Social science & medicine
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Social science & medicine · Oct 2009
The extent and distribution of inequalities in childhood mortality by cause of death according to parental socioeconomic positions: a birth cohort study in South Korea.
It has been shown that childhood mortality is affected by parental socioeconomic positions; in this article, we investigate the extent and distribution of inequalities across major causes of childhood death. We built a retrospective birth cohort using individually linked national birth and death records in South Korea. 1,329,540 children were followed up to exact age eight from 1995 to 1996 and total observed person-years were 10,594,168.18. Causes of death were identified from death records while parental education, occupation and birth characteristics were identified from birth records. ⋯ We conclude that there were inequalities of childhood mortality in every major cause of death. External cause was the leading cause of both all-cause mortality and overall inequalities. Public health interventions to reduce inequalities are necessary and external cause should be primarily considered.
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Social science & medicine · Oct 2009
'A bed in the middle of nowhere': parents' meanings of place of death for adults with cystic fibrosis.
As populations age and chronic conditions become more prevalent, an individual's ability to choose the location of their end-of-life care and death is increasingly considered important in the provision of good healthcare, with home implied as the 'best' place of death through UK government policy and specialist and voluntary palliative care services. However, considering meanings of place of end-of-life care and death is complex for young adults with life-limiting conditions where the disease course is variable and uncertain, and aggressive and palliative treatments are administered both at home and in hospital often until death. Although 'place' is a pivotal element in healthcare practice, research and policy, there has been little attempt to understand the meaning and importance of place in understanding experiences of care at end of life. ⋯ Preferences for possible locations of death are generally limited early in the disease course by choice of aggressive treatment, particularly lung transplantation. Rate of health decline, organisation and delivery of services, and relationships with specialist and general healthcare staff strongly influence parents' experience of death at home or in hospital, although no physical location was regarded a 'better' place of death. Meanings of, and attachment to place are mediated for families through these factors, questioning the appropriateness of a 'home is best' policy for those dying from life-limiting conditions.
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Social science & medicine · Sep 2009
"Women's autonomy and pregnancy care in rural India: a contextual analysis".
Studies in low-income countries have shown that women's autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998-1999) of rural India to investigate whether women's autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. ⋯ The effect of women's autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported women's autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in women's autonomy and these village factors may improve healthier child bearing in rural India.
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Social science & medicine · Sep 2009
Randomized Controlled TrialExperimental emotional disclosure in women undergoing infertility treatment: Are drop outs better off?
So far, the beneficial effects of personal written emotional disclosure have been mainly examined in relation to past or current stressful/traumatic experiences. The anticipation of a medical event has rarely been studied within this paradigm. This randomized-controlled study examined whether written emotional disclosure would reduce emotional distress and increase pregnancy rates in women undergoing in-vitro fertilization treatment. ⋯ The present study did not support the hypotheses that emotional disclosure will reduce infertility-related or general psychological distress and improve pregnancy outcomes in women undergoing in-vitro fertilization treatment. However, women who refused to participate in the study were more likely to get pregnant. Differences in the beneficial effects of emotional disclosure are discussed.