity. The description of attributes of continuity of home care that emerged from this study is compared to definitions found in the nursing, mental health and primary care literature.
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Social science & medicine · Jan 2004
Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities.
This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. ⋯ Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go beyond" the income inequality hypothesis towards consideration of a broader set of the social determinants of health.