Social Science & Medicine最新文献

While prior research has highlighted social disparities in health associated with informal caregiving, the findings are inconsistent, often based on non-representative samples, and overlook variations in caregiving situations (e.g., caregiving intensity). This study integrates the Stress Process Model and the intersectionality perspective to examine how informal caregiving intensity interacts with various social determinants of health (SDOHs), guided by the PROGRESS-Plus framework, which includes factors such as socioeconomic status, gender, and social support, in shaping mental health, as measured by life satisfaction and depressive symptoms. We used three waves of nationally representative data from the Canadian Longitudinal Study on Aging for the analysis. We applied linear mixed models to assess the association between informal caregiving and mental health, accounting for repeated measures within individuals and unobserved, time-invariant characteristics. Interaction effects were examined to explore whether SDOHs condition the association between informal caregiving intensity and mental health. Results show that intensive caregiving is associated with poorer mental health, whereas moderate-intensity caregiving is not significantly detrimental, and low-intensity caregiving is associated with higher life satisfaction. Social support mitigates the negative effects of caregiving on life satisfaction among moderate-intensity and intensive caregivers and on depressive symptoms among intensive caregivers. Other PROGRESS-Plus dimensions show limited evidence of moderating this association.

This study adopts social practice theory to explore the mechanisms through which differences in family social class influence children's leisure-time physical activity. It aims to enhance children's engagement in leisure-time physical activity and improve their overall health. Using a sample of 1169 families in Guangdong Province, this study constructs a multiple-chain mediation model to analyze the relationship between family social class and children's leisure-time physical activity. It further examines the mediating roles of parenting styles and the family sports environment in this relationship. The findings indicate that family social class does not exert a direct influence on children's leisure-time physical activity. Instead, it indirectly promotes the level of such activity through the internalization of parenting styles and the subsequent transformation of the family sports environment. Among these mechanisms, authoritative parenting styles facilitate the development of a family sports environment and enhance children's participation in leisure-time physical activities, whereas authoritarian parenting styles exert a negative influence on children's participation in leisure-time physical activities. These findings validate the explanatory power of Bourdieu's social practice theory framework, suggesting that to effectively promote children's leisure-time physical activity levels, it is insufficient to solely examine and analyze the family's social class. Instead, greater emphasis should be placed on understanding and prioritizing parenting styles and the family sports environment.

This paper reports early outcome findings from the Restart Project, a community-based, longitudinal research demonstration study examining the integration of Housing First for Youth (HF4Y), mental health, and addiction services to better support youth experiencing homelessness and co-occurring mental health and substance use problems in Kelowna, British Columbia, and Toronto, Ontario, Canada. A cohort of 72 youth aged 16-23 was recruited between 2020 and 2023 and followed for 24 months. Quantitative outcomes were assessed at baseline and 12 months, and qualitative interviews were conducted with a subsample at 18 months. At 12 months, participants in the Restart HF4Y group had significantly greater housing stability than the Waitlist/Usual Care group (71.8% vs. 35.6% of days stably housed). Qualitative findings highlighted the critical role of housing as a foundation for recovery and personal growth, while also identifying challenges of isolation and housing quality. These early results suggest that HF4Y programs with integrated mental health and addiction services can effectively support youth experiencing homelessness with complex needs to rapidly exit homelessness within a relatively short period of time (12 months), creating a foundation for changes in other life areas.

Institutions of health professions education have taken measures to address the injustices faced by marginalized patients, health professionals and students, and the communities in which these institutions are embedded by illuminating the tacit ways of learning, often named as the hidden curriculum. The hidden curriculum has not adequately explained the ways that students, particularly historically marginalized and unrecognized students, navigate learning environments where forms of injustice actively shape their experiences of learning. Illuminating the underlying power dynamics and structures is not enough to address these injustices. A more solution-based approach is needed that can offer suggested remedies to the unintended consequences that inevitably affect learners and practitioners, as well as the many individuals who seek care in these systems. In this special issue, we include a range of health professionals and students in midwifery, social work, dentistry, nursing, and medicine in Palestine, Vanuatu, India, Japan, and the United States, among other places.

Brazil is rapidly aging with limited welfare infrastructure to support healthy aging, making spouses and adult children among the primary sources of support. Declining fertility and marital transitions may threaten older adults' health, raising a critical question: Are there gender differences in older Brazilians' mortality risks by partnership and parenthood status? We used baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) of adults 50 and older (2015-2016), including 9412 participants with deaths linked to Brazil's Mortality Information System. Cox proportional hazard models assessed mortality by close kin availability: (1) partnered with children, (2) partnered childless, (3) unpartnered with children, and (4) unpartnered and childless, adjusting for demographic, early-life conditions, health, and social factors. For both men and women, lacking both traditional family ties presents the highest mortality risks, but for men, having children and lacking a partner also elevate mortality risks. We discuss these findings in the context of demographic and social changes in the availability of close kin and the potential opportunities to enhance survival among older adults in Brazil.

Electronic health records (EHRs) may be a promising alternative to traditional health surveys for population health surveillance due to their detailed health and patient information, low cost, and minimal respondent burden. However, concerns about the population representativeness of EHRs raise questions about their validity for public health monitoring and tracking social determinants of health. This study addresses these concerns by evaluating the representativeness of EHRs from UNC Health, a large integrated health delivery system in North Carolina, by linking individual-level EHRs (2018-2022; n = 2.12 million unique patients) with individual-level microdata from the nationally representative American Community Survey (ACS, 2018-2022). Specifically, we evaluate how demographic factors (age, sex, race/ethnicity), socioeconomic factors (education, employment, poverty, food stamps, public assistance), and health insurance impact the likelihood that a North Carolina ACS respondent will appear in the UNC Health EHRs. Linear probability models indicate that although UNC Health patients are not fully representative of the state population, selection biases are small and align with known patterns of healthcare utilization (e.g., overrepresentation among females, older adults, and individuals with health insurance). Moderate selection is observed by race/ethnicity and socioeconomic status, with overrepresentation at both the high and low ends of the socioeconomic spectrum. These findings provide cautious reassurance for the use of appropriately weighted EHR data in population health monitoring while demonstrating the value of evaluating and improving the utility of EHRs in public health research through linkages with individual-level nationally representative data.

Objective: Cognitive impairment is a significant component of health decline in later life. This study aims to examine the temporal sequence of domain-specific cognitive decline among China's older population, to inform healthcare practitioners for more targeted and timely screening and intervention for dementia.

Methods: Data from the 1998-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national longitudinal survey of Chinese older adults, were used. Cognitive impairment was measured using the validated Chinese version of the Mini-Mental State Examination (MMSE). Proportional Odds Modeling (POM) was utilized to analyze impairment progressions across domains of cognition, and longitudinal analyses were conducted to ensure empirically robust and temporally validated findings.

Results: Findings indicate that the progression of cognitive impairment in older adults is staged across domains: the earliest manifestations appear in language and orientation, followed sequentially by recall, calculation, and registration. Recall and calculation are the first domains to reach complete impairment, while registration, language, and orientation deteriorate subsequently.

Conclusion: Cognitive decline across multiple domains is staged at older ages. The observed pattern of domain-staged cognitive decline at older ages can enable more targeted screening and interventions to prevent the onset of dementia and delay its progression.