Social science & medicine
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Social science & medicine · Apr 2009
Case ReportsCommunity-based delivery of maternal care in conflict-affected areas of eastern Burma: perspectives from lay maternal health workers.
In settings where active conflict, resource scarcity, and logistical constraints prevail, provision of maternal health services within health centers and hospitals is unfeasible and alternative community-based strategies are needed. In eastern Burma, such conditions necessitated implementation of the "Mobile Obstetric Maternal Health Worker" (MOM) project, which has employed a community-based approach to increase access to essential maternal health services including emergency obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM service delivery model and, because they are accessible to both the communities inside Burma and to outside project managers, they serve as key informants for the project. ⋯ They suggest that some emergency obstetric care services that are conventionally delivered only within healthcare settings might be feasible in community or home-based settings when alternatives are not available. This paper provides an opportunity to hear directly from community-based workers in a conflict setting, perspectives seldom documented in the scientific literature. A rights-based approach to service delivery and its suitability in settings where human rights violations are widespread is highlighted.
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Social science & medicine · Apr 2009
Comparative StudySocial patterns of pay systems and their associations with psychosocial job characteristics and burnout among paid employees in Taiwan.
Today, performance-based pay systems, also known as variable pay systems, are commonly implemented in workplaces as a business strategy to improve workers' performance and reduce labor costs. However, their impact on workers' job stress and stress-related health outcomes has rarely been investigated. By utilizing data from a nationally representative sample of paid employees in Taiwan, we examined the distribution of variable pay systems across socio-demographic categories and employment sectors. ⋯ Those remunerated through a piece-rated/time-based pay were found to have the lowest job control, shortest working hours, highest job insecurity, lowest potential for career growth, and lowest job satisfaction. The results of multivariate regression analyses showed that employees earning through performance-based and piece-rated pay systems showed higher scores for personal burnout and work-related burnout, as compared to those who were given fixed salaries, after adjusting for age, education, marital status, employment grade, job characteristics, and family care workloads. As variable pay systems have gained in popularity, findings from this study call for more attention on the tradeoff between the widely discussed management advantages of such pay systems and the health burden they place on employees.
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Social science & medicine · Apr 2009
Historical ArticleFamine, death, and madness: schizophrenia in early adulthood after prenatal exposure to the Chinese Great Leap Forward Famine.
Using data from large scale, nationally representative sample surveys, we tested the hypothesis that prenatal exposure to famine increases schizophrenia risk at adulthood by studying the Great Leap Forward Famine in China (1959-1961). Our results show that, in the urban population, being conceived and born during the famine increased the risk of developing schizophrenia at early adulthood as compared to both the pre-famine and post-famine cohorts. ⋯ This finding contrasts sharply with previous studies on the Dutch Hunger Winter as well as with smaller scale local studies in China based on hospital records. We offer an explanation for the urban-rural difference in the schizophrenia-famine relationship based on population selection by differential excess mortality and provide supportive evidence through province- and cohort-level ecological analysis.
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Social science & medicine · Apr 2009
Writing social determinants into and out of cancer control: an assessment of policy practice.
A large literature concurs that social determinants of health (SDH) are demonstrable, important, and insufficiently attended to in policy and practice. A resulting priority for research should be to determine how the social determinants of health can best be addressed. In this paper we support the more effective transfer of social determinants research into policy by: (1) describing a qualitative analysis of thirty-two cancer control policy documents from six English-speaking OECD countries and two transnational organizations, demonstrating great variability in the treatment of social determinants in these policies; (2) critiquing these various policy practices in relation to their likely impact on social determinants of health; and (3) advancing a tool that policy writers can use to assess the way in which social determinants of health have been addressed in their work. ⋯ These five discourses implied, respectively: that group membership was intrinsically risky; that not enough was known about SDH; that risk arose from choices made by individuals; that groups were constrained by circumstance; or that structural change was necessary. Socio-cultural factors were generally presented negatively, though New Zealand policies modeled a possible alternative. Based on their empirical work, the authors propose a matrix and a set of questions to guide the development and assessment of health policy.
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Social science & medicine · Apr 2009
Job loss is bad for your health - Swedish evidence on cause-specific hospitalization following involuntary job loss.
This paper examines the impact of job loss on a number of non-fatal health events, which are nonetheless severe enough to require hospital in-patient care. We focus on job loss due only to establishment closures, as this reduces the problem of distinguishing between causation and selection. ⋯ During a subsequent 12-year period, we find that job loss significantly increases the risk of hospitalization due to alcohol-related conditions, among both men and women, and due to traffic accidents and self-harm, among men only. We find no evidence, however, that job loss increased the risk of severe cardiovascular diseases such as myocardial infarction or stroke.