Social Science & Medicine最新文献

Inequities in systolic blood pressure (SBP), a widely used biomarker, have been shown to be patterned by age, sex, and socioeconomic position, but few studies have investigated how they combine to result in differential SBP risk. This study brings new insights by simultaneously considering sex, age, education, as well as race/ethnicity - a dimension seldom investigated in French health studies- in an intersectional perspective. Using data from the CONSTANCES cohort (2012-2021) in the French general population, we applied intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine SBP levels among 150,739 adults, not under BP lowering treatment, nested within 126 intersectional strata. Our models revealed substantial heterogeneity in SBP across strata, mainly driven by age and sex additive main effects. Older age, male sex, lower education, and Subsaharan African (SSA) and Overseas France (DROMs) groups were associated with increased SBP. SSA and DROMs individuals with fewer years of formal education consistently exhibited among the highest SBP values within each sex-age combination. Although age explained most of the between-strata variance, 25-39-year-old SSA and DROMs with fewer years of formal education displayed higher SBP levels than some 40-59-year-old individuals from other ethnoracial backgrounds, suggesting a premature increase of SBP levels for these strata. Our results show that SBP varies according to socially structured experiences, to the disadvantage of marginalized social groups. They emphasize the need for more intersectionality-grounded research on a wider range of biomarkers, and advocate for a more systematic inclusion of racism as a major axis of oppression in health inequities studies.

The increasing presence of older immigrants in European societies has led to growing interest in how they and their families experience and manage care in ageing. This study aimed to explore the pattern of reflections and expectations of 2^nd generation Turkish immigrants in Norway regarding family care. Qualitative design was employed in this study. The sample consisted of 18 2^ndgeneration individuals of Turkish origin living in Norway. All participants lived in and around the same city in the middle part of Norway. Data was collected through individual face-to-face interviews conducted between November 2024 and January 2025. The transcripts were examined using reflexive thematic analysis. Four main themes were identified. 1) Cultural Background and Caregiving: Traditional Turkish Norms, 2) Intergenerational Care Expectations: Shifting Norms and Values, 3) Family Care Under the Same Roof: Wishes and Realities, and 4) Negotiating Family Care Responsibility. These findings demonstrate that cultural norms and caregiving, intergenerational care expectations, and family care practices are dynamically negotiated among 2^nd generation Turkish immigrants. The findings indicate that while caregiving responsibilities are primarily framed in terms of love and moral obligation, economic, spatial, and emotional challenges significantly complicate this process.

Despite targeted policy interventions, patients within China's hierarchical healthcare system persistently opt for tertiary hospitals over secondary hospitals for inpatient care. Utilizing discrete choice modeling of hospitalization data from a major Chinese city participating in the China PEACE Million Persons Project, we examine inpatient hospital choice trade-offs based on records collected between 2016 and 2023 with a final sample of 1,894 cases. Our analysis explicitly distinguishes institutional prestige from disease-specific expertise and investigates how these trade-offs differ between emergency and non-emergency admissions. Results demonstrate that patients unequivocally prioritize specialty matching over institutional reputation, especially during emergency admissions and among patients with severe cardio-cerebrovascular conditions. Willingness-to-travel (WTT) calculations indicate patients are willing to accept, on average, 14.8 extra minutes of travel time for superior specialty alignment. Furthermore, our analysis identifies significant preference heterogeneity, revealing systematic disparities emerging from interactions between individual socioeconomic characteristics and hospital attributes. Decomposition analysis elucidates critical structural disadvantages of secondary hospitals, primarily stemming from inadequate specialty alignment and prolonged inpatient stays. These findings underscore the need for reforms that address both supply-side constraints and demand-side sorting, by strengthening secondary hospitals' disease-specific roles, integrating them into medical alliances, and linking reimbursement rules to clinical appropriateness and referral pathways.

Gambling is associated with both enjoyment and harm, yet conventional prevalence measures may understate its wider consequences. Subjective wellbeing data offer a broader lens for understanding how gambling relates to individual welfare. Using nationally representative data from the Health Survey for England, we analyse wellbeing across the gambling risk spectrum. Individuals classified as problem gamblers report markedly lower wellbeing than non-gamblers, with a deficit around twice as large as the gap associated with unemployment, conditional on other life circumstances. Wellbeing is also lower among those at lower risk levels, particularly among women, indicating that gambling-related harm extends beyond the small minority formally identified as problem gamblers, consistent with public health frameworks that treat harm as a continuum. By contrast, gambling without problematic indicators is associated with modestly higher wellbeing than abstinence, reflecting the heterogeneity of experiences. These associations are consistent over time and across multiple wellbeing domains, with the exception of optimism. Taken together, the findings highlight the importance of considering a broader group when assessing gambling-related harm, while also calling for proportionate policy responses that address harms without overlooking that many gamblers experience no deficit.

Young adults continue to suffer from high rates of suicidal ideation (SI), attempts, and deaths. How young adults enact help-seeking in their daily lives remains undertheorized. To fill this gap, this study draws from assemblage theory to explore how young adults seek help for SI. Utilizing one-on-one interviews with 39 young American adults conducted from January to July 2024, I draw from assemblage theory to offer a relational understanding of how, in the context of suicide-related help-seeking, diverse elements gather together to construct care. In the first two sections, I examine two phenomena-intimacy and spatiality-that function contingently, flowing through variably scaled assemblages, motivating courses of action, and producing particular affective experiences and relations. In the final section, I explore how these relations prime participants for a practice I call attuned disclosure, in which, given temporary arrangements of particular assemblage elements such as risk logics and technological affordances, young adults calibrate SI disclosure to achieve their desired level of care. This perspective facilitates understanding suicide-related help-seeking not as a set of behaviors but rather as a terrain on which relations between diverse entities, including services, affects, logics, and individuals, are forged and disbanded. In this perspective, help is not sought, but rather, enacted. This focus suggests that, to enhance services for young adults with SI, service providers and broader service systems may benefit from considering help-seeking practices as temporary, emergent, and highly contextual, flowing from subtle impressions and affects, and susceptible to rapid rearrangements.

Background: In the evaluation of complex interventions, economic evaluations aim to determine the relative cost-effectiveness of interventions but generate little explanation of how or why contexts and underlying causal mechanisms impact this. Conversely, realist approaches aim to explain 'what works, for whom, in which circumstances and why' but rarely capture the economic costs and consequences of interventions. As a result, many evaluations remain partial.

Objective: To identify past attempts to integrate realist and economic evaluation approaches and summarise the recent developments in realist and economic evaluation approaches in the evaluation of complex health and social care interventions.

Methods: We conducted a series of scoping reviews using online academic databases, personal libraries and expert stakeholder workshops, to identify the theoretical, methodological, and practical challenges and developments in bringing together realist and economic evaluation approaches.

Findings and recommendations: Although increasing, there remain relatively few examples of evaluations that have attempted to integrate realist and economic evaluation approaches, and challenges for their integration mean that further guidance is required. The wider literature indicated challenges in the theoretical (e.g. ontology, causality), methodological (e.g. accounting for context, study design, mixing methods) and practical (e.g. terminology, scale and scope) domains, for which we have developed recommendations.

Conclusion: To deliver services that are both effective and efficient, evaluations must synthesise relevant explanatory evidence with cost and outcome data to enable policymakers and commissioners to make informed decisions. Findings and recommendations from this review were used to inform the development of guidance for the integration of realist and economic evaluation approaches.

Losing a marital partner to death is a stressful life event with adverse health effects, including excess mortality risk. Previous research has focused on examining the widowhood effect within mixed-sex unions. Despite the increasing number of same-sex unions, gender composition within a union has not been considered when investigating the widowhood effect. Utilizing Danish Register Data from 1989 to 2022, this study investigates disparities in mortality risk following partner loss among surviving same-sex and mixed-sex partners. Within three years after widowhood, surviving same-sex partners may have a higher risk of dying than mixed-sex partners, although its statistical significance depends on comparison group. After three years, the mortality disadvantage for surviving same-sex over mixed-sex partners ends or reverses. The results suggest that, in the short term, the health implications of widowhood may be more profound for individuals who were in a same-sex union. Additional minority stress experienced during widowhood, a lack of social support, and higher health concordance among same-sex partners may contribute to increased vulnerability and, consequently, elevated mortality risk. Relationship dynamics within same-sex unions may also prepare surviving same-sex partners to eventually adapt to the new life situation the loss entails.

Subhealth () refers to a liminal state between health and disease that, while lacking clear biomedical markers, has become a prominent target of intervention in China's healthcare landscape. This study examines the socio-political construction of subhealth by integrating bibliometric analysis with historical and political-economic perspectives. Drawing on a dataset of nearly 20,000 Chinese-language publications (1995-2022), complemented by discourse analysis of policy documents and academic literature, we analyze three interrelated dimensions: (1) the commercial and economic dynamics that enabled the proliferation of subhealth-related industries and wellness markets; (2) the scientization of Traditional Chinese Medicine (TCM), which legitimized subhealth through diagnostic standardization and biomedical frameworks; and (3) the institutional support by the Chinese state, which incorporated subhealth into public health campaigns and national development goals. By examining these dimensions together, we argue that subhealth has emerged as a hybrid construct shaped by the convergence of market incentives, scientific discourse, and state strategies. This case offers new insight into how medical categories are socially engineered and mobilized within a unique configuration of post-socialist governance and health reform.

Epistemic injustice, the unfair treatment of individuals in their capacity as knowers, has implications for the credibility, autonomy, and well-being of healthcare professionals. This scoping review addressed the following question: "What is known about epistemic injustice in healthcare professional practice as it relates to the experience of practitioners?". Guided by Arksey & O'Malley's methodology (2005), we searched eight databases for English and French language publications from 2007 to 2024. Of the 4186 records retrieved, 30 papers met the inclusion criteria. Fifteen papers originated in North America, with twenty-seven published between 2020 and 2024. Epistemic injustice was predominantly conceptualized through Miranda Fricker's constructs of testimonial and hermeneutical injustice, with numerous studies building on or extending Fricker's conceptualizations, and introducing other theorists and evolving concepts. The papers used qualitative research methodologies and theoretical analysis/commentary approaches; none used quantitative or mixed methods designs. Five themes related to epistemic injustice in healthcare professional practice were identified: (1) hierarchy of epistemic credibility, (2) epistemic politics, (3) constrained agency of healthcare practitioners, (4) pressures to modify professional self or identity, and (5) complex interplay of intersectional and social identities. A sixth cross-cutting theme highlighted (6) approaches aimed at mitigating epistemic injustice. The findings highlight the contextual, complex, and often obscure nature of epistemic injustice in the knowledge sharing practices of healthcare professionals. The review underscores the need for a more nuanced and justice-oriented conceptualization of these dynamics, greater visibility of their impact in everyday practice, and structural and educational reforms to foster more equitable knowledge sharing environments.

Health universalists believe that preference-based measure (PBM) instruments can be applied across cultures because they share similar health concepts in the world. This is the prevailing policy in PBM development. However, health pluralists refute this idea, as they argue that the concept and components of health differ depending on culture. To incorporate the pluralist view, we developed the Asian Preference-Based Measure-7 Dimensions (AP-7D), a "culture-specific" PBM for Asian countries. This survey aimed to address cultural differences in utility measurement by developing an AP-7D value set in Japan, as part of a series of AP-7D developments. This study used a web-based survey to evaluate AP-7D health states with a triplet discrete choice experiment (DCE). The design followed an established international protocol. We conducted the web-based survey and data collection in October 2024. Respondents aged 20-79 were recruited via quota sampling based on sex and age. A total of 2681 individuals were included in the DCE analysis. We applied a mixed logit model to the DCE data and obtained decrements for each level in each domain. The worst health state had an AP-7D value of -0.448. Pain/discomfort, mobility, and burden to others were the most influential items on AP-7D values. Only one non-monotonicity were observed. Our survey successfully created the first AP-7D culture-specific PBM value set, and we can convert responses to AP-7D value for QALY calculation. We believe that our pluralistic approach is a novel and important attempt to reconsider health universalism and inform the future development of PBMs.