Social Science & Medicine最新文献

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.

Digitalization is intended to help address the rapidly growing demand for psychiatric care by offering cost-efficient and accessible treatment. This paper examines how psychologists working in digital psychiatry enact and negotiate their professional expertise. I use a novel STS framework synthesizing the conceptual lenses of expertise and tinkering, to show how psychologists become entangled with technology, confusing divisions of labor. Moreover, I suggest that technology is neither replacing psychologists, as critics propose, nor augmenting their work, as advocates assert; it is displacing them. In this displaced position, psychologists must employ tinkering care practices that support both technology and patient self-care-what I call a meta-role. On the one hand, this role can make psychologists feel professionally redundant. On the other hand, digitalization can be seen as bolstering the psychology profession within psychiatry-a field where psychologists conventionally occupy a marginal position-because it addresses mild to moderate conditions that do not need medical interventions. Thus, the paper discusses the future epistemic domain of psychiatry and how technology, coinciding with the rise of self-help, affects professional identities. The paper is based on extensive participant observations at a digital therapy initiative and interviews with 17 psychologists working there.

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.