Social Science & Medicine最新文献

Restrictive school phone policies are expected to positively influence adolescent in-school phone use and improve pupil wellbeing. However, there is a lack of research that explains how school phone policies impact on phone use and wellbeing. This qualitative comparative case study aimed to provide such explanatory data. Data were collected from 40 focus group interviews in 7 case study secondary schools in England (4 with permissive phone policies; 3 with restrictive phone policies), with 177 pupil, parent and school staff participants. Data were analysed using thematic analysis. Data show that both restrictive and permissive phone polices have positive and negative impacts on pupil wellbeing. School policies influenced aspects of wellbeing related to health, connectedness, learning, agency and resilience, and the development of safe and supportive environments. Impacts of policies on wellbeing were further shaped by contextual factors. This study presents a conceptual model to inform future research, policy, and practice concerning the ways in which phones-and school phone policies-may shape adolescent wellbeing. The findings underscore that interventions targeting phone use should be integrated within broader, holistic approaches to supporting adolescent wellbeing that operate across both school and out-of-school environments.

While prior research has documented associations between neighborhood conditions and physiological markers of aging, the relationship between neighborhood conditions and cellular aging remains underexplored. We quantified the association between neighborhood opportunity and expression of cellular senescence markers among 1,215 biomarker participants in the Midlife in the United States study. Neighborhood opportunity was assessed using the Childhood Opportunity Index 3.0 (Overall, Education, Health and Environment, Social and Economic Resources). Four transcriptomic markers of cellular senescence were examined from peripheral blood mononuclear cells: CDKN2A RNA abundance, DNA Damage Response (DDR30) composite score, and two Senescence-Associated Secretory Phenotype (SASP10, SASP57) composite scores. After covariate adjustment, individuals living in low-opportunity neighborhoods had significantly elevated CDKN2A RNA abundance (β = 0.32, 95% CI: 0.04, 0.59, p = 0.024) compared to those in high-opportunity neighborhoods. Secondary analysis suggested that this association was potentially driven by low Social and Economic Resources (β = 0.35, 95% CI: 0.07, 0.63, p = 0.013), rather than by Education or Health and Environment domains. No statistically significant relationships were observed for neighborhood opportunity with DDR30, SASP10, and SASP57. These findings provide molecular evidence that low neighborhood opportunity may be biologically embedded at the cellular level. The specificity of associations to social and economic resources and to upstream senescence regulation suggests that neighborhood associations with aging may operate through distinct biological pathways. Future longitudinal studies are needed to establish temporality and explore potential mechanisms linking neighborhood conditions to senescence.

We analyze the ways in which people with ostomies experience care from varying scales of expertise in the medical system: medical doctors, nurses, and the patients themselves. Through in-depth interviews with people with ostomies, we reveal that medical doctors often frame the ostomy as a last resort. In contrast, we find that specialized care nurses, or Wound, Ostomy, and Continence Nurses (WOCN), engaged with a different kind of grounded expertise that uplifted and prepared people with ostomies to feel empowered to handle their ongoing care. In addition to medical and nursing constructions of the body, people with ostomies have a particular experience of caring for the self that engages with the knowledge and language they receive from doctors and nurses. We unpack how that medical and surgical knowledge, nursing knowledge, and a knowledge of the self are all impacted by the language and expertise in this system of medical care. We explore the concept of ostomy work: the ongoing, often invisible, embodied process of normalizing ostomies in daily life through carefully curated expertise and practice. We conclude with a discussion of the importance of specialized care nurses (WOCN) to empower people with ostomies to find a sense of normalcy and control in their ongoing ostomy care.

The quality of institutions is widely recognized as a key determinant of public sector performance across various levels of governance. This paper investigates how institutional quality shaped the resilience of Italian Labour Market Areas during the COVID-19 pandemic. To this end, we introduce a localized, non-parametric Interrupted Time Series (ITS) approach, using long-run mortality data (2004-2023), to construct a data-driven, local-level resilience index. This index captures deviations from counterfactual mortality trajectories, reflecting the ability of local areas to withstand and recover from the pandemic. We then assess the determinants of this resilience index, with a particular focus on institutional quality. Our findings show that higher institutional quality - particularly the quality of local politicians - emerges as the most significant factor driving differences in performance at the local level. Multiple robustness checks, including alternative model specifications and pre-pandemic forecast accuracy benchmarks, confirm the reliability of our results.

Burnout has become a prevalent topic in both medical and public discourse, yet there remains little consensus on how it should be defined or addressed. Digital mental health technologies, especially mindfulness meditation apps like Headspace, position themselves as accessible responses to this condition. However, research in medical anthropology demonstrate that such technologies do not merely reflect dominant understandings of health, they actively shape health, illness/disease and care practices. Focusing on the mindfulness meditation mobile phone application Headspace, this article shows how the app reframes health as a moral obligation, equating well-being with productivity and "fitness for work." Based on an ethnographic discourse analysis of Headspace's burnout-related content, the analysis demonstrates how burnout is constructed as an individual moral failing, entailing techniques of self-optimization aimed at restoring productive capacity. This study contributes to medical anthropology and digital health studies by revealing how mobile mental health apps encode neoliberal ideals of responsibility, productivity, and affective control into everyday self-care practices. In doing so, it expands critical scholarship on burnout by showing how digital technologies transform subjective experiences of exhaustion into sites of moral evaluation, underscoring the need for closer attention to how digital health platforms shape imaginaries of health, wellbeing, and subjectivity.

China's National Volume-Based Procurement (NVBP) policy, introduced in 2018, aims to reduce pharmaceutical prices by exchanging large guaranteed purchase volumes for substantial price concessions on selected drugs. While existing research documents substantial price reductions for contracted drugs, less is known about how this selective price regulation affects pricing behavior in the broader pharmaceutical market. Using public hospital procurement data and exploiting variation in the timing of NVBP implementation, this study examines spillover effects on prices, sales quantities, and revenues of non-contracted drugs. We find that NVBP is associated with significant increases in both prices and revenues of non-contracted drugs. These effects are consistent with strategic margin reallocation by multi-product firms seeking to offset revenue losses from contracted products. Spillovers are not uniform. They are larger in chronic-disease therapeutic areas, where demand is more predictable, and substitution is limited, and in poorer regions, where market competition and regulatory capacity are weaker. Additional analyses show that spillover effects are amplified in more concentrated therapeutic markets, suggesting that market structure constrains competitive responses. The findings highlight an important trade-off in centralized procurement policies. While NVBP successfully reduces prices for targeted medicines, selective price regulation may generate unintended spillovers in the broader pharmaceutical market.

Background: The World Health Organization's Framework on Integrated, People-Centred Health Services (IPCHS) proposes five interdependent strategies to guide health system transformation. In low- and middle-income countries (LMICs), implementation of IPCHS is often fragmented due to limited understanding of how its strategies interact in practice. Community Health Workers (CHWs), situated between households and formal health systems, offer a unique lens to examine these dynamics.

Methods: This study used a multi-phase realist approach, integrating a realist synthesis and two realist evaluations in KwaZulu-Natal, South Africa. Findings from each phase contributed to refining an initial programme theory into a dynamic, mechanism-sensitive model that captures how IPCHS strategies function interdependently. Findings were analysed using context-mechanism-outcome (CMO) configurations. Systems thinking tools, including causal loop diagrams, were used to visualise mechanism chaining and feedback loops across system levels and strategies.

Results: Three cross-cutting meta-mechanisms: trust, motivation, and professional legitimacy (with institutional support) were found to underpin CHW performance across all five IPCHS strategies. These mechanisms interacted recursively, meaning activation or erosion of one affected others. People-centred care is not the outcome of any single strategy but rather emerges from the alignment and interaction of mechanisms triggered by multiple strategies in different contexts. When mechanisms align, they reinforce CHW performance and advance IPCHS; when misaligned, they contribute to system fragility and poor outcomes.

Conclusion: People-centred care is an emergent property of aligned, interacting IPCHS strategies, as opposed to isolated interventions. Further research should test and refine the proposed mechanism-sensitive approach to implementing the IPCHS framework.

Background: Discrete choice experiment (DCE) methods are increasingly used to generate value sets for paediatric health-related quality of life (HRQoL) instruments, typically relying on latent scale DCE choice tasks and external data anchoring. This study used qualitative methods to: 1) examine how adults and adolescents (12-17) complete both latent scale DCE and DCE with duration; 2) explore the use of different perspectives ('self' or '10-year-old'); and 3) assess DCE valuation of three paediatric HRQoL instruments (CHU9D, EQ-5D-Y-5L, HUI3).

Methods: Ninety-four participants (47 adolescents and 47 adults) were interviewed via Zoom in six iterative rounds (10-20 interviews per round), incorporating think-aloud and structured elements. Findings informed subsequent interview rounds. DCE choice tasks varied by inclusion of a duration attribute, perspective, and HRQoL instrument. Thematic analysis was used for interview data.

Results: DCE tasks with duration were feasible for adolescents aged 12-17, and duration helped participants clarify priorities. The CHU9D and HUI3 were found to be more comprehensive in covering the aspects of quality of life. The EQ-5D-Y-5L was favoured in DCE choice tasks for its brevity. Choice tasks involving HUI3 states were found to be difficult to understand. Quality of life, length of life, perspective and non-health considerations influenced decision-making.

Conclusions: These results can inform the development of valuation protocols in healthcare decision-making. Notably, adolescents as young as 12 can value health using DCE with duration, supporting the creation of adolescent-specific value sets when required.