Social Science & Medicine最新文献_第3页

“It should have been my decision”: A mixed methods investigation of contraceptive coercion among U.S. patients with and without disabilities “这应该是我的决定”：一项对美国残疾和非残疾患者强制避孕的混合方法调查。

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

Social Science & Medicine

Pub Date : 2026-02-03 DOI: 10.1016/j.socscimed.2026.119058

Lindsay M. Cannon , Tiffany L. Green , Meaghan E. Bethea , Laura E.T. Swan

Background

People with disabilities have long faced threats to their bodily autonomy and reproductive decision-making. One such threat, provider-based contraceptive coercion, occurs when healthcare providers pressure patients to use (upward coercion) or not use (downward coercion) birth control. Yet, modern experiences of contraceptive coercion among people with disabilities remain underexplored.

Methods

In 2023, we surveyed U.S. reproductive-aged people assigned female at birth using Prolific, a national panel of vetted respondents. Participants reported their disability status and contraceptive care experiences. We examined differences in contraceptive coercion by disability status and tested whether self-reported discrimination in contraceptive care mediated this relationship. We also used reflexive thematic analysis to explore contraceptive coercion among people with disabilities.

Results

In our analytic sample (N = 1150), people with disabilities were significantly more likely than those without to report ever experiencing any contraceptive coercion (49.4% vs. 38.9%), including upward coercion (40.1% vs. 31.1%) and downward coercion (23.3% vs. 13.2%). These disparities persisted after adjusting for sociodemographic controls. Self-reported discrimination in contraceptive care mediated the relationship between disability status and contraceptive coercion. Open-ended analysis revealed the complex ways that contraceptive coercion is intertwined with disability status, often involving discriminatory, dismissive, and contradictory contraceptive counseling.

Conclusions

Contraceptive coercion is more common among individuals with disabilities and is explained by self-reported discriminatory care. Understanding these experiences is key to resisting coercive practices and advancing disability-informed reproductive justice.

背景：长期以来，残疾人的身体自主权和生育决策一直面临威胁。其中一种威胁是基于提供者的避孕强制，当医疗保健提供者迫使患者使用（向上强迫）或不使用（向下强迫）节育措施时，就会发生这种威胁。然而，残疾人强制避孕的现代经验仍未得到充分探索。方法：2023年，我们对美国生育年龄的人进行了调查，他们在出生时被指定为女性，这是一个由经过审查的全国性调查小组。参与者报告了他们的残疾状况和避孕护理经历。我们研究了残疾状况对避孕强制的差异，并测试了自我报告的避孕护理歧视是否介导了这种关系。我们还使用反身性专题分析来探讨残疾人的避孕强制措施。结果：在我们的分析样本（N = 1150）中，残疾人比非残疾人更有可能报告曾经经历过任何避孕强迫（49.4%比38.9%），包括向上强迫（40.1%比31.1%）和向下强迫（23.3%比13.2%）。在调整了社会人口控制因素后，这些差异仍然存在。自我报告的避孕护理歧视在残疾状况与避孕强制之间的关系中起中介作用。开放式分析揭示了强制避孕与残疾状况交织在一起的复杂方式，往往涉及歧视性、不屑一顾和相互矛盾的避孕咨询。结论：强迫避孕在残疾人中更为常见，这可以用自我报告的歧视性护理来解释。了解这些经验是抵制强制性做法和推进残障知情生殖司法的关键。

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引用次数: 0

Perceived ideological polarization, trust in science and healthcare, and COVID-19 vaccination intention: A four-wave cross-lagged mediation panel analysis 意识形态极化感知、对科学和医疗保健的信任与COVID-19疫苗接种意图：四波交叉滞后中介面板分析

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

Social Science & Medicine

Pub Date : 2026-02-03 DOI: 10.1016/j.socscimed.2026.119057

Andrej Kirbiš, Stefani Branilović

Ideological polarization is often theorized to erode trust in science and healthcare, thereby reducing compliance with health guidelines and vaccine uptake. In this study, we examined the longitudinal relationships between perceived ideological polarization, trust in science and healthcare, and COVID-19 vaccination intention, using a four-wave panel design. We analysed four waves of panel data from a sample of 488 Slovenians, representative by gender, age, and education. Pearson correlations and a random intercept cross-lagged panel model (RI-CLPM) were used to assess both within- and between-person associations, and to test whether trust in science and healthcare mediated the relationship between perceived ideological polarization and vaccination intention over time. Baseline correlations showed a positive association between perceived ideological polarization, trust, and vaccination intention, though these associations weakened and became non-significant in later waves. RI-CLPM results revealed no evidence of causal, within-person effects of perceived ideological polarization on later trust or vaccination intention, and no longitudinal mediation pathways. However, between-person effects indicated that individuals with consistently higher trust in science and healthcare reported higher vaccination intentions across time. These findings challenge the assumption that ideological polarization undermines trust and vaccination intention, suggesting that cross-sectional associations observed in prior research may reflect stable between-person differences rather than dynamic causal processes. By distinguishing cross-sectional from longitudinal evidence, this study underscores institutional trust as the key predictor of vaccination intention and calls for comparative research across political and cultural contexts.

意识形态的两极分化经常被理论化，以削弱对科学和医疗保健的信任，从而减少对健康指南的遵守和疫苗的吸收。在这项研究中，我们使用四波面板设计，研究了感知到的意识形态两极分化、对科学和医疗保健的信任以及COVID-19疫苗接种意图之间的纵向关系。我们分析了来自488名斯洛文尼亚人样本的四波面板数据，这些数据按性别、年龄和教育程度具有代表性。使用Pearson相关性和随机截距交叉滞后面板模型（RI-CLPM）来评估人与人之间和人与人之间的关联，并测试对科学和医疗保健的信任是否会随着时间的推移介导感知的意识形态极化和接种意愿之间的关系。基线相关性显示，感知到的意识形态极化、信任和疫苗接种意图之间存在正相关，尽管这些关联在后来的浪潮中减弱并变得不显著。RI-CLPM结果显示，没有证据表明意识形态两极分化对后来的信任或疫苗接种意图有因果关系，也没有纵向中介途径。然而，人与人之间的影响表明，对科学和医疗保健的信任度一贯较高的个体报告了更高的疫苗接种意愿。这些发现挑战了意识形态两极分化破坏信任和疫苗接种意图的假设，表明在先前的研究中观察到的横断面关联可能反映了稳定的人与人之间的差异，而不是动态的因果过程。通过区分横截面证据和纵向证据，本研究强调了机构信任是疫苗接种意图的关键预测因素，并呼吁进行跨政治和文化背景的比较研究。

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引用次数: 0

Sauna culture improves physical and mental wellbeing in the UK through social connection and ritual 桑拿文化通过社会联系和仪式改善了英国人的身心健康。

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

Social Science & Medicine

Pub Date : 2026-02-03 DOI: 10.1016/j.socscimed.2026.119061

M. Newson , R. McGrath , I. Mosina , G. Reason , L. Peitz

Sauna culture is experiencing rapid global growth, yet beyond physical health benefits, remains largely understudied within academic research. We investigate both its physical and mental health benefits in the UK using the Social Cure model in conjunction with a ritual lens to understand how feelings of connection grow via sauna. Across three studies (N = 1,907), we explored the role of social identities in shaping wellbeing outcomes among sauna users. Studies 1 and 3 employed longitudinal designs, revealing increases in emotional wellbeing over time, while Study 2 used a cross-sectional approach and showed that stronger sauna identities were associated with self-reported improvements in both physical and emotional wellbeing. Study 3 further demonstrated that perceiving sauna use as a ritual, alongside experiencing emotional synchrony during sauna sessions, was positively linked to stronger sauna identities. Together, these findings suggest that the social and ritual aspects of sauna use may contribute to its wellbeing effects, with potential implications for sauna operators in the UK and beyond.

桑拿文化正在全球迅速发展，但除了对身体健康的好处之外，学术研究在很大程度上仍未得到充分研究。我们在英国使用社会治疗模型结合仪式镜头调查了桑拿对身体和心理健康的好处，以了解通过桑拿建立联系的感觉是如何增长的。通过三项研究（N = 1907），我们探讨了社会身份在塑造桑拿使用者健康结果中的作用。研究1和研究3采用纵向设计，揭示了情绪幸福感随着时间的推移而增加，而研究2采用横断面方法，表明更强的桑拿身份与自我报告的身体和情绪幸福感的改善有关。研究3进一步表明，将桑拿视为一种仪式，同时在桑拿过程中体验情感同步，与更强的桑拿身份正相关。总之，这些发现表明，使用桑拿的社交和仪式方面可能有助于其健康影响，这对英国及其他地区的桑拿运营商有潜在的影响。

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引用次数: 0

The gendered landscape of informal caregiving: Cohort effects and socioeconomic inequalities in England 非正式看护的性别景观：英格兰的群体效应和社会经济不平等。

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

Social Science & Medicine

Pub Date : 2026-02-02 DOI: 10.1016/j.socscimed.2026.119052

Maria Petrillo , Ricardo Rodrigues , Matt Bennett , Gwilym Pryce

We provide the first detailed cohort analysis of the gender care gap that examines the association between caregiving provision, individual-level poverty, meso-level deprivation, and individual circumstances. Using data from the UK Household Longitudinal Study, we use (i) multilevel mixed-effects logistic regression to provide a detailed age cohort analysis of the probability of providing informal care by sex; and (ii) Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to provide an intersectional examination of informal carers.

Our results reveal a clear age pattern in caregiving, peaking between ages 60–70 before declining, with earlier-born cohorts showing higher caregiving likelihood at the same ages than later-born cohorts. The gender care gap is most pronounced among middle-born cohorts (1969–1978, 1959–1968, and 1949–1958), particularly between ages 50 and 60. While overall caregiving prevalence is higher among individuals experiencing poverty and living in deprived areas, the gender care gap is larger among individuals above the poverty line and in non-deprived areas. Caregiving is primarily associated with the independent effects of cohort, gender, poverty, and meso-level deprivation, with limited evidence of multiplicative intersectional effects.

Policy attempts to address the gender care gap need to be mindful of these variations, not least because they potentially elucidate the potential sources of gender inequalities in care.

我们首次对性别护理差距进行了详细的队列分析，研究了护理提供、个人贫困、中水平剥夺和个人环境之间的关系。使用来自英国家庭纵向研究的数据，我们使用(i)多层次混合效应逻辑回归提供了详细的年龄队列分析，按性别提供非正式护理的概率；（ii）个体异质性和歧视性准确性的多水平分析（MAIHDA），以提供非正式照顾者的交叉检查。我们的研究结果揭示了一个明确的年龄模式，在60-70岁之间达到高峰，然后下降，早出生的队列在同一年龄比晚出生的队列显示出更高的照顾可能性。性别护理差距在中间出生的队列（1969-1978年、1959-1968年和1949-1958年）中最为明显，特别是在50 - 60岁之间。虽然贫困和生活在贫困地区的个人总体护理普及率较高，但在贫困线以上和非贫困地区的个人中，性别护理差距更大。看护主要与队列、性别、贫困和中观水平剥夺的独立影响有关，有限的证据表明多重交叉效应。解决性别护理差距的政策尝试需要注意这些差异，尤其是因为它们可能阐明护理中性别不平等的潜在根源。

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引用次数: 0

Spatially heterogeneous and neighborhood impacts of deep tubewells on childhood diarrhea in rural Bangladesh 孟加拉国农村深管井对儿童腹泻的空间异质性和邻里影响

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

Social Science & Medicine

Pub Date : 2026-02-02 DOI: 10.1016/j.socscimed.2026.119043

Varun Goel , Mark M. Janko , Katerina EB. Beach , Md Yunus , Md Taslim Ali , Md Al Fazal Khan , Md Nurul Alam , A.S.G. Faruque , Paul L. Delamater , Marc L. Serre , Mark D. Sobsey , Md Sirajul Islam , Michael Emch

Deep tubewells that procure groundwater from deep arsenic-free aquifers are crucial sources of safe drinking-water in rural Bangladesh. However, their health benefits may be heterogeneous and context dependent: inequitable distribution, long collection distances and continued use of unsafe alternatives may increase microbial contamination and diarrheal disease. We examined whether the association between household deep tubewell use and under-five diarrhea varies across space and how neighborhood context helps explain this variation. Prospective diarrhea surveillance was conducted across 19,203 households with under-five children in Matlab, Bangladesh from March 2018 to October 2019. We fitted hierarchical logistic regression models accounting for spatially varying relationships and neighborhood-level measures of deep tubewell use. In non-spatial models, household deep tubewell use is associated with lower childhood diarrhea (Odds Ratio (OR) 0.81, 95% Uncertainty Interval (UI) 0.68–0.96). Accounting for space suggests spatial confounding and that the effect of household deep tubewell use on diarrhea may change based on location. Additionally, there is evidence of neighborhood effects: households in areas where more than 60% of neighbors used deep tubewells had lower odds of childhood diarrhea than those in neighborhoods with lower deep tubewell use (OR 0.72, 95% UI 0.57–0.92), with strongest protection among households that used deep tubewells. Results suggest that despite positive effects, benefits of deep tubewells are unequally distributed, and increasing deep tubewell density can further reduce childhood diarrheal disease burden in rural Bangladesh. This study highlights the importance of incorporating geographic context in the design and evaluation of drinking-water and other population health interventions.

从深层无砷含水层获取地下水的深管井是孟加拉国农村安全饮用水的重要来源。然而，它们对健康的益处可能是不同的，并取决于具体情况：分配不公平、收集距离长以及继续使用不安全的替代品可能会增加微生物污染和腹泻病。我们研究了家庭深管井使用与五岁以下儿童腹泻之间的关系是否因空间而异，以及社区环境如何帮助解释这种差异。2018年3月至2019年10月，在孟加拉国Matlab对19,203个5岁以下儿童家庭进行了前瞻性腹泻监测。我们拟合了层次逻辑回归模型，考虑了空间变化关系和深管井使用的邻里水平措施。在非空间模型中，家庭深管井使用与儿童腹泻发生率降低相关（优势比（OR） 0.81, 95%不确定区间（UI） 0.68-0.96）。考虑到空间因素，表明空间混淆，家庭深管井对腹泻的影响可能因地点而异。此外，还有邻里效应的证据：超过60%的邻居使用深管井的地区的家庭比使用深管井较少的社区的家庭患儿童腹泻的几率更低（OR 0.72, 95% UI 0.57-0.92），使用深管井的家庭的保护最强。结果表明，尽管深管井具有积极作用，但效益分布不均，增加深管井密度可以进一步减轻孟加拉国农村儿童腹泻疾病负担。这项研究强调了在饮用水和其他人口健康干预措施的设计和评价中纳入地理环境的重要性。

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引用次数: 0

Shift work and risk of chronic kidney disease: A systematic review and meta-analysis 轮班工作和慢性肾脏疾病的风险：一项系统回顾和荟萃分析。

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

Social Science & Medicine

Pub Date : 2026-02-02 DOI: 10.1016/j.socscimed.2026.119055

Jiyoun Jung , Cheol Whee Park , Dong-Wook Lee , Seong-Sik Cho , Seilin Uhm , Jongin Lee , Mo-Yeol Kang

Objectives

This systematic review and meta-analysis is aimed to critically evaluate and quantify the association between shift work and chronic kidney disease (CKD).

Methods

We searched PubMed, Embase, and Web of Science through May 2025 for observational studies examining shift work—including night or rotating shifts—and CKD outcomes among adults. Eligible outcomes included reduced estimated glomerular filtration rate (eGFR), proteinuria, or albuminuria. Study quality was assessed using the Newcastle–Ottawa Scale, and meta-analyses were performed where feasible.

Results

Twelve studies were included in this systematic review. Most studies defined CKD as eGFR below 60 mL/min/1.73 m² or presence of albuminuria, although outcome definitions varied. Meta-analysis of 6 studies found that shift workers had significantly higher odds of CKD (pooled odds ratio: 1.43; 95% CI: 1.06–1.92) compared to non-shift workers. Risk of bias was moderate to low across studies. Heterogeneity was modest, and no significant publication bias was detected.

Conclusions

Shift work is associated with a modestly increased risk of CKD. Circadian disruption and related metabolic disturbances may underlie this relationship. Given the widespread prevalence of shift work and the global burden of CKD, these findings support the need for targeted occupational health surveillance and preventive strategies for shift-working populations.

目的：本系统综述和荟萃分析旨在批判性地评估和量化轮班工作与慢性肾脏疾病（CKD）之间的关系。方法：我们检索了PubMed， Embase和Web of Science到2025年5月的观察性研究，研究轮班工作（包括夜班或轮班）和成人CKD结局。符合条件的结果包括肾小球滤过率（eGFR）、蛋白尿或蛋白尿降低。使用纽卡斯尔-渥太华量表评估研究质量，并在可行的情况下进行荟萃分析。结果：本系统综述纳入了12项研究。大多数研究将CKD定义为eGFR低于60 mL/min/1.73 m2或存在蛋白尿，尽管结果定义各不相同。6项研究的荟萃分析发现，与非轮班工人相比，轮班工人患慢性肾病的几率明显更高（合并优势比：1.43;95% CI: 1.06-1.92）。所有研究的偏倚风险为中到低。异质性不大，未发现显著的发表偏倚。结论：轮班工作与CKD风险适度增加有关。昼夜节律紊乱和相关的代谢紊乱可能是这种关系的基础。鉴于轮班工作的普遍存在和CKD的全球负担，这些发现支持了对轮班工作人群进行有针对性的职业健康监测和预防策略的必要性。

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引用次数: 0

An intersectional approach to understanding systolic blood pressure distribution in a large French study: a MAIHDA analysis 在一项大型法国研究中，了解收缩压分布的交叉方法：MAIHDA分析。

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

Social Science & Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.socscimed.2026.119054

Léna Silberzan , Fé·e Santos , Ainhoa Ugarteche-Perez , Emmanuel Wiernik , Nathalie Bajos , Michelle Kelly-Irving

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.

收缩压（SBP）是一种广泛使用的生物标志物，已被证明与年龄、性别和社会经济地位有关，但很少有研究调查这些因素如何共同导致不同的收缩压风险。这项研究从交叉的角度同时考虑了性别、年龄、教育以及种族/民族——这是法国健康研究中很少调查的一个维度——带来了新的见解。使用来自法国普通人群constance队列（2012-2021）的数据，我们应用交叉性理论和个体异质性和歧视准确性的多层次分析（MAIHDA）来检查150,739名成年人的收缩压水平，这些成年人没有接受降血压治疗，嵌套在126个交叉性地层中。我们的模型显示，不同地层的收缩压存在很大的异质性，主要受年龄和性别加性主效应的驱动。年龄较大、男性、受教育程度较低、撒哈拉以南非洲（SSA）和海外法国（DROMs）组与SBP升高有关。正规教育年数较少的SSA和DROMs个体在每个性别年龄组合中始终表现出最高的SBP值。虽然年龄解释了阶层间差异的主要原因，但25-39岁的SSA和受正规教育年限较短的DROMs比40-59岁的其他种族背景的个体显示出更高的收缩压水平，这表明这些阶层的收缩压水平过早升高。我们的研究结果表明，SBP根据社会结构经验而变化，对边缘社会群体不利。他们强调需要对更广泛的生物标志物进行更多基于交叉性的研究，并主张在卫生不平等研究中更系统地将种族主义作为压迫的主要轴心纳入其中。

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引用次数: 0

Family care reflections and expectations among 2nd generation Turkish immigrants in Norway: A qualitative study 挪威第二代土耳其移民的家庭照顾反思与期望：一项质性研究。

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

Social Science & Medicine

Pub Date : 2026-01-31 DOI: 10.1016/j.socscimed.2026.119046

Büşra Nur Temür , Nilgün Aksoy , Lillian Karlsen , Anne-Sofie Helvik

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.

越来越多的老年移民出现在欧洲社会，这使得人们对他们和他们的家庭如何经历和管理老年护理越来越感兴趣。本研究旨在探讨在挪威的第二代土耳其移民对家庭照顾的反思和期望模式。本研究采用质性设计。样本包括18名居住在挪威的土耳其裔第20代人。所有参与者都住在挪威中部的同一个城市及其周围。数据是通过在2024年11月至2025年1月期间进行的个人面对面访谈收集的。使用反身性主题分析对文本进行了检查。确定了四个主题。1)文化背景和照顾：传统的土耳其规范；2)代际照顾期望：改变规范和价值观；3)同一屋檐下的家庭照顾：愿望和现实；4)协商家庭照顾责任。这些研究结果表明，第二代土耳其移民之间的文化规范和护理、代际护理期望和家庭护理实践是动态协商的。研究结果表明，尽管照顾责任主要是基于爱和道德义务，但经济、空间和情感方面的挑战使这一过程变得更加复杂。

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引用次数: 0

Why do inpatients bypass secondary hospitals? A discrete choice analysis of reputation, specialty matching, and travel time in China's hierarchical healthcare system 住院病人为什么不去二级医院？中国分级医疗体系中声誉、专业匹配和出行时间的离散选择分析。

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

Social Science & Medicine

Pub Date : 2026-01-31 DOI: 10.1016/j.socscimed.2026.119051

Jiarui Han , Liping Fu , Wenhao Hu , Yingyi Zhang , Kunmeng Li

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.

尽管有针对性的政策干预，中国分级医疗体系中的患者仍然坚持选择三级医院而不是二级医院进行住院治疗。利用参与中国和平百万人项目的中国主要城市住院数据的离散选择模型，我们基于2016年至2023年收集的记录，最终样本为1894例，检查了住院患者的住院选择权衡。我们的分析明确区分了机构声誉与特定疾病的专业知识，并调查了这些权衡在急诊和非急诊入院之间的差异。结果表明，患者明确优先考虑专科匹配而不是机构声誉，特别是在急诊入院和严重心脑血管疾病患者中。出行意愿（WTT）计算表明，患者愿意接受平均14.8分钟的额外出行时间，以获得更好的专业定位。此外，我们的分析确定了显著的偏好异质性，揭示了个体社会经济特征和医院属性之间相互作用产生的系统性差异。分解分析阐明了二级医院的关键结构劣势，主要源于专业对齐不足和住院时间过长。这些发现强调了解决供给侧约束和需求侧分类的改革必要性，方法是加强二级医院在特定疾病方面的作用，将其整合到医疗联盟中，并将报销规则与临床适当性和转诊途径联系起来。

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引用次数: 0

Enacting assemblages of care: How young adults seek support for suicidal ideation 制定护理组合：年轻人如何寻求自杀意念的支持。

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

Social Science & Medicine

Pub Date : 2026-01-31 DOI: 10.1016/j.socscimed.2026.119001

Kate LaForge

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.

年轻人自杀意念（SI）、企图自杀和死亡的比例仍然很高。年轻人在日常生活中如何寻求帮助仍未得到充分的理论解释。为了填补这一空白，本研究从组合理论中探索年轻人如何寻求SI帮助。我从2024年1月到7月对39名年轻的美国成年人进行了一对一的访谈，利用组合理论来提供一种关系理解，在与自杀相关的寻求帮助的背景下，不同的元素如何聚集在一起来构建关怀。在前两节中，我考察了两种现象——亲密感和空间性——它们偶然地发挥作用，流经不同规模的集合，激发行动过程，并产生特定的情感体验和关系。在最后一节中，我探讨了这些关系如何成为我称之为“协调披露”的实践的主要参与者，在这种实践中，给定特定组合元素（如风险逻辑和技术支持）的临时安排，年轻人校准SI披露以达到他们所需的护理水平。这种观点有助于理解与自杀相关的寻求帮助，而不是将其视为一系列行为，而是将其视为不同实体（包括服务、影响、逻辑和个人）之间的关系形成和解除的一个领域。从这个角度来看，帮助不是寻求，而是付诸实施。这一重点表明，为了加强对患有SI的年轻人的服务，服务提供者和更广泛的服务系统可能会受益于将寻求帮助的做法视为临时的、紧急的、高度情境化的、来自微妙的印象和影响的、易受快速重新安排影响的行为。

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引用次数: 0