Social Science & Medicine最新文献

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.

Gun violence is a leading cause of death among children and adolescents in the United States, and school shootings represent one of its most traumatic and visible manifestations. These events can generate severe and long-lasting consequences for children, but also extend beyond direct victims to affect entire communities. Yet responses to this public health crisis remain mired in political polarization: some advocate for stricter firearm regulations to limit opportunities for violence, while others promote expanded access in the name of deterrence. Meanwhile, limited prior empirical work has formally examined firearm legislation as a structural intervention capable of reducing school shooting risk. Integrating 20 years of data on K-12 school shootings (2000-2019) with that on state firearm legislation, we conduct a state-year panel analysis to examine how restrictive firearm laws (measured both as an aggregated restrictiveness index and partitioned by policy type) relate to the incidence of school shootings. Results show that the implementation of more restrictive gun laws is significantly associated with fewer school shootings, yetmeaningful heterogeneity emerges across policy types. Notably, none of the examined laws show evidence of increasing school shootings, contrary to deterrence claims. These findings align with prior literatures linking state firearm legislation and violence, and position firearm regulation as a potential structural intervention for preventing violence against children.

Ambulance service workplace demographic has become more feminized, therefore female-specific issues must be included in workforce planning, policies, and procedures. Ambulance personnel who menstruate, including women, trans, and non-binary paramedics who menstruate as well as undergraduate paramedicine students attending clinical placement, may face additional difficulties when managing their menstruation in the workplace. Research on menstrual health amongst individuals working in the ambulance service environment is limited, prompting this investigation into how those - ambulance service personnel or undergraduate paramedicine students - who menstruate, manage their menstrual cycle while performing workplace duties or completing clinical placements in the emergency ambulance [health] service workplace environment. To our knowledge, this is the first study to investigate, describe, and measure the impacts and experiences of people who menstruate while working for Australasian ambulance services. Participants in this study completed an anonymous online survey about their menstrual cycle and effects on their workplace performance. Results indicate those who menstruate whilst working in an ambulance environment are adversely impacted by their menstruation. This psychological safety, and health and wellbeing issue requires addressing both in research and workforce policy for the ambulance industry. The findings and discussion are informed by Foucauldian analyses of disciplinary power to illustrate how organizational practices regulate, normalize, and produce gendered bodies, determining the conditions under which they are either rendered invisible or made visible. As paramedicine continues to grow as a profession, and diversify, it is imperative that bodily difference is not treated as a private inconvenience but as a legitimate consideration of organizational responsibility. Addressing menstrual inequity is a matter of workplace gendered practices, dignity, wellbeing, justice, and basic human rights. The researchers recommend the ambulance industry/paramedic profession moves towards open discussions, education of the workforce, and the instigation of supportive workplace practices that have a positive impact on people who menstruate while working in the ambulance service environment.

Background: Socioeconomic disadvantage is recognized as a risk factor for cognitive decline, yet its associated neural pathways remain unclear. We investigated whether neighborhood disadvantage, measured by the Area Deprivation Index (ADI), was associated with cognitive performance in older adults and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD), and whether structural brain differences explained this relationship.

Methods: Participants included 822 older adults (478 cognitively unimpaired [CU], 271 with MCI, and 73 with AD). Associations between ADI, cognition, and brain structure were examined using regression models adjusting for age and sex. Mediation analyses tested whether total brain volume accounted for ADI-cognition relationships.

Results: Higher ADI was associated with poorer cognitive performance across all domains in CU individuals (National ADI: memory β = -0.008, p < 0.001; executive function β = -0.005, p < 0.001; language β = -0.005, p < 0.001; visuospatial β = -0.004, p < 0.001) and across multiple domains in MCI (memory β = -0.007, p = 0.002; executive β = -0.007, p < 0.001). ADI was also associated with smaller total cerebral, gray, and white matter volumes in CU (State ADI and gray matter β = -2.37, FDR-p = 0.006) and greater white matter hyperintensity burden (β = 0.152, FDR-p = 0.009). Associations were weaker in MCI and absent in AD. Mediation analyses showed that total brain volume significantly mediated the effect of ADI on language performance (ACME p = 0.024; proportion mediated = 19.7 %, p = 0.036).

Conclusions: Neighborhood disadvantage is linked to widespread cognitive vulnerability and structural brain differences. However, brain volume explains only a small portion of these associations, suggesting that environmental and contextual factors shape cognitive performance through pathways that extend beyond structural neurodegeneration.