Social Science & Medicine最新文献_第5页

The ‘us and them divide’: A qualitative study of student experiences of global health education through the lens of ‘inclusivity’

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2025.117759

Mariam Sbaiti , Eliel Cohen , Xuan Odofin , Julianne K. Viola , Jin Keng Stephen Lam

The Global Health (GH) field is characterised by stark inequalities, including a strong over-representation of GH leaders from/trained in high-income countries (HICs). There are no empirical studies exploring how experiences of GH education in HICs could have a role in reproducing, or potentially challenging, these inequalities. We address this by qualitatively analysing student and alum experiences of a one-year GH Bachelor of Science course at a research-intensive UK university (April 2019 and April 2020). Drawing from educational literature, we mobilise the concept of inclusivity to access participants' course experiences, and the concept of ‘tensionality’ to situate the ‘lived’ context of the GH classroom. We also situate this context within broader theories of a Western or foreign ‘gaze’, the concept of ‘cognitive’ or ‘epistemic’ (in)justice and field of critical pedagogy. We find that the underpinning inequalities in GH, the ways in which communities that are the “object of study” are re-presented and their frequent absence (non-representation), creates a tension experienced by all students, regardless of their identities. However, the inclusive/non-inclusive dichotomy is not a simple one. GH education can be experienced as simultaneously empowering and alienating. The paper identifies the most promising curricular and pedagogic principles and concludes that GH educators must embrace the underpinning ‘tensionality’ of GH education. Whilst doing so is insufficient to resolve tensions and inequalities, it can enhance educational by modelling simple action to acknowledge cognitive injustice, gesturing towards pluriversality and engaging practically with the potential of the GH education sector to impact inequalities in the field.

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引用次数: 0

Economic hardships during COVID-19 and maternal mental health: Combining samples with low incomes across three cities COVID-19期间的经济困难与孕产妇心理健康：结合三个城市的低收入样本。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117636

Anne Martin , Elizabeth B. Miller , Rachel S. Gross , Pamela A. Morris-Perez , Daniel S. Shaw , Luciane da Rosa Piccolo , Jennifer Hill , Marc A. Scott , Mary Jo Messito , Caitlin F. Canfield , Lauren O'Connell , Richard C. Sadler , Ashleigh I. Aviles , Chelsea Weaver Krug , Christina N. Kim , Juliana Gutierrez , Ravi Shroff , Alan L. Mendelsohn

The COVID-19 pandemic increased maternal depression and anxiety, imperiling both mothers' own wellbeing and that of their children. To date, however, little is known about the extent to which these increases are attributable to economic hardships commonly experienced during the pandemic: income loss, job loss, and loss of health insurance. Few studies have examined the individual impacts of these hardships, and none have lasted beyond the first year of the pandemic. This study harmonizes data from six evaluations of pediatric-based parenting programs for women with young children and low incomes across three U.S. cities (N = 1,254). Low-income mothers are of special interest because their families have been disproportionately affected by economic shocks due to COVID-19, and mothers of young children have been more distressed than other mothers by COVID-19. The studies’ combined window of observation lasted from the onset of the pandemic to over three years later. Results indicate that income loss, job loss, and health insurance loss were all significantly associated with depression and anxiety. When each hardship was assessed net of the others, lost income was associated with more than a two-fold increase in the odds of anxiety, and a lost job and lost health insurance were associated with 50% and 90% greater odds of depression, respectively. Associations between hardships and maternal mental health did not diminish over time during the window of observation. These associations are likely to have been even greater in the absence of generous social policies enacted during the pandemic.

2019冠状病毒病大流行加剧了孕产妇的抑郁和焦虑，危及母亲自身和子女的健康。然而，迄今为止，人们对这些增长在多大程度上归因于大流行期间常见的经济困难（收入损失、失业和健康保险损失）知之甚少。很少有研究审查了这些困难的个别影响，而且没有一项研究持续到大流行的第一年之后。这项研究协调了美国三个城市（N = 1,254）针对有年幼子女和低收入妇女的儿科教育项目的六项评估数据。低收入母亲尤其值得关注，因为她们的家庭受到新冠肺炎造成的经济冲击的影响尤为严重，而且年幼子女的母亲比其他母亲更受新冠肺炎的影响。这些研究的联合观察窗口从大流行开始持续到三年多以后。结果表明，收入损失、失业和医疗保险损失均与抑郁和焦虑显著相关。当每项困难都与其他困难进行净评估时，失去收入与焦虑的可能性增加两倍以上有关，而失去工作和失去健康保险与抑郁的可能性分别增加50%和90%。在观察期间，困难与产妇心理健康之间的关联并没有随着时间的推移而减弱。如果大流行期间没有制定慷慨的社会政策，这些关联可能会更大。

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引用次数: 0

Medical ambivalence and Long Covid: The disconnects, entanglements, and productivities shaping ethnic minority experiences in the UK 医疗矛盾心理和长期Covid：英国少数民族经历的脱节、纠缠和生产力。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117603

Damien T. Ridge , Alex Broom , Nisreen A. Alwan , Carolyn A. Chew-Graham , Nina Smyth , Dipesh Gopal , Tom Kingstone , Patrycia Gaszczyk , Samina Begum

Structural violence - related to ‘isms’ like racism, sexism, and ableism – pertains to the ways in which social institutions harm certain groups. Such violence is critical to institutional indifference to the plight of ethnic minority people living with long-term health conditions. With only emergent literature on the lived experiences of ethnic minorities with Long Covid, we sought to investigate experiences around the interplay of illness and structural vulnerabilities. Thirty-one semi-structured interviews with a range of UK-based participants of varying ethnic minorities, ages and socio-economic situations were undertaken online between June 2022 and June 2023. A constant comparison analysis was used to develop three over-arching themes: (1) Long Covid and social recognition; (2) The violence of medical ambivalence; and (3) Pathways to recognition and support. Findings showed that while professional recognition and support were possible, participants generally faced the spectre and deployment of a particular mode of structural violence, namely ‘medical ambivalence’. The contours of medical ambivalence in the National Health Service (NHS) as an institution had consequences, including inducing or accentuating suffering via practices of care denial. Despite multiple structurally shaped ordeals (like healthcare, community stigma, and sexism), many participants were nevertheless able to gain recognition for their condition (e.g. online, religious communities). Participants with more resources were in the best position to ‘cobble together’ their own approaches to care and support, despite structural headwinds.

结构性暴力——与种族主义、性别歧视和残疾歧视等“主义”有关——与社会制度伤害某些群体的方式有关。这种暴力是对长期健康状况不佳的少数民族人民的困境漠不关心的制度的关键。在仅有关于长冠少数民族生活经历的新兴文献的情况下，我们试图调查疾病与结构性脆弱性之间相互作用的经验。该研究在2022年6月至2023年6月期间在线进行了31次半结构化访谈，参与者来自不同的少数民族、年龄和社会经济状况。通过持续的比较分析，得出了三个总体主题：(1)长冠状病毒和社会认可；(2)医疗矛盾心理的暴力；(3)获得认可和支持的途径。调查结果显示，虽然专业认可和支持是可能的，但参与者普遍面临着一种特定模式的结构性暴力的幽灵和部署，即“医疗矛盾心理”。国民保健服务（NHS）作为一个机构的医疗矛盾心理的轮廓产生了后果，包括通过拒绝护理的做法诱发或加重痛苦。尽管经历了多重结构性的考验（如医疗保健、社区耻辱和性别歧视），但许多参与者仍然能够获得对其状况的认可（如在线、宗教社区）。拥有更多资源的参与者处于最有利的位置，可以“拼凑”出自己的关怀和支持方法，尽管存在结构性阻力。

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引用次数: 0

Getting the numbers right: Power, creativity and ‘good’ routine maternal and neonatal health data in Southern Tanzania 正确的数字：坦桑尼亚南部的权力、创造力和“良好”的常规孕产妇和新生儿健康数据。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117668

Jil Molenaar , Amani Kikula , Josefien van Olmen , Andrea Pembe , Lenka Beňová

What makes routine maternal and neonatal health data to be ‘good quality’? That depends on whom you ask – the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards of two hospitals in Southern Tanzania. We draw from focused ethnographic observation at these two labour wards and 29 in-depth qualitative interviews with health care workers (HCWs), hospital leaders, and relevant district- and regional-level managers.

We distinguish between two different types of power that shape how people engage with routine maternal and neonatal health data: authoritative and discretionary power. Authoritative power, or top-down power ‘over’, is reflected in how maternal and neonatal health targets and measurement demands are imposed on individuals lower in the power hierarchy. We show how this results in an environment where data are seen as ‘political things’ and where HCWs feel pressured and fear being blamed for poor health outcomes. Yet, data can also be a means for HCWs to exercise discretionary power – a type of bottom-up power to act creatively to deflect scrutiny and protect themselves and others.

Strategically handling and manipulating data, HCWs ‘get the numbers right’ by balancing their own needs, top-down expectations, and structural challenges. HCWs may hereby compromise their own definitions of ‘good’ data, and as as consequence, limit the usefulness of routine data to inform clinical decision making and health system planning. We underline the importance of supportive supervision, feasibility and perceived relevance of routine health data for those tasked to collect and report it, in order to better navigate the blurry line between constructive accountability and counter-productive pressure.

是什么使常规孕产妇和新生儿健康数据“高质量”？这取决于你问的是谁——在卫生系统各级收集和报告这些数据的人员有不同的优先事项，面临不同的限制。数据是由人构建的，是关于人的，它们既反映又影响着人类的互动。本研究分析了影响坦桑尼亚南部两家医院产房日常健康数据收集和报告方式的权力动态。我们对这两个产房进行了重点人种学观察，并对卫生保健工作者（HCWs）、医院领导以及相关的区级和地区级管理人员进行了29次深入的定性访谈。我们区分了两种不同类型的权力，这些权力塑造了人们如何参与日常的孕产妇和新生儿健康数据：权威权力和自由裁量权。权威权力，或自上而下的权力，反映在如何将孕产妇和新生儿健康目标和测量要求强加给权力层次较低的个人。我们展示了这在数据被视为“政治事物”的环境中是如何造成的，在这种环境中，卫生保健工作者感到压力，害怕因健康状况不佳而受到指责。然而，数据也可以成为卫生工作者行使自由裁量权的一种手段——一种自下而上的权力，可以创造性地采取行动，转移审查，保护自己和他人。从战略上处理和操纵数据，医护人员通过平衡自己的需求、自上而下的期望和结构性挑战来“获得正确的数字”。因此，卫生保健工作者可能会损害他们自己对“良好”数据的定义，并因此限制了常规数据在临床决策和卫生系统规划方面的有用性。我们强调对负责收集和报告日常卫生数据的人员进行支持性监督、可行性和感知相关性的重要性，以便更好地把握建设性问责制与适得其反的压力之间的模糊界限。

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引用次数: 0

Socioeconomic inequality in the outcomes of a psychological intervention for depression for South Africans with a co-occurring chronic disease: A decomposition analysis 社会经济不平等对南非合并慢性疾病的抑郁症进行心理干预的结果：分解分析。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117659

Amarech Obse , Susan Cleary , Rowena Jacobs , Bronwyn Myers

Task-shared psychological interventions are effective for reducing the severity of depression symptoms, but differences in treatment outcome by socioeconomic status is uncertain. This study examines socioeconomic inequalities (SEI) in depression outcomes among people with HIV and/or diabetes who participated in a cluster randomised controlled trial in the Western Cape Province of South Africa. The trial took place at 24 primary care clinics randomised to deliver a task-shared psychological intervention or treatment as usual (TAU). The trial enrolled 1119 participants meeting criteria for probable depression. Depression symptom severity was evaluated at baseline and 24-month follow-up. Using a concentration index (CI), SEIs in depression were assessed for the intervention and TAU arms. Demographic and socioeconomic variables were used to decompose the CI to identify contributors to SEI. Results indicate poorer participants at the intervention arm have significantly worse 24-month outcomes than wealthier counterparts (CI = – 0.080; SE = 0.025). Race (34.2%), unemployment (17.4%) and food insecurity (15%) were the main contributing factors. While policymakers need to invest in psychological interventions to reduce the burden caused by depression, this study suggests treatment outcomes may be different across the socioeconomic spectrum. Decomposition of these findings points to structural constraints, such as unemployment, as the key contributors towards poorer treatment outcomes. These findings suggest a need to combine psychological interventions with structural interventions that address the broader socio-economic determinants of mental health.

任务分担心理干预对减轻抑郁症状的严重程度是有效的，但不同社会经济地位对治疗结果的差异是不确定的。本研究调查了社会经济不平等（SEI）在南非西开普省参加了一项随机对照试验的艾滋病毒和/或糖尿病患者的抑郁结果。该试验在24个初级保健诊所随机进行，以提供任务共享心理干预或常规治疗（TAU）。该试验招募了1119名符合可能抑郁标准的参与者。在基线和24个月随访时评估抑郁症状严重程度。使用浓度指数（CI），评估干预组和TAU组的抑郁症SEIs。使用人口统计和社会经济变量来分解CI以确定SEI的贡献者。结果表明，在干预组中，较贫穷的参与者的24个月预后明显差于较富裕的参与者(CI = - 0.080；se = 0.025)。种族（34.2%）、失业（17.4%）和粮食不安全（15%）是主要影响因素。虽然政策制定者需要在心理干预方面进行投资，以减轻抑郁症造成的负担，但这项研究表明，不同社会经济阶层的治疗结果可能不同。这些发现的分解表明，结构性限制，如失业，是导致治疗效果较差的关键因素。这些发现表明，有必要将心理干预与结构性干预相结合，以解决影响心理健康的更广泛的社会经济决定因素。

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引用次数: 0

Infant birth weight in Brazil: A cross-sectional historical approach 巴西婴儿出生体重：横断面历史方法。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2025.117677

Cassia Roth

In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n = 2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84 g lighter (p-value = 0.002 [95% CI -137, −32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (preta) women had birth weights estimated to be 100 g lighter (p-value = 0.001 [95% CI -160, −39]) and infants born to mixed-race (parda) women had birth weights estimated to be 70 g lighter (p-value = 0.022 [95% CI -130, −10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality – including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.

1888年，巴西成为美洲最后一个废除奴隶制的国家。历史学家概述了废奴后时期非洲人后裔的种族健康差异。流行病学家已经表明，21世纪的健康差距继续反映出一个多世纪前的模式。这个横断面分析量化在废除后的妇产医院使用婴儿出生体重的健康差距。该研究依靠巴西里约热内卢市Maternidade Laranjeiras医院1922年至1926年间出生的婴儿（n = 2845）的医院记录，运行线性模型，评估婴儿出生体重在母亲肤色、年龄、怀孕次数（胎次）和国籍方面的差异。非洲血统与较低的出生体重相关。非洲裔女性所生婴儿的出生体重估计比欧洲裔女性所生婴儿轻84克（p值= 0.002 [95% CI -137, -32]）。在非洲裔妇女中，黑人（preta）妇女所生婴儿的出生体重估计比白人妇女所生婴儿轻100克（p值= 0.001 [95% CI -160, -39]），混血儿（parda）妇女所生婴儿的出生体重估计比白人妇女所生婴儿轻70克（p值= 0.022 [95% CI -130, -10]）。这些发现很可能是奴隶制遗留问题的结果，尤其是基于种族的社会经济不平等——包括对非洲人后裔来说，更繁重的工作时间表、更差的营养和更不卫生的生活环境。这些发现与目前巴西种族化健康差异的研究结果一致，并表明了历史发现对公共卫生研究的重要性。

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引用次数: 0

How is process tracing applied in health research? A systematic scoping review 过程追踪如何应用于卫生研究？系统的范围审查。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117539

Rebecca Johnson , Derek Beach , Hareth Al-Janabi

Complex health system questions often have a case study (such as a country) as the unit of analysis. Process tracing, a method from policy studies, is a flexible approach for causal analysis within case studies, increasingly used in applied health research. The aim of this study was to identify the ways in which process tracing methods have been used in health research, and provide insights for best practice. We conducted a systematic scoping review of applied studies purporting to use process tracing methods in health research contexts. We examined the range of studies and how they conducted and reported process tracing. We found 84 studies published from 2011 to 2023. Studies were categorised into two groups: those with greater methodological description (n = 19 studies) and those with less methodological description (n = 65 studies). A majority of studies were focused on public health and health policy with around half of studies focused on low and middle income countries. Of those 19 studies that provided greater methodological description eight studies featured four areas of good practice: (1) reporting the development of a mechanistic theory and making it explicit; (2) linking empirical material collected to the mechanistic theory; (3) clearly presenting the causal mechanism tracing; and (4) reporting how consideration of counterfactuals or evidence of alternatives within the study were analysed in practice. The review demonstrates the rapid take-up of process tracing to generate theory and evidence to support a better understanding of causal mechanisms in complex health research. To support future studies in conducting and reporting process tracing, we provide emergent recommendations.

复杂的卫生系统问题通常以案例研究（如一个国家）作为分析单位。进程追踪是政策研究的一种方法，是在案例研究中进行因果分析的一种灵活方法，越来越多地用于应用卫生研究。本研究的目的是确定在卫生研究中使用过程追踪方法的方式，并为最佳实践提供见解。我们对旨在在健康研究背景下使用过程追踪方法的应用研究进行了系统的范围评估。我们检查了研究的范围，以及它们是如何进行和报告过程跟踪的。我们发现从2011年到2023年发表了84项研究。研究被分为两组：方法描述较多的研究（n = 19）和方法描述较少的研究（n = 65）。大多数研究侧重于公共卫生和卫生政策，约有一半的研究侧重于低收入和中等收入国家。在这19项研究中，提供了更多的方法描述，其中8项研究突出了四个方面的良好实践：(1)报告机制理论的发展并使其明确；(2)将收集到的经验材料与机制理论联系起来；(3)清晰呈现因果机制溯源；(4)报告如何在实践中分析研究中的反事实或替代证据。这一综述表明，在复杂的卫生研究中，快速采用过程追踪来产生理论和证据，以支持更好地了解因果机制。为了支持未来在进行和报告过程跟踪方面的研究，我们提供了紧急建议。

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引用次数: 0

Transition symptom management careers: Historical patterns of mental health symptoms and service use among young adults experiencing a psychiatric crisis 过渡症状管理职业：经历过精神危机的年轻成年人的精神健康症状和服务使用的历史模式。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117657

Sarah C. Narendorf , Umaira Khan , Michelle R. Munson , Vanessa V. Klodnick , Jamaica Harrell

Young adults access mental health services at lower rates than both older and younger age groups despite high levels of need. Mental health service use is known to be influenced by prior experiences with treatment, with episodes of symptoms and treatment producing patterns of service use over time, or what we call a “symptom management career”. This qualitative study examined the symptom management careers of 55 young adults (ages 18–25) who were admitted to an inpatient, short term, crisis stabilization unit. Participants completed research interviews at the hospital following a psychiatrist's assessment. During semi-structured qualitative interviews, participants retrospectively narrated their experiences of mental health symptoms and service use from symptom onset to the current episode. The research team used an inductive qualitative approach to identify distinct patterns of symptom management, while also examining factors that contributed to service use. Six distinct types of symptom management careers were identified based on the timing of symptom onset and service participation. Notably, none of the participants experienced an uninterrupted pattern of service use from adolescence into young adulthood. The team identified a set of themes that influenced these patterns including traumatic experiences, social supports, social service systems, and substance use. Findings highlight the developmental nature of service connection and disconnection and suggest potential points of intervention in non-specialty settings, such as schools, child welfare, and the juvenile legal system. Findings also demonstrate the need for flexible services that respond to the developmental need for autonomy and self-determination as youth transition into young adulthood.

年轻人获得心理健康服务的比例低于老年人和年轻人，尽管他们的需求很高。众所周知，心理健康服务的使用受到先前治疗经历的影响，随着时间的推移，症状和治疗的发作会产生服务使用模式，或者我们称之为“症状管理职业”。本定性研究调查了55名年轻成人（18-25岁）的症状管理职业，他们住进了一个短期的危机稳定住院病房。在精神病医生的评估后，参与者在医院完成了研究访谈。在半结构化定性访谈中，参与者回顾性地叙述了他们从症状出现到当前发作的心理健康症状和服务使用经历。研究小组使用归纳定性方法来确定症状管理的不同模式，同时也检查了导致服务使用的因素。根据症状出现的时间和服务参与，确定了六种不同类型的症状管理职业。值得注意的是，没有一个参与者经历过从青春期到成年早期不间断的服务使用模式。研究小组确定了一系列影响这些模式的主题，包括创伤经历、社会支持、社会服务系统和物质使用。研究结果强调了服务连接和断开的发展性质，并提出了非专业环境（如学校、儿童福利和少年法律系统）的潜在干预点。调查结果还表明，有必要提供灵活的服务，以满足青年向青年过渡时对自主和自决的发展需求。

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引用次数: 0

A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis 以生物心理社会方法了解西班牙裔和非西班牙裔白人膝关节骨关节炎患者在运动参与方面的差异。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117610

Navin Kaushal , Donya Nemati , Eric Kholodovsky , Jacob Jahn , Thomas M. Best

Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.

有规律的锻炼对控制膝骨关节炎（KOA）症状至关重要。尽管有既定的研究结果，但对于KOA患者来说，持续的运动采用仍然是一个挑战，西班牙裔患者之间存在显著差异，需要确定解释运动参与中种族差异的决定因素。本研究的目的是采用生物心理社会模型来确定运动参与的决定因素，并强调种族差异。来自大学医院诊所的患者（n = 163）进行了医学检查，根据x线片被认为符合研究条件。符合条件的参与者完成了经过验证的调查措施，评估了过去两周的运动参与情况，以及生物、心理和社会领域的措施，以预测未来的运动意图。结构方程模型对路径进行了假设。过去的运动行为预测态度、自我效能和未来的运动意图。疼痛灾难化与运动参与相关，但医生和（个人）社会支持对运动的竞争效应抵消了疼痛灾难化对运动参与的重要性。重要的种族比较发现，非西班牙裔白人患者受教育程度更高，收入更高，身体质量指数更低，态度和自我效能得分更高，锻炼时间更长。两种族间的非显著影响包括意向、医生支持和社会支持。设计一种有助于促进患者医生和最近的朋友/家庭成员支持的干预措施可以在两个种族的运动参与中发挥至关重要的作用。对拉美裔人态度和自我效能感的进一步关注可以解决一些差异。本文还提供了利用生物心理社会方法促进运动公平的进一步说明。

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Female versus viral: Understanding the UK gender health inequalities during the Covid-19 pandemic using e-archives 女性与病毒：利用电子档案了解Covid-19大流行期间英国的性别健康不平等。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117589

Chen Qu

Despite the development of digital health infrastructure, female health inequalities have worsened during the pandemic. This transdisciplinary study, through health, feminist, and infrastructural geographical lens, examines how gender health inequalities may have emerged or worsened during Covid-19 in the UK. This study leverages a novel web archive collection, Python coding-powered data-handling text analysis (of over 0.2 billion words), and thematic analysis to examine three themes: vaccines, social minority groups, and women’s self-care. The findings suggest that the pandemic has impacted health inequalities among British women and girls and more, in a ‘more-than-gender’ way in terms of health (care) outcomes and access. In addition to reflecting on the use of e-archives in this study including suggesting the potential of combining e-archiving, coding, natural language processing (NLP) and generative AI/Large Language Models (LLMs) in producing and analysing trans-temporal (big) datasets, I argue that a geographical crisis perspective that balances the needs of everyday life and possible crises can be considered when preparing for public health emergencies. I adopt the e-archiving of this study to rethink ‘digital health infrastructure’ as ‘actors’, ‘facilitators’, and ‘voicers’, revealing how human-computer interaction and people in the virtual realm can be infrastructure.

尽管数字卫生基础设施得到了发展，但在大流行期间，女性卫生不平等现象加剧。这项跨学科研究通过健康、女权主义和基础设施地理视角，研究了英国在2019冠状病毒病期间性别健康不平等是如何出现或恶化的。这项研究利用了一个新颖的网络档案收集，Python编码驱动的数据处理文本分析（超过2亿字），以及主题分析来研究三个主题：疫苗，社会少数群体和妇女自我保健。调查结果表明，就卫生（保健）结果和获取而言，疫情影响了英国妇女和女孩等群体的卫生不平等，其影响“超越了性别”。除了反思本研究中电子档案的使用，包括建议将电子存档、编码、自然语言处理（NLP）和生成式人工智能/大型语言模型（llm）结合起来生产和分析跨时间（大）数据集的潜力之外，我认为，在准备应对突发公共卫生事件时，可以考虑从地理危机的角度来平衡日常生活的需求和可能的危机。我采用本研究的电子存档，将“数字卫生基础设施”重新思考为“行动者”、“促进者”和“发声者”，揭示虚拟领域中的人机交互和人如何成为基础设施。

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引用次数: 0