Social Science & Medicine最新文献

Divergence in smoking and drinking trends: Results from age-period-cohort analytical approach 吸烟和饮酒趋势的差异：年龄-时期-队列分析方法的结果

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-11-02 DOI: 10.1016/j.socscimed.2024.117474

Background

Smoking has dropped substantially over time while alcohol consumption has increased. Understanding how smoking and drinking relate to age, time-period or birth cohorts may improve public health measures.

Method

The cross-sectional Continuous Household Survey in Northern Ireland provided bi-annual, household-level data on smoking and drinking from 1985 to 2015. An age-period-cohort approach was employed using 10-year age groups and 9 birth cohorts. A descriptive analysis of smoking and drinking by birth cohort was performed and supplemented by a joinpoint analysis. An Intrinsic Estimator model was used to examine behaviour patterns defined separately by age, time-period, and cohort.

Results

Age effects showed that smoking and drinking peaked during adolescence and young adulthood (relative risk (RR) of age 25–34 vs. all ages: RR _smoking = 1.59, RR _drinking = 1.61, p < 0.001), followed by a progressive subsequent decline with age. Distinct secular trends were observed whereby smoking decreased over time but non-abstinence rates in relation to alcohol consumption increased substantially from 1985 to 2015. Cohort effects in smoking and drinking suggested that Generation X (born around 1961–1980) appeared to have a slightly higher likelihood of smoking and drinking but this converged with other cohorts over time.

Conclusion

The absence of similar policy efforts for alcohol as given to smoking may explain the divergence in secular trends of smoking and drinking. Targeting interventions towards adolescents and young adults may offer the best chance of reducing smoking and drinking prevalence. Cohort effects suggest the need for further research about the relationship between drinking and Northern Ireland's political history.

背景随着时间的推移，吸烟率大幅下降，而饮酒量却在增加。了解吸烟和饮酒与年龄、时间段或出生队列之间的关系可改进公共卫生措施。方法北爱尔兰的横断面连续住户调查提供了从 1985 年到 2015 年每两年一次的家庭层面的吸烟和饮酒数据。采用年龄段-队列方法，使用 10 年年龄组和 9 个出生队列。按出生队列对吸烟和饮酒情况进行了描述性分析，并辅以连接点分析。结果年龄效应显示，吸烟和饮酒在青春期和青年期达到高峰（25-34 岁与所有年龄段相比的相对危险度 (RR)：吸烟 RR = 1.59，饮酒 RR = 1.59）：吸烟 RR = 1.59，饮酒 RR = 1.61，p < 0.001），随后随着年龄的增长而逐渐下降。从1985年到2015年，吸烟率随着时间的推移有所下降，但与饮酒相关的非戒酒率却大幅上升。吸烟和饮酒的队列效应表明，X一代（1961-1980年左右出生）吸烟和饮酒的可能性似乎略高，但随着时间的推移，这种情况与其他队列趋于一致。针对青少年的干预措施可能是降低吸烟和饮酒流行率的最佳途径。队列效应表明，有必要进一步研究饮酒与北爱尔兰政治历史之间的关系。

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引用次数: 0

Longitudinal bidirectional relations between psychological maltreatment by teachers and psychosocial adjustment during early adolescence 教师心理虐待与青少年早期社会心理适应之间的纵向双向关系

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-11-02 DOI: 10.1016/j.socscimed.2024.117475

This study examined three models (relationship-driven model, symptom-driven model and transactional model) testing the across-time bidirectional relations between psychological maltreatment by teachers and early adolescents' psychosocial adjustment (i.e., internalizing problems, externalizing problems, and academic achievement) during early adolescence. A total of 4169 Chinese early adolescents (M_age = 9.93 years, SD = 0.73, 54% males) completed assessments across five waves, every six months. Employing autoregressive latent trajectory models with structured residuals (ALT-SR), the results revealed that adolescents’ internalizing problems and academic achievement were predicted by psychological maltreatment by teachers (supporting the relationship-driven model), whereas externalizing problems and psychological maltreatment by teachers were bidirectionally related (supporting the transactional model). Moreover, sex moderated the relations between psychological maltreatment by teachers and psychosocial adjustment. The finding of differential relations between psychological maltreatment by teachers and three components of psychosocial adjustment (i.e., internalizing problems, externalizing problems, and academic achievement) indicated that prevention and interventions should be tailored to different psychosocial adjustment difficulties.

本研究通过三个模型（关系驱动模型、症状驱动模型和交易模型）检验了教师心理虐待与青少年早期心理社会适应（即内化问题、外化问题和学业成绩）之间的跨时间双向关系。共有4169名中国早期青少年（年龄=9.93岁，SD=0.73，54%为男性）完成了每六个月一次的五波评估。通过自回归潜在轨迹结构残差模型（ALT-SR），研究结果表明，青少年的内化问题和学业成绩受教师心理虐待的预测（支持关系驱动模型），而外化问题和教师心理虐待是双向关系（支持交易模型）。此外，性别也调节了教师心理虐待与心理社会适应之间的关系。教师的心理虐待与社会心理适应的三个组成部分（即内化问题、外化问题和学业成绩）之间的不同关系表明，应针对不同的社会心理适应困难采取相应的预防和干预措施。

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引用次数: 0

Changes in suicide inequalities in the context of an increase and a decrease in suicide mortality: The case of South Korea, 1995–2020 自杀死亡率上升和下降背景下的自杀不平等变化：1995-2020 年韩国的情况

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.socscimed.2024.117472

South Korea experienced a sharp increase until 2010 followed by a gradual decrease in suicide mortality. This study examined changes in socioeconomic inequalities in suicide over 25 years and how suicide inequalities changed in the context of both an increase and a decrease in suicide mortality. Data with five-year intervals were extracted from the Korean death registry and census data between 1995 and 2020. Using Poisson regression, four measures of suicide inequalities were calculated for the slope of inequality index (SII), relative index of inequality, rate ratios, and ratio differences. Educational inequalities in suicide were obvious across all sub-populations, measures, and periods. The widening of suicide inequalities, particularly with absolute measures, followed an increase in suicide mortality until 2010. In contrast, a decline of suicide inequalities concurred after 2010 during the period of a decline in suicide mortality. SII among the total population decreased by 35.4%, from 62.4 per 100,000 people (95% confidence interval [CI], 59.8–64.9) in 2010 to 40.3 (95% CI, 38.3–42.4) in 2020. The pattern of widening and narrowing in suicide inequalities observed in the whole population was only concordant with the older population. However, the younger and the middle-aged population showed a gradual increase or stalemate in the inequalities throughout the period. Overall, suicide inequalities narrowed in the recent decade. This decline was largely led by the older population, and was attributed to the provision of social protection. A decline of suicide inequalities can accompany a decline in suicide mortality, when the provision of social protection favored the less educated.

韩国的自杀死亡率在 2010 年前急剧上升，随后逐渐下降。本研究考察了 25 年来自杀中社会经济不平等现象的变化，以及自杀死亡率上升和下降背景下自杀不平等现象的变化。研究人员从 1995 年至 2020 年期间的韩国死亡登记和人口普查数据中提取了五年间隔的数据。利用泊松回归法，计算出了不平等指数斜率（SII）、相对不平等指数、比率比和比率差四种衡量自杀不平等的指标。在所有子人群、衡量指标和时期中，自杀的教育不平等现象都很明显。自杀不平等的扩大，尤其是绝对值的扩大，是随着 2010 年之前自杀死亡率的上升而出现的。与此相反，2010 年之后，在自杀死亡率下降期间，自杀不平等现象也随之减少。总人口中的自杀不平等指数下降了 35.4%，从 2010 年的每 10 万人 62.4 例（95% 置信区间 [CI]，59.8-64.9）下降到 2020 年的 40.3 例（95% 置信区间，38.3-42.4）。在整个人口中观察到的自杀不平等扩大和缩小的模式仅与老年人口一致。然而，年轻和中年人口的不平等现象在整个期间呈现出逐渐增加或停滞的趋势。总体而言，自杀不平等现象在最近十年有所缩小。这一下降主要是由老年人口导致的，并归因于社会保护的提供。当提供的社会保护有利于受教育程度较低的人时，自杀不平等现象的减少会伴随着自杀死亡率的下降。

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引用次数: 0

Repairing with a warm heart: How medical practitioners cultivate affective relationships with clients 用温暖的心进行修复：医疗从业者如何培养与客户的情感关系。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-30 DOI: 10.1016/j.socscimed.2024.117449

Healthcare providers are often advised to manage emotions to adhere to professional feeling rules and avoid deep affection for clients, but there are situations where this would not apply. We offer an atypical case of a cleft lip and palate (CLP) treatment program where affectionate medical provider-patient relationships are encouraged. Participant observation in a CLP department, in-depth interviews with the medical team, and public online content from the official WeChat account of the department showed that a meaningful bond was formed through a contextual concordance of moral consideration and professionalism across the organization. Medical practitioners have developed and justified such emotional work at the individual, professional, and organizational levels through three concordant micro-processes: developing the moral deservingness of the patient, instilling moral fulfillment into professionalism, and establishing moral consensus among medical professionals. This study enhances our current understanding of emotional work in healthcare by recognizing the moral consideration of patients and its influence on medical practices and by highlighting the complexities and dynamics of different feeling rules.

人们通常建议医疗服务提供者管理好情绪，遵守职业感情规则，避免与客户产生深厚感情，但在某些情况下，这并不适用。我们提供了一个唇腭裂（CLP）治疗项目的非典型案例，在该项目中，医疗服务提供者与患者之间的深厚感情受到了鼓励。对唇腭裂科室的参与观察、对医疗团队的深入访谈以及来自该科室官方微信账号的公开网络内容都表明，通过整个组织的道德考量和专业精神的背景协调，形成了一种有意义的纽带关系。医务工作者通过三个相互协调的微观过程，在个人、专业和组织层面发展并证明了这种情感工作的合理性，这三个微观过程是：发展患者的道德应得性、将道德成就灌输到专业精神中，以及在医务人员中建立道德共识。这项研究认识到了患者的道德考量及其对医疗实践的影响，并强调了不同情感规则的复杂性和动态性，从而加深了我们目前对医疗领域情感工作的理解。

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引用次数: 0

Later-life social network profiles of male war survivors in Vietnam: Implications for health behaviors 越南战争男性幸存者的晚年社交网络概况：对健康行为的影响

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-30 DOI: 10.1016/j.socscimed.2024.117465

Emerging research emphasizes early-life war exposure as a key determinant of later-life health in older adults from low- and middle-income countries (LMICs). Yet, the linkages between war exposure, social networks, and later-life health behaviors have received little attention. Using data from the 2018 Vietnam Health and Aging Study, we investigate how early-life war experiences relate to the social networks and health behaviors of 1195 Vietnamese men aged 60+ who survived the Vietnam War (1965–1975). We utilize latent class analysis to identify men's network types and examine the associations between military service, war trauma, PTSD, and later-life network profiles. Furthermore, we assess the linkages between war experiences and risky health behaviors (physical inactivity, frequent alcohol and tobacco consumption) and the moderating effect of social networks on these behaviors. Our findings reveal that exposure to wartime malevolent living conditions, as opposed to direct war violence, and recent PTSD symptoms are linked to lower support levels in respondents' network profiles. Moreover, although diverse and supportive networks correspond to a reduced risk of physical inactivity, they are associated with higher risks of frequent alcohol consumption and are marginally associated with tobacco use. Importantly, social network profiles moderate the relationship between PTSD symptoms and the risk of frequent alcohol consumption. This evidence underscores the need for policymakers to consider the historical and social contexts of LMICs when deploying social support as a health intervention.

新近的研究强调，早年的战争经历是中低收入国家（LMICs）老年人晚年健康的一个关键决定因素。然而，战争暴露、社交网络和晚年健康行为之间的联系却很少受到关注。利用 2018 年越南健康与老龄化研究的数据，我们调查了早年的战争经历与 1195 名 60 岁以上、在越南战争（1965-1975 年）中幸存的越南男性的社会网络和健康行为之间的关系。我们利用潜类分析来识别男性的网络类型，并研究服兵役、战争创伤、创伤后应激障碍和晚年生活网络特征之间的关联。此外，我们还评估了战争经历与危险健康行为（缺乏运动、频繁饮酒和吸烟）之间的联系，以及社交网络对这些行为的调节作用。我们的研究结果表明，相对于直接的战争暴力而言，战时恶劣的生活条件和近期的创伤后应激障碍症状与受访者网络档案中较低的支持水平有关。此外，虽然多样化的支持性网络会降低缺乏运动的风险，但它们与频繁饮酒的较高风险有关，与吸烟的关系不大。重要的是，社交网络状况缓和了创伤后应激障碍症状与频繁饮酒风险之间的关系。这些证据突出表明，决策者在将社会支持作为一种健康干预措施时，需要考虑低收入和中等收入国家的历史和社会背景。

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引用次数: 0

Social and policy characteristics associated with injurious shootings by police in US counties: A multilevel analysis, 2015–2020 美国各县与警察枪击致伤事件相关的社会和政策特征：2015-2020 年多层次分析。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-29 DOI: 10.1016/j.socscimed.2024.117460

From 2015 to 2020, shootings by police injured or killed 1769 people annually in the United States, disproportionately harming members of minoritized groups. Prior studies of the structural determinants of these inequities have largely examined state-level aggregations and fatal outcomes. This study aimed to: 1) describe state and county variation in fatal and nonfatal injurious shootings by police, and 2) analyze the relationship between state and county context and differences in county rates of injurious shootings by police. Injury data were developed from manual review of incidents listed in the Gun Violence Archive, then aggregated by county-year. Covariate selection was informed by theories of police use of force and the Social Basis of Disparities in Health conceptual framework. Fixed effects negative binomial regression models were estimated, nesting years within counties and states. Analyses controlled for county population, local reporting presence, and multiple measures of social conflict and community violence. From 2015 to 2020, 56% of counties experienced injurious shootings by police. Higher county rates of victimization were associated with greater state spending on police relative to health, county income inequality, prevalence of unmet substance use disorder needs, higher county firearm availability, and permitless concealed carry statutes. Firearm purchaser licensing polices were associated with lower incidence of injurious shootings by police. To prevent patterns of injurious shootings by police, policymakers should consider addressing undermanaged substance use disorder through crisis fund allocation and use, adopting stronger firearm licensing systems, and evaluating local strategies to combat inequities and strengthen non-policing responses to social needs.

从 2015 年到 2020 年，美国每年有 1769 人因警察枪击而受伤或死亡，少数群体成员受到的伤害尤为严重。此前对这些不公平现象的结构性决定因素的研究主要考察了州一级的总体情况和致命结果。本研究旨在1) 描述州和县在警察致命和非致命伤害性枪击事件中的差异，以及 2) 分析州和县背景与县级警察伤害性枪击事件发生率差异之间的关系。伤害数据是通过对枪支暴力档案中列出的事件进行人工审核，然后按县-年汇总得出的。协变量的选择参考了警察使用武力的理论和健康差异的社会基础概念框架。对固定效应负二项回归模型进行了估计，将年份嵌套到县和州中。分析控制了各县人口、当地报告存在情况以及社会冲突和社区暴力的多种衡量标准。从 2015 年到 2020 年，56% 的县发生了警察枪击伤人事件。较高的县级受害率与以下因素有关：相对于健康而言，州政府在警察方面的支出较多、县级收入不平等、药物使用障碍需求未得到满足、县级枪支可用性较高以及无证隐蔽携带枪支法规。枪支购买者许可证政策与警察伤害性枪击事件发生率较低有关。为防止警察伤害性枪击事件的发生，政策制定者应考虑通过危机基金的分配和使用来解决药物使用障碍管理不足的问题，采用更有力的枪支许可制度，并评估当地消除不平等和加强非警务应对社会需求的策略。

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引用次数: 0

Mind the glass ceiling: The gender gap in how depressive symptoms after age 55 relate to earlier career mobility in CONSTANCES 注意玻璃天花板：55岁后抑郁症状与早期职业流动性之间的性别差距》（CONSTANCES.

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-29 DOI: 10.1016/j.socscimed.2024.117446

A substantial body of research has shown an association between career mobility and mental health in later life through health selection and causal processes, with favourable health outcomes associated with upward mobility. However, gender differences in these associations have been largely overlooked, despite evidence of gender inequalities in career opportunities.

We use data on individuals aged 55–69 from the CONSTANCES cohort. We examine their current mental health and career trajectories between ages 20–55, reconstructed through a retrospective questionnaire. Using sequence analysis, we identify 11 types of past occupational mobility (upward, downward, stagnant) across a gradient from unskilled to high-skilled occupations. We use nested logistic regression to assess their association with depressive symptoms (CES-D) in men and women separately, controlling for socio-demographic variables and occupational hazards.

For both men and women, depressive symptoms are strongly associated with careers involving unskilled jobs, with no difference between directions of mobility. For men, upward mobility into skilled or high-skilled jobs is associated with fewer depressive symptoms compared to a stagnant career. This is not the case for women, for whom upward career mobility to high-skilled jobs is associated with more depressive symptoms compared to stagnation at origin.

Our findings show a gendered relationship between mental health in later life and past career mobility and highlight the mental health issues faced by women who break through the glass ceiling. They call for further research into the circumstances of women's careers that challenge their mental health in later life.

大量研究表明，通过健康选择和因果过程，职业流动性与晚年心理健康之间存在关联，向上流动性会带来有利的健康结果。然而，尽管有证据表明职业机会中存在性别不平等，但这些关联中的性别差异却在很大程度上被忽视了。我们使用了 CONSTANCES 队列中 55-69 岁人群的数据。我们通过回顾性问卷调查，研究了他们目前的心理健康状况以及 20-55 岁之间的职业轨迹。通过序列分析，我们确定了从非技术性职业到高技术性职业梯度上的 11 种过去职业流动类型（向上、向下、停滞）。在控制社会人口变量和职业危害的前提下，我们使用嵌套逻辑回归法分别评估了男性和女性的抑郁症状（CES-D）。对于男性和女性而言，抑郁症状与从事非技术性工作的职业密切相关，而流动方向则没有差异。对于男性来说，与停滞不前的职业生涯相比，向上流动从事熟练或高技能工作与抑郁症状较少相关。而女性的情况则不同，与原职业停滞不前相比，向上流动到高技能工作岗位与更多抑郁症状相关。我们的研究结果表明，晚年心理健康与过去的职业流动之间存在性别关系，并强调了突破玻璃天花板的女性所面临的心理健康问题。这些研究呼吁进一步研究妇女职业生涯中挑战其晚年心理健康的环境。

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引用次数: 0

Context dependent preferences in prestige bias learning about vaccination in rural Namibian pastoralists 纳米比亚农村牧民对疫苗接种的威望偏好取决于具体情况。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-29 DOI: 10.1016/j.socscimed.2024.117461

Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts.

社会科学领域的大量研究表明，疫苗接种决定受制于激励、偏见和社会学习过程，包括声望偏见的传播。在某些条件下，医生和公共卫生官员等地位较高的人可以成为疫苗接种信息和接种率的有效传播者。在医疗不信任严重、与市场和正规医疗系统互动较少的社区，声望偏见的社会学习可能会通过不同的渠道进行。在此，我们研究了声望偏差对两个族群（辛巴族和赫雷罗族）疫苗接种决策的影响，这两个族群的市场一体化程度和与正规医疗系统的接触经验各不相同。受试者完成了一项排名任务，比较了四个有声望的人对疫苗接种决策的影响，并完成了一项关于医疗不信任的调查。利用 Plackett-Luce 模型，我们比较了地点、种族归属和其他协变量对排名的影响。一个多层次模型比较了族群内外的影响，以及专科医生（医生/治疗师）和全科医生（主任/州长）声望的影响。结果表明，在城乡梯度上，有名望的人的等级发生了变化。我们的研究结果表明，在疫苗决策方面，有威望的社会学习存在很大差异。医疗不信任并不影响排名。与以往的研究相反，我们发现有名望的人在当地是否有名望比他们在相关领域（健康和治疗）的专业知识更重要。这些发现强调了对声望偏差进行更多特定情境研究的必要性，这些研究可以提高我们对医疗决策的理解，并指导不同情境下的公共卫生信息传播。

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引用次数: 0

Hierarchy, class, race and PPE in an American hospital in the early days of COVID-19: What the pandemic stress test can teach us about building equitable health systems COVID-19 初期美国医院中的等级制度、阶级、种族和个人防护设备：大流行病压力测试对建立公平医疗体系的启示。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-29 DOI: 10.1016/j.socscimed.2024.117463

Because hospitals are spaces where life and death are routinely at stake, social hierarchies, pressures, and cultural norms are heightened. This was particularly true in the early days of the COVID-19 pandemic. Examining the dynamics in that era can provide insight into the nature of race and hierarchy in hospital structures.

In the large literature on the experiences of hospital staff in the COVID-19 era, class and racial dynamics in hospitals are often sidestepped. In addition, the experiences of service staff such as environmental service workers and food service workers are severely under-represented.

Here, we explore hierarchy, class, race and risk in two hospitals in the city of Baltimore in the first months of the pandemic in 2020, through the lens of availability of PPE. We draw on a survey of 403 staff in two Baltimore hospitals, and semi-structured interviews with 57 of those staff. Respondents worked in a variety of roles, from administration to clinical to service staff.

A large majority of non-clinical service staff identified as Black, in contrast to a small minority of clinical staff with advanced degrees. The experience of access to PPE in the early pandemic differed across cadres of workers. Everyone in the hospital had to ration PPE, but many service staff felt that they were not prioritized in the same ways as clinical staff. PPE availability took on powerful symbolic resonance as a demonstration of how different cadres of workers were valued.

The COVID-19 pandemic threw social and class dynamics within the hospital into relief, shedding light on what so often ran below the surface. Thus, it could also potentially be an impetus to examine these fault lines, and to push hospital structures a bit more in the direction of justice.

由于医院是生死攸关的地方，社会等级、压力和文化规范都会随之加强。这在 COVID-19 大流行的早期尤为明显。研究那个时代的动态可以让我们深入了解医院结构中种族和等级制度的本质。在有关 COVID-19 年代医院员工经历的大量文献中，医院中的阶级和种族动态往往被回避。此外，环境服务人员和餐饮服务人员等服务人员的经历也严重缺乏代表性。在此，我们通过个人防护设备的可用性这一视角，探讨了 2020 年流感大流行最初几个月巴尔的摩市两家医院中的等级制度、阶级、种族和风险。我们对巴尔的摩两家医院的 403 名员工进行了调查，并对其中 57 名员工进行了半结构化访谈。受访者的工作岗位多种多样，有行政人员、临床人员和服务人员。绝大多数非临床服务人员自称是黑人，与之形成鲜明对比的是少数拥有高等学历的临床人员。在大流行初期，不同级别的工作人员获得个人防护设备的情况各不相同。医院里的每个人都必须配给个人防护设备，但许多服务人员认为他们没有像临床人员那样被优先考虑。个人防护设备的可用性具有强大的象征意义，表明了不同级别的工作人员是如何受到重视的。COVID-19 大流行使医院内部的社会和阶级动态变得更加清晰，揭示了经常隐藏在表面之下的问题。因此，它也有可能成为审视这些断层线的动力，并推动医院结构朝着公正的方向发展。

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引用次数: 0

Do discrepancies between subjective and objective health shift over time in later life? A markov transition model 晚年主观和客观健康之间的差异会随着时间的推移而改变吗？马尔可夫转换模型

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2024-10-28 DOI: 10.1016/j.socscimed.2024.117441

Subjective health (SH) deteriorates less rapidly than objective health (OH) in older adults. However, scant evidence exists regarding if discrepancies between SH and OH shift in the same individuals over time. We explore whether such discrepancies change over time in a sample of older adults living in England, through a prospective, observational cohort study design. Using data from the English Longitudinal Study of Ageing, we followed a sample of 6803 older adults, aged 60+ years at baseline, over three waves of data collection (2002–2007), yielding two wave transitions. A ‘health asymmetry’ metric classified older adults into four categories at each wave, based on the level of agreement between their SH and OH scores (‘health pessimist’, ‘health optimist’, ‘good health realist’ and ‘poor health realist’). First-order Markov transition and generalised logit models yielded estimated transition probabilities and odds ratios for health asymmetry transitions over time. At baseline, 36.84% of the sample were ‘good health realists’, 33% were ‘poor health realists’, 14.54% were ‘health optimists’, and 15.62% were ‘health pessimists’. Good and poor health realists were likely to remain health realistic over time. Good health realists who did transition however, were likely to become health optimists. Subsequently, the proportion of health optimists in the sample increased over time. Health pessimists had a high probability of being lost to study attrition. In conclusion, health optimism (i.e. where SH is rated better than OH) becomes more prevalent over time, in later life. Future research should investigate if promoting positive SH appraisals among health pessimists and poor health realists can optimise health and survival outcomes.

老年人主观健康（SH）的恶化速度低于客观健康（OH）。然而，关于同一人的主观健康状况和客观健康状况之间的差异是否会随着时间的推移而发生变化的证据却很少。我们通过前瞻性、观察性队列研究设计，对居住在英格兰的老年人样本进行了调查，以了解这种差异是否会随着时间的推移而发生变化。利用英国老龄化纵向研究的数据，我们对基线年龄在 60 岁以上的 6803 名老年人样本进行了三波数据收集（2002-2007 年），产生了两波过渡。健康不对称 "指标根据老年人的 "健康悲观主义者 "和 "健康乐观主义者 "得分之间的一致程度，在每个波次将老年人分为四类（"健康悲观主义者"、"健康乐观主义者"、"健康现实主义者 "和 "健康现实主义者"）。一阶马尔可夫转换模型和广义对数模型估算出了健康不对称随时间变化的转换概率和几率比率。基线样本中有 36.84% 是 "良好健康现实主义者"，33% 是 "不良健康现实主义者"，14.54% 是 "健康乐观主义者"，15.62% 是 "健康悲观主义者"。健康状况良好和健康状况较差的现实主义者可能会长期保持健康状况现实。然而，健康状况良好的现实主义者很可能会转变为健康状况乐观主义者。随后，健康乐观主义者在样本中的比例随着时间的推移而增加。健康悲观主义者很有可能因研究减员而流失。总之，随着时间的推移，健康乐观主义（即 "健康乐观 "比 "健康悲观 "更好）在晚年生活中越来越普遍。未来的研究应探讨在健康悲观主义者和健康现实主义者中推广积极的健康乐观主义评价是否能优化健康和生存结果。

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