Social science & medicine
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Social science & medicine · Jul 2008
Pathways to depression: the impact of neighborhood violent crime on inner-city residents in Baltimore, Maryland, USA.
Crime and neighborhood disorder may negatively impact the health of urban residents. Neighborhoods with high levels of violent crime may also increase residents' risk of experiencing violence. Most studies supporting the assertion that neighborhood disorder impacts mental health have used residents' own ratings of their neighborhoods. ⋯ Also, we hypothesized that neighborhood violence had a direct and indirect impact on depressive symptoms. Results support a model in which violence is associated with psychological distress through perceptions of neighborhood disorder, and through experiences of violence. We conclude that community and structural level interventions are needed to decrease neighborhood crime and improve residents' perception of their neighborhood.
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Social science & medicine · Jul 2008
What influences referrals within community palliative care services? A qualitative case study.
Evidence suggests that the utilisation of community palliative care services varies considerably according to different patient characteristics. Most literature describes this variability, but does not address why such differences exist. Exploring the processes underpinning referral making rather than simply describing the outcomes of referrals may further our understanding of this variability. ⋯ These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and interprofessional factors have the potential to shape referral practices. Practitioners could be more explicit about influences on decision making, and policy makers take account of these complex influences on referrals rather than just mandating change.
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Social science & medicine · Jul 2008
Are 'anonymous' and 'non-directed' prerequisites for living altruistic donation? The views of transplant physicians from France and Québec.
It can be argued that living altruistic donors should remain anonymous and should not express preferences in the selection of organ recipients. This study aimed to describe the views of transplant physicians in France and Québec regarding these issues. A total of 27 French and 19 Québec renal transplant physicians took part in individual, semi-directed interviews. ⋯ Regarding the issue of directed donation, most of the French physicians (78%) were opposed to any form of the practice, compared to only a third of their Québec colleagues (32%). We found that these positions were embedded in their respective cultural, legal and social contexts. These results afford a better understanding of these complex issues in two different cultural contexts, and will be useful in the development of international guidelines for LAD.
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Social science & medicine · Jun 2008
The economic impact of chronic diseases: how do households respond to shocks? Evidence from Russia.
The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, labour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. ⋯ Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied.
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Social science & medicine · Jun 2008
Eating patterns may mediate the association between marital status, body mass index, and blood cholesterol levels in apparently healthy men and women from the ATTICA study.
Marital status has been recognized as a significant health-influencing factor, including cardiovascular disease (CVD) risk. The aim of the present paper was to evaluate whether eating habits mediate the relationship between marital status and levels of CVD risk factors among apparently healthy men and women from the ATTICA Study. During 2001-2002, we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old) from the Attica area, Greece; the sampling was stratified by the age-gender distribution of the region. ⋯ After controlling for potential confounders (i.e., age, gender, physical activity, anxiety score and smoking habits), the reported marital status of the participants was associated only with body mass index and total serum cholesterol levels. When the analysis was repeated after taking into account the information on dietary habits by creating four "new" dietary-adjusted marital status groups, no significant association was revealed between marital status and body mass index and blood cholesterol levels. This finding implies that, in our population, eating patterns may explain the observed differences between marital status and selected CVD risk factors.