Social Science & Medicine最新文献_第10页

‘They're big and I is small’: The precarious identity reconstruction process of a low-status occupational group “他们大，我小”：低地位职业群体不稳定的身份重建过程。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.119000

Marieke van Wieringen

This paper studies how certified nursing assistants (CNAs), as members of a low-status occupational group, engage in identity reconstruction as they attempt to alter their marginalized position within long-term care organizations. Micro-level process data consist of 160 h of participant observations of a professional development programme for CNAs and 130 in-depth interviews with programme participants and their colleagues in care organizations. The findings show that the identity reconstruction process involved four micro-processes: 1) recognizing the dominance of marginalized identity, 2) seeking an upgraded identity, 3) grappling with identity validation and dissociation, 4) experiencing disillusion when struggling to sustain upgraded identity. By capturing these micro-processes, this research contributes, first, by showing that identity reconstruction in low-status occupational groups begins not from a coherent identity under threat but from a fractured, self-diminishing identity, making the recognition of marginality itself a pivotal catalyst for upgrading identity. Second, it conceptualizes how identity reconstruction centers on identity upgrading, surfacing and legitimizing undervalued forms of knowledge, rather than acquiring new roles or competencies. The third contribution lies in revealing that early affirmations can create a false sense of establishment, even complacency, and deter further proactive “work” in asserting and enacting a reconstructed identity within broader organizational contexts, thereby undermining previous identity work done. Taken together, this study offers a more comprehensive understanding of identity reconstruction processes by members of low-status occupational groups, showing its precariousness.

本文研究了注册护理助理（CNAs）作为低地位职业群体的成员，在试图改变其在长期护理组织中的边缘化地位时，如何进行身份重建。微观层面的过程数据包括160小时的参与者对CNAs专业发展计划的观察和130次对计划参与者及其护理组织同事的深入访谈。研究结果表明，身份重建过程包括四个微观过程：1)认识到边缘化身份的主导地位；2)寻求升级的身份；3)与身份验证和分离作斗争；4)在努力维持升级的身份时经历幻灭。通过捕捉这些微观过程，本研究的贡献如下：首先，表明低地位职业群体的身份重建并非始于一种受到威胁的连贯身份，而是始于一种断裂的、自我削弱的身份，这使得对边缘地位的认识本身成为身份升级的关键催化剂。其次，它概念化了身份重建如何以身份升级为中心，使被低估的知识形式浮出水面并合法化，而不是获得新的角色或能力。第三个贡献在于揭示早期的肯定会产生一种虚假的建立感，甚至自满，并阻止在更广泛的组织环境中主张和制定重建身份的进一步积极的“工作”，从而破坏之前所做的身份工作。综上所述，本研究对低地位职业群体成员的身份重建过程提供了更全面的理解，显示了其不稳定性。

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引用次数: 0

Residential segregation of Black and Latinx older adults and brain imaging outcomes 黑人和拉丁裔老年人的居住隔离与脑成像结果

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118995

Lilah M. Besser , Sarah Forrester , Diana Mitsova , Pauline Maillard , Charles DeCarli , Rachel Whitmer , Oanh L. Meyer

Ethnoracial segregation has been associated with worse cognitive functioning among Black older adults, while its impact on Latinx individuals is less clear. We investigated whether Black and Latinx older adults living in segregated neighborhoods demonstrate worse magnetic resonance imaging (MRI) outcomes. We used data on participants from the University of California Davis Alzheimer's Disease Research Center. MRI outcomes included hippocampal and white matter hyperintensity (WMH) volumes. Black and Latinx segregation was defined using the Getis-Ord (Gi∗) statistic, which compares the proportion of Black or Latinx residents, respectively, in the participant's Census tract to surrounding neighborhoods and greater study region (higher Gi∗ = greater clustering/segregation). Multivariable linear regression analyses examined associations between Gi∗ segregation measures and MRI outcomes, stratified by the participants' ethnoracial group (Black, Latinx, or White). Participants (n = 269) were on average 74 ± 7 years of age and 24 % were Black, 25 % were Latinx, and 51 % were White. In adjusted analyses, Black participants in more Latinx segregated neighborhoods had lower hippocampal volumes, and Latinx participants in more Black segregated neighborhoods had lower hippocampal volumes. Latinx participants in more Latinx segregated neighborhoods had greater white matter hyperintensity volumes. Overall, Black and Latinx but not White participants living in segregated neighborhoods had worse MRI outcomes. Future studies are needed to replicate our findings in geographically diverse samples and to elucidate the potential psychosocial/social determinant and biological mechanisms that relate segregation to brain health (e.g., Latinx segregated neighborhoods may have fewer recreational and physical activity resources to promote healthy lifestyles).

种族隔离与黑人老年人的认知功能恶化有关，而其对拉丁裔个体的影响尚不清楚。我们调查了居住在隔离社区的黑人和拉丁裔老年人是否表现出更差的磁共振成像（MRI）结果。我们使用的数据来自加州大学戴维斯分校阿尔茨海默病研究中心的参与者。MRI结果包括海马和白质高强度（WMH）体积。黑人和拉丁裔的隔离使用Getis-Ord （Gi∗）统计来定义，该统计将参与者的人口普查区中黑人或拉丁裔居民的比例分别与周围社区和更大的研究区域进行比较（更高的Gi∗=更大的聚集/隔离）。多变量线性回归分析检验了Gi *隔离措施与MRI结果之间的关系，并按参与者的种族群体（黑人、拉丁裔或白人）分层。参与者（n = 269）平均年龄为74±7岁，24%为黑人，25%为拉丁裔，51%为白人。在调整分析中，居住在拉丁裔隔离社区的黑人参与者的海马体体积更低，而居住在黑人隔离社区的拉丁裔参与者的海马体体积更低。居住在拉丁裔隔离社区的拉丁裔参与者有更大的白质高密度体积。总体而言，居住在隔离社区的黑人和拉丁裔参与者的MRI结果更差，而白人参与者则没有。未来的研究需要在地理上不同的样本中复制我们的发现，并阐明隔离与大脑健康相关的潜在社会心理/社会决定因素和生物学机制（例如，拉丁裔隔离社区可能缺乏促进健康生活方式的娱乐和体育活动资源）。

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引用次数: 0

Kinlessness, sole family survivorship, and the mental and physical health of U.S. older adults 美国老年人的亲属关系、家庭唯一幸存者与身心健康。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118996

Susan L. Brown , I-Fen Lin , Francesca A. Marino , Kagan A. Mellencamp

Limited family ties are increasingly common among U.S. older adults. Kinless individuals lack a family of procreation, namely a spouse/partner and children. Sole family survivorship refers to lacking family of origin kin, including parents and siblings. Familial ties are linked to health across the life course and, in line with socioemotional selectivity theory, play an increasingly salient role with age. Consequently, older adults who are kinless or sole family survivors may face worse health outcomes than their counterparts with kin. However, substitution of friends or relatives nearby may mitigate some of the health burden of limited family ties. Drawing on 191,146 person-waves of data from the 1998–2018 Health and Retirement Study, we assessed how these two forms of limited family ties were associated with chronic conditions, (instrumental) activities of daily living (ADL/IADL) limitations, self-rated poor health, and depressive symptoms. Among women, kinlessness was largely unrelated to women's health, only being associated with an increased rate of ADL/IADL difficulties. In contrast, sole family survivorship was positively associated with women's ADL/IADL difficulties, self-rated poor health, and depressive symptoms. Among men, kinlessness was not associated with worse health outcomes. Sole family survivorship was associated with more ADL/IADL difficulties and depressive symptoms among men. Social ties were not uniformly protective of women's and men's health, calling into question the viability of substitutes and underscoring the unique advantages of immediate family ties in later life. Our study demonstrates the utility of examining multiple forms of limited family ties which have distinct ramifications for older adult well-being.

在美国老年人中，有限的家庭关系越来越普遍。无亲属个体缺乏一个生育家庭，即配偶/伴侣和子女。孤家寡人是指没有亲生亲属，包括父母和兄弟姐妹。家庭关系在整个生命过程中都与健康有关，并且与社会情感选择性理论相一致，随着年龄的增长，家庭关系的作用越来越突出。因此，无亲属或唯一家庭幸存者的老年人可能比有亲属的老年人面临更差的健康结果。然而，附近的朋友或亲戚的替代可能减轻一些有限的家庭关系的健康负担。利用1998-2018年健康与退休研究中的191146人波数据，我们评估了这两种形式的有限家庭关系如何与慢性病、（工具性）日常生活活动（ADL/IADL）限制、自评健康状况不佳和抑郁症状相关。在妇女中，无亲属行为基本上与妇女的健康无关，只是与ADL/IADL困难率增加有关。相反，单独的家庭生存与女性的ADL/IADL困难、自评健康状况不佳和抑郁症状呈正相关。在男性中，冷漠与较差的健康结果无关。在男性中，单一家庭生存与更多的ADL/IADL困难和抑郁症状相关。社会关系并不能完全保护妇女和男子的健康，这使人们怀疑替代品的可行性，并强调了直系家庭关系在晚年生活中的独特优势。我们的研究证明了检验多种形式的有限家庭关系的效用，这些家庭关系对老年人的福祉有明显的影响。

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引用次数: 0

The impact of media coverage of a celebrity suicide on suicide and attempted suicide rates in Taiwan 媒体报导名人自杀对台湾自杀率及企图自杀率的影响。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118994

Ying-Yeh Chen , Vera Yu Men , Cheuk Yui Yeung , Kevin Chien-Chang Wu , Ying-Chen Chi , Paul SF. Yip

Media coverage of celebrity suicides can shape population-level suicidal behavior, yet most existing evidence focuses on mortality rather than non-fatal attempts. This study investigates the impact of media coverage following the suicide of Chiung Yao, an 86-year-old best-selling novelist and cultural figure in Chinese-speaking societies, on suicide mortality and suicide attempts in Taiwan.

We drew on suicide attempt data from Taiwan's National Suicide Surveillance System and mortality data from the Taiwan Death Registry. Using an interrupted time-series design with quasi-Poisson regression, we analyzed seven-day rolling counts of suicide attempts and deaths during the four weeks before and after her death (December 4th, 2024), stratified by sex, age group, and suicide method.

No significant overall changes in suicide attempts or mortality were observed. However, suicide attempts increased by 12.3 % among women aged 45–64 (IRR = 1.123; 95 % CI: 1.030–1.225), with a slight increase of the post-death trend among women aged 25–44. Suicide deaths by charcoal burning, the method used by the celebrity, increased by 47.0 % (IRR = 1.470; 95 % CI: 1.195–1.807), and mortality among men aged 25–44 and ≥65 rose by 35.5 % (IRR = 1.355; 95 % CI: 1.095–1.679) and 20.7 % (IRR = 1.207; 95 % CI: 0.992–1.468), respectively.

Media coverage of the suicide of an older celebrity was not associated with population-level increases in suicide, but associated with method- and subgroup-specific changes in suicide attempts and mortality. These findings highlight the importance of monitoring media practices with attention to differential vulnerability following highly publicized suicides.

媒体对名人自杀的报道可以影响大众层面的自杀行为，然而，大多数现有证据关注的是死亡率，而不是非致命性的自杀企图。摘要本研究探讨台湾86岁畅销小说家、华语社会文化人物琼瑶自杀事件后，媒体报导对台湾自杀死亡率及自杀企图的影响。使用准泊松回归的中断时间序列设计，我们分析了她死亡前后（2024年12月4日）四周内7天的自杀企图和死亡滚动计数，并按性别、年龄组和自杀方式分层。在自杀企图和死亡率方面没有观察到明显的总体变化。然而，45-64岁妇女的自杀企图增加了12.3% (IRR = 1.123; 95% CI: 1.030-1.225)， 25-44岁妇女的死后趋势略有增加。名人使用的燃烧木炭自杀死亡人数增加了47.0% (IRR = 1.470; 95% CI: 1.195-1.807)， 25-44岁和≥65岁男性的死亡率分别增加了35.5% （IRR = 1.355; 95% CI: 1.095-1.679）和20.7% （IRR = 1.207; 95% CI: 0.992-1.468）。媒体对年长名人自杀的报道与人口自杀率的上升无关，但与方法和亚群体特定的自杀企图和死亡率的变化有关。这些发现强调了监测媒体做法的重要性，并注意高度宣传自杀后的不同脆弱性。

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引用次数: 0

Towards a care continuum: A socio-material analysis of intra-acting public-private maternity care in South Africa 迈向护理连续体：对南非公私产科护理的社会物质分析

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118998

Nicole Miriam Daniels

Contributing to critical health scholarship, this multi-sited ethnography into private sector obstetrics in Cape Town, South Africa generated comparative public sector data through observation and interviews with seven obstetricians and fourteen pregnant women between 2017 and 2019. Entrenched inequalities in the provision and access to quality obstetric care, provoked in the politics of birth, are significant for broader societal movements and governance approaches towards universal healthcare in Africa. With near universal maternity care, South Africa is an important case study for understanding possible private sector contributions to National Health Insurance reforms aiming to consolidate health services for all. Drawing on feminist new materialist theory and socio-material analysis, I outline a care continuum, which I use to interrogate the logics of care that articulate an interdependent yet dichotomized health system. Dichotomized as poles either end of the care continuum is a generalised public sector and individualised private sector. A continuum helps demonstrate that material, experiential and discursive differences in care are not pre-existing but intra-actively related, meaning their differences are produced and maintained through relatedness. I illustrate this looking at movements of obstetric practices, patients, and providers, spatialities of services, and temporalities in care to propose that that public-private maternity care boundaries are co-produced through their mutual entanglement.

2017年至2019年期间，通过对7名产科医生和14名孕妇的观察和访谈，这项针对南非开普敦私营部门产科的多地点人种志研究产生了比较公共部门的数据，为重要的健康学术贡献了力量。在提供和获得优质产科护理方面根深蒂固的不平等现象是由生育政治引起的，这对非洲实现全民保健的更广泛的社会运动和治理方法具有重要意义。南非几乎普及了产妇保健，是了解私营部门可能对旨在巩固全民保健服务的国民健康保险改革作出贡献的一个重要研究案例。借鉴女权主义新唯物主义理论和社会物质分析，我概述了一个护理连续体，我用它来询问护理的逻辑，阐明了一个相互依存但又一分为二的卫生系统。作为两极，护理连续体的两端是一般的公共部门和个性化的私营部门。连续体有助于证明护理中的物质、经验和话语差异不是预先存在的，而是主动相关的，这意味着它们的差异是通过相关性产生和维持的。我通过观察产科实践、病人和提供者的运动、服务的空间性和护理的临时性来说明这一点，从而提出公私产科护理的界限是通过相互纠缠而共同产生的。

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引用次数: 0

Area-socioeconomic disadvantage and cognitive function among Chinese older adults: the mediating role of healthcare resources and the moderating role of individual socioeconomic status 中国老年人的地区-社会经济劣势与认知功能：医疗资源的中介作用和个体社会经济地位的调节作用

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118987

Xiaqing Jiang , Yuying Zhang , Jiamin Gao

Objectives

This study examines how city-level socioeconomic status (SES) is associated with cognitive function among older adults in China, and explores the mediating role of healthcare resources and the moderating role of individual SES in this context.

Methods

We relied on data from the 2018 wave of the China Health and Retirement Longitudinal Study, which provided individual cognitive function and demographic characteristics. Area-level SES and healthcare resource indicators were obtained from national statistical sources. A total of 9520 individuals aged 60 years or older from 123 cities were included in the analysis. A multilevel moderated mediation model was applied, and subgroup analyses by gender were conducted.

Results

Both individual- and area-level SES were positively associated with cognitive function. Multilevel mediation models of healthcare resources showed that only physician density (i.e., not hospital or bed supply) partially mediated the association between area-level SES and cognitive function. After individual SES was introduced as a moderator, the cognitive benefits of healthcare human resources were greater for low-SES individuals than for high-SES individuals. However, evidence for this moderating effect was not consistently supported across variations in sample composition and cognitive measurement. Gender-stratified analyses further showed no clear evidence supporting an individual-SES-based moderating effect in either men or women.

Conclusion

Our findings emphasize the fact that area-level SES and healthcare human resources shape late-life cognition, suggesting equity-focused policies that address structural disadvantage to reduce disparities in cognitive aging.

目的研究城市社会经济地位（SES）与中国老年人认知功能的关系，并探讨医疗资源的中介作用和个体社会经济地位的调节作用。方法采用2018年中国健康与退休纵向研究的数据，提供个体认知功能和人口统计学特征。地区一级的社会经济状况和保健资源指标是从国家统计来源获得的。来自123个城市的9520名60岁及以上的老年人被纳入分析。采用多水平调节的中介模型，并按性别进行亚组分析。结果个体和区域SES水平与认知功能呈正相关。医疗资源的多层次中介模型表明，只有医生密度（即医院或床位供应）部分中介了区域水平SES与认知功能之间的关联。在引入个体社会经济地位作为调节因素后，低社会经济地位个体的医疗人力资源的认知效益大于高社会经济地位个体。然而，在样本组成和认知测量的差异中，这种调节效应的证据并不一致。性别分层分析进一步显示，没有明确的证据支持基于个体的ses对男性或女性的调节作用。结论本研究结果强调了区域经济地位和医疗人力资源塑造老年认知的事实，提示以公平为重点的政策可以解决结构性劣势，以减少认知老龄化的差异。

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引用次数: 0

Following the power: social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease in the United States 跟随权力：美国意外中毒、自杀和慢性肝病死亡率的社会阶级不平等。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118991

Jerzy Eisenberg-Guyot , Candace M. Cosgrove , Alex Azan , Samuel R. Friedman , Seth J. Prins , Audrey Renson

Introduction

Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational theories suggest such hazards flow from power imbalances between workers, managers, and employers – social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed class inequities in the cause-specific mortality.

Methods

We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents as incorporated business owners, unincorporated business owners, managers, workers, or not in the labor force based on their employment, occupational, and business-ownership status. Then, using an inverse-probability-weighted Aalen-Johansen estimator, we estimated risk differences in the cause-specific mortality across classes at the end of follow-up, including by sex, race/ethnicity, and education.

Results

Our sample included 2,304,500 respondents and 10,870 accidental-poisoning, suicide, and chronic-liver-disease deaths. Compared to incorporated business owners, those not in the labor force, workers, and unincorporated business owners had, respectively, 8.9 (95 % CI: 8.0, 9.7), 0.9 (95 % CI: 0.4, 1.5), and 1.1 (95 % CI: 0.3, 1.9) greater 12-year age- and sex-adjusted risks of the cause-specific mortality per 1000. Managers' risks resembled incorporated business owners’. Inequities largely persisted after thorough sociodemographic adjustment. Among workers, risks were elevated among the unemployed and those with blue-collar or service occupations. Finally, inequities were greater among men and less-educated respondents than among women and more-educated respondents.

Discussion

We estimated considerable class inequities in the cause-specific mortality, adding to research connecting class relations to mortality inequities and worsening population health.

危险的工作条件加剧了意外中毒、自杀和慢性肝病死亡率方面的不平等。相关理论认为，这种危险来自于工人、管理者和雇主之间的权力不平衡——这些社会阶层是由对财产和劳动力的权力划分的。然而，据我们所知，没有美国研究使用相关措施分析了特定原因死亡率的阶级不平等。方法：我们使用了美国社区死亡率差异数据集，该数据集将2008年美国社区调查与截至2019年12月31日的国家死亡指数联系起来。我们根据受访者的就业、职业和企业所有权状况，将受访者分为注册企业所有者、非注册企业所有者、管理人员、工人或非劳动力。然后，使用反概率加权的aallen - johansen估计器，我们估计了随访结束时不同班级的特定原因死亡率的风险差异，包括性别、种族/民族和教育程度。结果：我们的样本包括2,304,500名受访者和10,870例意外中毒，自杀和慢性肝病死亡。与合并企业所有者相比，非劳动力、工人和非合并企业所有者的12年死亡率（经年龄和性别调整后）分别高出8.9 （95% CI: 8.0, 9.7）、0.9 （95% CI: 0.4, 1.5）和1.1 （95% CI: 0.3, 1.9）。管理者的风险类似于公司业主的风险。在彻底的社会人口调整之后，不平等现象在很大程度上仍然存在。在工人中，失业人员、蓝领或服务行业的风险较高。最后，男性和受教育程度较低的受访者的不平等程度高于女性和受教育程度较高的受访者。讨论：我们估计在特定原因死亡率方面存在相当大的阶级不平等，增加了将阶级关系与死亡率不平等和人口健康恶化联系起来的研究。

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引用次数: 0

Accountability as Self-Determination: Abolitionist conceptions of health, wellbeing, and safety 作为自决的责任：废除健康、幸福和安全的概念

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118970

Cameron W. Rasmussen , Mimi E. Kim

Carceral paradigms and practices of punishment are widely understood to have devastating consequences for individual and community health. In response, abolitionist practitioners, organizers, and scholars have conceptualized forms of non-punitive accountability as a remedy to harm and violence, primarily through the practices and politics of restorative and transformative justice. Despite clear evidence punishment harms health and wellbeing, virtually no research has explored if and how accountability-based approaches may impact health and wellbeing for people who have caused harm. This conceptual article examines and theorizes accountability as one basis of how abolitionist politics and practice function as an affirmative social determinant of health. We argue that non-punitive accountability – understood through the theoretical, political and practice frameworks of abolition, and restorative and transformative justice – has the potential to positively impact health and wellbeing. Specifically, we assert that accountability practices adopted by groups and communities grounded in abolitionist politics and guided by principles of agency and self-determination, and commitments to challenging both state and interpersonal violence, can act as affirmative social determinants of health. Abolitionist frameworks for considering health and wellbeing are explored followed by a critical analysis of how agency in restorative justice and self-determination in transformative justice function both theoretically and practically — not only as key distinctions between accountability and punishment, but as foundational elements for improved health and wellbeing. We then analyze existing practice-based research that suggests a positive correlation between accountability and health and conclude with implications for practice, discourse, and future research.

人们普遍认为，惩罚的形式和做法对个人和社区健康具有破坏性后果。作为回应，废除主义实践者、组织者和学者们将非惩罚性问责的形式概念化，作为对伤害和暴力的补救措施，主要是通过恢复性和变革性司法的实践和政治。尽管有明确的证据表明惩罚会损害健康和福祉，但几乎没有研究探讨基于问责制的方法是否以及如何影响造成伤害的人的健康和福祉。这篇概念性的文章将问责制作为废除主义政治和实践如何作为健康的积极社会决定因素发挥作用的一个基础进行研究和理论化。我们认为，非惩罚性问责制-通过废除和恢复性和变革性司法的理论，政治和实践框架来理解-有可能对健康和福祉产生积极影响。具体而言，我们断言，以废除主义政治为基础，以代理和自决原则为指导的团体和社区采取的问责制做法，以及挑战国家和人际暴力的承诺，可以作为健康的积极社会决定因素。探讨了考虑健康和福祉的废除主义框架，然后批判性地分析了恢复性司法中的机构和变革司法中的自决如何在理论和实践中发挥作用-不仅是问责和惩罚之间的关键区别，而且是改善健康和福祉的基本要素。然后，我们分析了现有的基于实践的研究，这些研究表明问责制与健康之间存在正相关关系，并总结了对实践、话语和未来研究的启示。

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引用次数: 0

Nature, gender, trauma: The role of nature in recovering from intimate partner violence 自然，性别，创伤：自然在从亲密伴侣暴力中恢复中的作用

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118992

Kimberley Kinder

Scholars in public health, urban planning, and social work embrace the notion that contact with nature promotes health and wellness, including in the context of trauma. This article analyzes the lived experiences of women recovering from Intimate Partner Violence (IPV) to explore two propositions: (a) contact with nature promotes trauma recovery for women and (b) access to nature as a healing aid is compromised by experiences of gender and trauma. Based on qualitative interviews with eighty IPV survivors, I found significant support for the first proposition: many participants experienced nature as an important source of support during the recovery process. However, I also found significant evidence for the second proposition: because access to nature is mediated by gender and violence, IPV creates negative feedback loops where the people most likely to experience IPV also have reduced access to nature as a wellness aid. Examining these gendered and trauma-related experiences reveals how power and inequity are woven into the natural environments often associated with healing.

公共卫生、城市规划和社会工作领域的学者都认为，与自然接触可以促进健康，包括在创伤的背景下。本文分析了从亲密伴侣暴力（IPV）中恢复的女性的生活经历，探讨了两个命题：(a)与自然的接触促进了女性的创伤恢复；(b)与自然的接触作为一种治疗手段，受到性别和创伤经历的损害。基于对80名IPV幸存者的定性访谈，我发现了对第一个命题的重要支持：许多参与者在恢复过程中将自然视为重要的支持来源。然而，我也发现了第二个命题的重要证据：因为接近自然是由性别和暴力介导的，IPV造成了负面反馈循环，在这种循环中，最有可能经历IPV的人也减少了接近自然作为健康援助的机会。研究这些性别和创伤相关的经历，揭示了权力和不平等是如何融入自然环境的，往往与愈合有关。

引用次数: 0

Empowerment or responsibilisation: Articulation work in English primary care coordination from the perspectives of patients and clinicians 授权或责任：从患者和临床医生的角度看英语初级保健协调的衔接工作。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.socscimed.2026.118986

Mhorag Goff , Patrick Burch , Jonathan Hammond , Kath Checkland , Sally Jacobs

In many well-developed primary care systems patients increasingly receive care from multiple clinicians within networks of providers rather than a single general practice clinician. This makes formal coordination between clinicians and providers necessary and requires informal ‘articulation work’ from both clinicians and patients to organise coordination of tasks across episodes of care. This is often hidden ‘behind the scenes’.

We used qualitative data from interviews with patients (n = 55) and healthcare professionals and other practice staff (n = 57) from two linked studies in English general practice. These studies investigated aspects of implications of the organisational shift to primary care networks. Using these datasets, we explored expectations about the articulation work involved in coordinating care.

We found differing experiences of primary care coordination and differing expectations about who bears responsibility for the articulation work involved. Patients tend to assume a cyclical care process in which care coordination continues between interactions with the practice, maintaining a care cycle. In contrast, contemporary primary care processes are structured to be ‘acute by default’, with patients responsible for re-initiating care after each care episode. Increasing responsibilisation of patients adds to their burden of treatment. Without the knowledge or capacities for such work patients may experience failures in care coordination. Better aligning expectations about responsibilities for articulation work requires explicit communication, sensitivity and flexibility in identifying patients who may find this difficult, facilitated by an ongoing patient-clinician relationship.

在许多发达的初级保健系统中，患者越来越多地接受来自提供者网络内的多名临床医生的护理，而不是单一的全科医生。这使得临床医生和提供者之间的正式协调成为必要，并且需要临床医生和患者进行非正式的“衔接工作”，以组织跨期护理任务的协调。这通常隐藏在“幕后”。我们使用了来自两项英国全科医学相关研究的患者（n = 55）、医疗保健专业人员和其他执业人员（n = 57）访谈的定性数据。这些研究调查了组织转移到初级保健网络的影响方面。使用这些数据集，我们探讨了对协调护理中涉及的发音工作的期望。我们发现不同的初级保健协调经验和不同的期望谁承担责任的衔接工作所涉及的。患者倾向于假设一个周期性的护理过程，在这个过程中，护理协调在与实践的相互作用之间继续进行，维持一个护理周期。相比之下，当代初级保健过程的结构是“默认急性”，患者负责在每次护理后重新开始护理。患者责任的增加增加了他们的治疗负担。没有这种工作的知识或能力，患者可能会经历护理协调失败。更好地协调对发音工作责任的期望需要明确的沟通、敏感性和灵活性，以识别可能发现这一困难的患者，并通过持续的医患关系加以促进。

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