Social Science & Medicine最新文献

Road traffic injuries (RTIs) pose significant public health threats, particularly for vulnerable road users such as pedestrians and cyclists. While recent studies have revealed adverse impacts of heat exposure on RTI frequency among motorized road users, a research gap persists in understanding these impacts on non-motorized road users, especially in tropical regions where their vulnerability can be heightened due to differential thermal exposure, adaptive capacity, and biological sensitivity. In this study, we compared associations between high temperatures and RTIs across four different crash-involved modes of transportation—pedestrians, cyclists, motorcyclists, and car drivers in Taiwan. Leveraging data on RTI records and temperature conditions in Taiwan's six municipalities from 2018 to 2022, we conducted a city-time-stratified case-crossover analysis. We employed distributed lag non-linear models with conditional Poisson regression models to estimate temperature-RTI associations for each mode of transportation, adjusting for various weather factors and unmeasured spatio-temporal patterns. Our findings reveal that individuals using exposed, open transportation modes (i.e., pedestrians, cyclists, and motorcyclists) exhibited higher relative risks of heat-induced RTIs than car drivers, with non-motorized mode users showing greater susceptibility compared to their motorized counterparts. These elevated risks can be attributed to the absence of built-in cooling systems in open travel modes and the increased exertional heat stress implied in active travel. Our study contributes novel insights to a global concern related to climate change, extending its impact to road safety, a health outcome rarely studied in the context of a changing climate. Our findings are thus important, especially for regions where rising temperatures regularly approach or exceed human physiological limits related to heat tolerance in the coming decades. Additionally, our findings hold significance in the existing urban health literature, particularly within the context of the emerging era of micromobility—a category of low-speed, non-enclosed, and lightweight vehicles increasingly integrated into urban activities worldwide.

Objective

Limited understanding exists regarding the cumulative impact of childhood household dysfunction (CHD) on adolescent depressive symptoms in developing countries, as well as the role of lifestyles in this association. This study aims to explore the associations of individual and cumulative CHD indicators with depressive symptoms among Chinese adolescents. Additionally, we investigate potential interactions and joint associations of CHD and lifestyles on depressive symptoms.

Methods

In the second phase of the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research, data on depressive symptoms, CHD indicators, lifestyle factors, and other covariates were collected from 3106 students (mean [SD] age, 15.16 [1.52] years). Linear and logistic mixed-effects models were employed, with both stratified and joint analyses conducted.

Results

Except for parental death, each CHD indicator was associated with an increased risk of depressive symptoms. The accumulation of CHD indicators exhibited a positive, graded association with depressive symptoms scores (β = 3.22, 95% CI: 2.48 to 3.97 for one CHD indicator; β = 5.45, 95% CI: 4.41 to 6.49 for two or more CHD indicators, all P < 0.01). A significant interaction was found between the number of CHD indicators and the healthy lifestyle score (interaction β = −0.40, 95% CI: −0.78 to −0.03, P < 0.05), indicating that healthy lifestyles may mitigate the risk of depressive symptoms in individuals experiencing CHD. For example, the OR for having depressive symptoms among adolescents with favourable lifestyles compared with those with unfavourable lifestyles was 0.21 (95% CI: 0.10 to 0.45, P < 0.01) among those experiencing CHD. Moreover, adolescents with two or more CHD indicators and unfavourable lifestyles faced the highest risk of having depressive symptoms (OR = 8.03, 95% CI: 4.83 to 13.34, P < 0.01) compared with those with no CHD indicator and favourable lifestyles.

Conclusions

These findings underscore the importance of promoting comprehensive healthy lifestyles and reducing CHD exposure for the prevention of depressive symptoms in adolescents.

Motor neurone disease (MND) is a progressive neurodegenerative disorder which is ultimately terminal. It causes muscle weakness which can lead to the need for assistance in breathing, for some with the disease. This paper draws on qualitative research using semi-structured interviews with 32 people bereaved by the death of a family member with MND who was dependent on home mechanical ventilation, from across the United Kingdom. Interviews explored how the end-of-life of a person who had used non-invasive ventilation to assist their breathing was experienced by participants, who had cared about, and for them. Four themes are used to examine the impact of dependent ventilation technology on the experience of dying on the part of bereaved family members. Themes are: accompanied dying, planned withdrawal of ventilation, blurred time of death, time post-death. The perception and experience of time was a key component across all four themes. Ventilator technology played a critical role in sustaining life, but it could also contribute to a complex dynamic where the realities of death were mediated or obscured. This raises ethical, emotional, and existential considerations, both for the individuals receiving ventilator support and their families, as well as for healthcare professionals involved in end-of-life care.

Introduction

Methods

Results

Conclusions

Refugees encounter multiple psychosocial stressors post-resettlement which increases their risk of developing a mental illness. Loneliness and social isolation are commonly reported in the refugee population and have been demonstrated to be associated with multiple physical and mental health comorbidities in the general population. However, no study to date has systematically reviewed how loneliness and social isolation may affect refugees who have resettled in high-income countries. This systematic review aims to study the prevalence, risk factors, consequences, and interventions for loneliness and social isolation among refugees who have resettled in high-income countries. Systematic searches on five electronic databases yielded 2950 papers, of which 69 were deemed eligible following a double-blinded review by title and abstract then later by full text. From the included studies, it was found that the reported range of prevalence rates of loneliness (15.9–47.7%) and social isolation (9.8–61.2%) were higher than population norms. Risk factors associated with loneliness and social isolation included family separation, acculturative stress, being female or a parent and a current diagnosis of a mental illness. Loneliness and social isolation were found to be associated with depression, post-traumatic stress disorder (PTSD), psychological distress as well as physical health problems. Only three interventions addressing loneliness and social isolation were identified which demonstrates the importance of integrating social support in refugee psycho-social support programs. In summary, loneliness and social isolation were reported by a large proportion of refugees who have resettled in high-income countries. Whilst certain risk factors were pre-migratory and static, most were post-migratory in nature and were found to adversely affect mental and physical health. Thus, interventions focused on reducing loneliness and social isolation that are guided by the needs of refugee communities are urgently required.

Rationale

Migrant care workers (MCWs) play a crucial role in addressing healthcare workforce shortages in many developed countries. Existing reviews document the significant challenges MCWs face—such as language barriers, interpersonal discrimination, and sexual harassment—and describe the social support that MCWs receive, but ambiguous application and heterogeneous measurement of theoretical constructs have thus far precluded researchers from deriving generalizable insights about how various types of social support positively and negatively impact MCWs’ well-being. Therefore, we conducted a scoping review on this topic and organized the literature using four theoretical perspectives on social support.

Objective

To synthesize interdisciplinary research on social support for MCWs and extend existing reviews, we conducted a scoping review of 56 empirical studies to understand how these studies conceptualize and operationalize social support for MCWs and the theoretical and methodological approaches they adopt.

Findings

Our findings suggest that scholars have implicitly and explicitly adopted a wide array of theoretical perspectives (e.g., stress and coping, social constructivism), with few studies engaging theories in substantive ways. The reviewed studies have demonstrated both positive and negative implications of social support for MCWs' well-being. However, these studies heavily focus on the social support MCWs receive, whereas the negative impacts of MCWs' unmet support needs remain under-investigated. Although empirical studies use diverse methodologies to study this topic, most quantitative studies approach social support from a stress and coping perspective. We advocate for researchers conducting quantitative studies to adopt a critical consciousness and work toward statistically modeling how the intersectionality of MCWs' identities and the multi-level nature of MCWs’ power positions within their social networks may impact whether MCWs successfully obtain the support they need to thrive.

Compassion in healthcare is valued by patients, healthcare professionals (HCPs), and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding ways to intervene remains limited. The aim of this study is to clarify compassion intervention needs in a diverse HCP workforce in public secondary healthcare in Aotearoa New Zealand (NZ) by utilising a co-design process. The co-design process involved a series of workshops with clinicians followed by in-depth interviews with healthcare leaders to derive input regarding feasibility and implementation. Reflexive thematic analysis was used to analyze the data. There was a great deal of interest in compassion interventions from healthcare professionals and leaders. However, for compassion interventions to be acceptable, feasible, and effective, compassion interventions design should be reimagined and reflected at each step of interventional design and implementation and span across organizational levels. Namely, the results of the study showed the preference for non-individual focused multi-level interventions to build bridges and connections. The desired compassion intervention components included practising connecting with others' humanity, improving compassion knowledge and relational and reflective skills, and cultural safety and anti-racism training. Experiential training embedded in models of cultural dialogue was the preferred interventional modality. Prioritising leadership as an intervention site was suggested to improve leadership's buy-in of compassion interventions and possibly serve as a starting point for transforming the broader culture, reviving interconnectedness in a healthcare system described as fragmented, disconnected, and alienating with compassion also acting as an equalizer of power.

The widespread discrimination against individuals with obesity often stems from a simplistic perception of obesity as a mere consequence of personal choices of overeating and insufficient physical activity. This reductionist perception fails to acknowledge the complexity of the epidemic of obesity, which extends beyond diet and exercise decisions. The concept of appetite self-regulation (ASR) has been explored as a crucial element in identifying obesogenic behavioral approaches to food. Although an extensive understanding of ASR in children is essential as an early precursor and modifiable factor influencing obesity, the prevailing view of self-regulation of eating solely as a matter of cognitive and behavioral processing tends to overlook interacting systems of influences. This narrow approach attributes obesity to the lack of voluntary self-control in food consumption while neglecting to account for the biological, psychological, and social influences implicated in the developmental processes of ASR, which may further contribute to the stigmatization of obesity. The current critical analysis provides a comprehensive developmental framework that could guide future studies with testable hypotheses, outlining pathways of interactions among biopsychosocial systems, all of which contribute to the development of ASR in early childhood. Adopting developmental perspectives allows a holistic approach to investigating ASR, which accounts for intricate interactions between biological (B), psychological (P), and social (S) factors influential in the early manifestation of ASR.