Social Science & Medicine最新文献_第7页

Cannabis vaping use in emerging adulthood: Characterizing transitions between stages of vaping among a diverse cohort in Texas 成年后吸食大麻：德克萨斯州不同人群吸食大麻阶段之间的过渡特征。

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

Social Science & Medicine

Pub Date : 2024-09-26 DOI: 10.1016/j.socscimed.2024.117326

Objective

To characterize and compare transitions in cannabis (THC) vaping by sociodemographic and other risk factors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021.

Methods

We analyzed six (6) waves of panel data from n = 2605 youth transitioning into young adulthood via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system; participants provided N = 13,974 observations (i.e., completed surveys). The TATAMS sample was 37.7% Hispanic, 31.7% NH-White, 14.5% NH-Black, and 16.1% among NH-Other. We applied a three-state Markov model to estimate cannabis vaping initiation (never→ever), experimentation (never→current), escalation (ever→current), and de-escalation (current→ever). First, we compared transitions in THC vaping by race/ethnicity, with non-Hispanic (NH) Black as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of cannabis vaping transitions, examining differences by: sex, age, alcohol use, depression (PHQ-9), anxiety (GAD-7) and nicotine vaping, across each race/ethnic category.

Results

At baseline, 72.7% never vaped cannabis, 12.7% ever vaped cannabis, and 14.5% currently vaped cannabis. Across three years, risk for cannabis vaping experimentation (never → current) was significantly greater among NH-Blacks, relative to Hispanics (aHR: 1.89), NH-Whites (aHR: 2.27), and NH-Other (aHR: 2.01). Stratified models showed that current alcohol use was a common predictor of cannabis vaping experimentation among NH-White (aHR: 5.08), Hispanic (aHR: 2.32), and NH-Black (aHR: 2.91) participants. Depression predicted cannabis vaping initiation among Hispanics (aHR: 1.75) and experimentation among NH-Blacks (aHR: 3.95).

Conclusions

Onset of cannabis vaping during youth and young adulthood was most common among NH-Black youth, relative to other race/ethnic categories. Alcohol was a common predictor of cannabis vaping across race/ethnic categories while depression was linked to cannabis vaping transitions among Hispanic and NH-Black youth, only. Future research should investigate the link between alcohol use, mental health, and cannabis vaping among young people.

目的通过对 2019 年春季至 2021 年秋季期间观察到的不同青年和年轻成年人队列中的社会人口和其他风险因素，描述和比较吸食大麻（THC）的过渡情况：我们通过德克萨斯州青少年烟草和营销监测（TATAMS）系统分析了六（6）波面板数据，这些数据来自 2605 名过渡到青年期的青少年；参与者提供了 N = 13,974 个观察结果（即完成的调查问卷）。TATAMS 样本中有 37.7% 的西班牙裔、31.7% 的新罕布什尔-白人、14.5% 的新罕布什尔-黑人和 16.1% 的新罕布什尔-其他族裔。我们采用了一个三态马尔可夫模型来估算吸食大麻的起始时间（从不→曾经）、尝试时间（从不→现在）、升级时间（曾经→现在）和降级时间（现在→曾经）。首先，我们以非西班牙裔（NH）黑人为参照，比较了不同种族/族裔吸食四氢大麻酚的转变情况。其次，我们按种族/族裔对马尔可夫模型进行了分层，以确定吸食大麻转变的共同和独特预测因素，并研究了每个种族/族裔类别在性别、年龄、酒精使用、抑郁（PHQ-9）、焦虑（GAD-7）和尼古丁吸食等方面的差异：基线时，72.7%的人从未吸食过大麻，12.7%的人曾经吸食过大麻，14.5%的人目前正在吸食大麻。在三年中，相对于西班牙裔（aHR：1.89）、新罕布什尔州-白人（aHR：2.27）和新罕布什尔州-其他族裔（aHR：2.01），新罕布什尔州-黑人尝试吸食大麻的风险（从未吸食→目前吸食）明显更高。分层模型显示，在新罕布什尔州-白人（aHR：5.08）、西班牙裔（aHR：2.32）和新罕布什尔州-黑人（aHR：2.91）参与者中，当前饮酒是大麻吸食实验的常见预测因素。抑郁预示着西班牙裔开始吸食大麻（aHR：1.75），预示着新罕布什尔州黑人开始尝试吸食大麻（aHR：3.95）：结论：相对于其他种族/族裔类别，在青年和青年期开始吸食大麻的情况在北卡罗来纳州黑人青年中最为常见。酒精是不同种族/族裔吸食大麻的常见预测因素，而抑郁症仅与西班牙裔和新罕布什尔州黑人青少年吸食大麻的转变有关。未来的研究应该调查年轻人中酗酒、心理健康和吸食大麻之间的联系。

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引用次数: 0

Applying CFIR to assess multi-level barriers to PrEP delivery in rural South Africa: Processes, gaps and opportunities for service delivery of current and future PrEP modalities 应用 CFIR 评估南非农村地区提供 PrEP 的多层次障碍：为当前和未来 PrEP 模式提供服务的过程、差距和机遇。

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

Social Science & Medicine

Pub Date : 2024-09-26 DOI: 10.1016/j.socscimed.2024.117370

Despite established efficacy for oral pre-exposure prophylaxis (PrEP) in reducing HIV incidence, multi-level barriers within the health system, clinics, and the processes that shape practice have hindered service delivery and subsequent population-level effects. We applied the Consolidated Framework for Implementation Research (CFIR) to assess the context of PrEP delivery for adolescent girls and young women (AGYW) in rural South Africa and identify the factors supporting and impeding PrEP implementation to develop strategies to improve PrEP delivery. Between 2021 and 2022, we conducted in-depth interviews with five young women with PrEP use experience and 11 healthcare providers as well as four key informant stakeholder interviews. Tailored interviews organized around the CFIR domains provided multiple perspectives on the inter-connected processes, gaps, and opportunities between health systems, clinics, communities, and PrEP services. Shifts in PrEP policies, funding pressures, and inconsistent communications from the National Department of Health spurred fragmented planning, engagement, execution, and monitoring of PrEP delivery processes within clinics already struggling to address multiple population health needs. Resulting challenges included: conflicting priorities within clinics and across NGO partners, unclear goals and targets, staffing and space constraints, and insufficient community engagement. Individual clinics’ implementation climate and readiness to deliver PrEP varied in terms of operational plans and delivery models. Interviewees reported complexity of initiation procedures and support for PrEP maintenance, with opportunities to improve systems communications and processes to facilitate integrated services and more user-friendly experiences. Applying CFIR identified opportunities to strengthen PrEP delivery across levels within this complex service delivery setting.

尽管口服暴露前预防疗法（PrEP）在降低艾滋病发病率方面具有公认的疗效，但卫生系统、诊所和实践过程中存在的多层次障碍阻碍了服务的提供以及随后在人群中产生的影响。我们采用实施研究综合框架（CFIR）来评估南非农村地区为少女和年轻女性（AGYW）提供 PrEP 的情况，并确定支持和阻碍 PrEP 实施的因素，从而制定改善 PrEP 实施的策略。2021 年至 2022 年期间，我们对 5 名有 PrEP 使用经验的年轻女性和 11 名医疗服务提供者进行了深入访谈，并对 4 名利益相关者进行了关键信息访谈。围绕 CFIR 领域组织的定制访谈为医疗系统、诊所、社区和 PrEP 服务之间相互关联的流程、差距和机遇提供了多种视角。PrEP 政策的转变、资金压力以及来自国家卫生部的不一致沟通，导致诊所内 PrEP 服务的规划、参与、执行和监督过程变得支离破碎，诊所已经在努力满足多种人群健康需求。由此带来的挑战包括：诊所内部和非政府组织合作伙伴之间的优先事项相互冲突、目标和指标不明确、人员和空间限制以及社区参与不足。各诊所的实施氛围和提供 PrEP 的准备情况在运营计划和提供模式方面各不相同。受访者表示，启动程序和对 PrEP 维护的支持都很复杂，有机会改善系统沟通和流程，以促进综合服务和更方便用户的体验。应用 CFIR 发现了在这种复杂的服务提供环境中加强各级 PrEP 服务提供的机会。

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引用次数: 0

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults 开启黑夜：探索夜间步行环境对老年人健康的影响。

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

Social Science & Medicine

Pub Date : 2024-09-26 DOI: 10.1016/j.socscimed.2024.117359

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

步行仍然是中国许多老年人的主要体育锻炼方式，而夜间步行环境的质量可能会决定老年人晚间外出的频率和持续时间。本研究揭示了夜间环境特征如何影响老年人的健康状况。研究利用西安市碑林区一家公共卫生服务机构的 87578 名老年人的体检记录，考察了夜间步行环境在慢性病管理中的作用。良好的夜间步行环境降低了老年人慢性病和合并症的患病率。然而，夜间步行环境对健康的影响具有异质性，仅对高血压和糖尿病等代谢性疾病有显著影响，而对其他疾病的影响并不明显。我们的研究结果是对健康老龄化理论的补充，强调了环境在管理慢性病方面的潜在价值，可作为老龄化社会中一种具有成本效益的健康干预措施。

引用次数: 0

The mitigating effect of social protection on undernourishment during economic downturns: A longitudinal study of 46 low- and middle-income countries over the last two decades 经济衰退期间社会保护对营养不良的缓解作用：对过去二十年 46 个中低收入国家的纵向研究。

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

Social Science & Medicine

Pub Date : 2024-09-26 DOI: 10.1016/j.socscimed.2024.117365

Background

Low- and middle-income countries (LMICs) are particularly vulnerable to the adverse effects of economic downturns on the Prevalence of Undernourishment (PoU). Our study aimed to evaluate the impact of Social Protection and Labor Programs (SPL) on PoU in 46 LMICs from 2001 to 2019, and to estimate SPL mitigating effects during economic downturns.

Methods

This cohort study used a multi-country ecological design with two-ways fixed effects multivariable linear regression models, adjusted for relevant demographic, socioeconomic, and contextual variables. Interaction terms between economic downturns and SPL were used to evaluate SPL mitigating effects.

Findings

Our study cohort displayed an average 15.30% PoU and 34.34% SPL coverage in the initial year, contrasting with 8.58% PoU and 43.81% SPL coverage in the final year. A 10% SPL coverage was associated with a 0.51% PoU reduction (95%CI: 0.04–0.99) across all countries and 0.78% reduction within the poorest subgroup. SPL have been able to prevent an estimated 1.01 billion (95% UI: 0.16–1.86) cases of undernourishment over the study period in the 46 LMICs. Economic downturns were associated with a 4.55% PoU increase (95% CI: 1.28–7.81) in all countries, and a 6.06% PoU increase in the poorest subgroup. High SPL coverage during the downturns had significant mitigating effects, reducing an overall 1.17% PoU for every 10% SPL coverage in all countries, and 1.81% PoU in the poorest nations.

Interpretation

Amid the ongoing multiple global crises, expanding the coverage of social protection could effectively mitigate the potential increases in undernourishment during economic downturns, contributing to the achievement of nutrition-related Sustainable Development Goals in LMICs.

背景：中低收入国家（LMICs）特别容易受到经济衰退对营养不良患病率（PoU）的不利影响。我们的研究旨在评估2001年至2019年期间社会保护和劳工计划（SPL）对46个中低收入国家营养不良患病率的影响，并估计SPL在经济衰退期间的缓解效果：这项队列研究采用了多国生态设计，使用双向固定效应多变量线性回归模型，并对相关人口、社会经济和环境变量进行了调整。经济衰退与 SPL 之间的交互项用于评估 SPL 的缓解效应：我们的研究队列在最初一年的平均PoU和SPL覆盖率分别为15.30%和34.34%，而在最后一年的PoU和SPL覆盖率分别为8.58%和43.81%。在所有国家，10% 的 SPL 覆盖率可使 PoU 降低 0.51%（95%CI：0.04-0.99），而在最贫困的亚群中，PoU 可降低 0.78%。在研究期间，在 46 个低收入和中等收入国家中，SPL 能够预防约 10.1 亿例营养不良（95% UI：0.16-1.86）。在所有国家中，经济衰退导致营养不良人数增加了 4.55%（95% 置信区间：1.28-7.81），而在最贫穷的分组中，营养不良人数增加了 6.06%。在经济衰退期间，SPL 的高覆盖率具有显著的缓解作用，在所有国家，SPL 的覆盖率每提高 10%，PoU 就会降低 1.17%，而在最贫困国家，PoU 则会降低 1.81%：在当前的多重全球危机中，扩大社会保护的覆盖面可有效缓解经济衰退期间营养不良现象的潜在增长，有助于低收入和中等收入国家实现与营养相关的可持续发展目标。

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引用次数: 0

The healthcare support program and healthcare utilization of older adults in ethnic minority areas in Vietnam 越南少数民族地区老年人的医疗保健支持计划和医疗保健利用情况

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

Social Science & Medicine

Pub Date : 2024-09-25 DOI: 10.1016/j.socscimed.2024.117357

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55–74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008 to 2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes.

在过去的几十年里，越南的卫生成果得到了显著改善，为低收入国家在缺乏资源的情况下在公共卫生领域取得重大成就提供了一个范例。然而，穷人、少数民族和其他弱势群体在获得医疗服务方面仍然存在不平等。为解决这一问题，越南政府于 2013 年在少数民族地区实施了一项医疗支持计划。我们研究了该计划对 55-74 岁老年人使用医疗服务的影响。采用差分法和 2008 年至 2018 年越南家庭生活水平调查的数据，我们发现该计划对公立医疗机构的住院就诊率有积极影响。但是，该计划对门诊量没有影响。其他分析显示，该计划增加了乡镇卫生站的门诊量和县级医院的住院量。此外，还有证据表明，私立医疗机构向公立医疗机构转变。我们的研究结果表明，向贫困地区提供医疗资源可以提高老年人对医疗服务的利用率，进而改善他们的健康状况。

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引用次数: 0

Prenatal testing technologies in Australia: Unintended clinical and emotional complexities in underprepared systems 澳大利亚的产前检测技术：准备不足的系统中意想不到的临床和情感复杂性

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

Social Science & Medicine

Pub Date : 2024-09-25 DOI: 10.1016/j.socscimed.2024.117368

The past decade has seen technological advances in prenatal screening technologies rapidly integrated into clinical practice. These technologies have revolutionised healthcare and raised complex socio-ethical issues such as equitable access, medical commercialisation, and new eugenics. However, the important issue of the impact of these technologies on healthcare professionals is receiving less attention. Exploring this issue in the Australian context, we conducted a survey from August to November 2022, targeting health and allied health professionals who work with parents in the perinatal period who have received a fetal diagnosis. We received 75 substantive responses from a diversity of professionals, including sonographers, midwives, genetic counsellors and medical providers.

In this article, we consider the unintended impacts of prenatal screening technologies on healthcare workers, drawing from Ziebland et al., ’s 2021 unintended consequences framework. Our reflexive thematic analysis produced three key themes: “Unintended Clinical Complexities”, “Adapting Work Practices to Keep Up in Systems that Lack”, and “Unintended Intensification of Emotional Labour”. Prenatal testing technologies have intentionally increased early testing and fetal information, offering veiled promises of increased certainty in pregnancy. However, our analysis highlights that these advancing technologies also generate more ambiguous results, creating unintended clinical and emotional complexities for healthcare providers. Workers must manage increased clinical uncertainty and constant change, creating intensified emotional labour in under-prepared systems. We conclude by identifying the need to recognise the impacts of advancing prenatal screening technologies on healthcare workers and for targeted professional training to prepare healthcare professionals for the complexities introduced by these new technologies.

过去十年间，产前筛查技术迅速融入临床实践。这些技术给医疗保健带来了革命性的变化，也引发了复杂的社会伦理问题，如公平获取、医疗商业化和新优生学等。然而，这些技术对医疗保健专业人员的影响这一重要问题却较少受到关注。为了在澳大利亚的背景下探讨这一问题，我们于 2022 年 8 月至 11 月期间进行了一项调查，调查对象是在围产期为接受过胎儿诊断的父母提供服务的医护人员和专职医护人员。我们收到了来自超声波技师、助产士、遗传咨询师和医疗服务提供者等不同专业人士的 75 份实质性回复。在本文中，我们借鉴齐布兰德等人的 2021 意外后果框架，考虑了产前筛查技术对医护人员的意外影响。我们的反思性主题分析产生了三个关键主题："意外的临床复杂性"、"在缺乏系统的情况下调整工作方法以跟上步伐 "和 "意外的情感劳动加剧"。产前检测技术有意识地增加了早期检测和胎儿信息，提供了增加孕期确定性的隐晦承诺。然而，我们的分析强调，这些先进的技术也产生了更多模棱两可的结果，给医疗服务提供者带来了意想不到的临床和情感复杂性。医护人员必须应对不断增加的临床不确定性和持续的变化，从而在准备不足的系统中加剧情绪劳动。最后，我们认为有必要认识到不断进步的产前筛查技术对医护人员的影响，并开展有针对性的专业培训，使医护人员为应对这些新技术带来的复杂性做好准备。

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引用次数: 0

Consubstantialities of resistance: Labor process, (bio)materialities, and pathogenicity 抵抗的实质：劳动过程、（生物）物质性和致病性。

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

Social Science & Medicine

Pub Date : 2024-09-25 DOI: 10.1016/j.socscimed.2024.117349

As social science scholarship has historically documented, social structure and clinical practice are more commonly as contradictory or incoherent as they are often framed. The increasing emphasis on the rise of antimicrobial resistance (AMR) has drawn attention to how social realms of resistance are entrenched and interconnected through varied structural, political, clinical, biological, and ecological relations. In this study, set in São Paulo, Brazil, I sought to unpack relational consubstantialities of AMR within the healthcare labor process and their enfolded (bio)materialities and pathogenicity by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Participants’ accounts reveal how the reproduction of the labor process in primary care foregrounds (bio)material relations in which antimicrobial resistance finds timely and proper coextensive social conditions of reproduction. In their turn, the study results highlight how work intensification relates to economies of scarcity, teamwork coerciveness, AMR virulence and pathogenicity, destabilizing ecological (bio)materialities amid structural and clinical practice interrelations. Building on renewed materialisms of the political economy of health, I propose an approach to complexify understandings of relational interconnectedness of resistance by instilling relational tension lines of objects against their pragmatic reification in health interventions and theory.

正如社会科学学术界历来记载的那样，社会结构和临床实践通常是相互矛盾或不一致的。抗菌药耐药性（AMR）的上升日益受到重视，这引起了人们对耐药性的社会领域如何通过不同的结构、政治、临床、生物和生态关系根深蒂固并相互关联的关注。在这项以巴西圣保罗为背景的研究中，我试图通过 2021 年末至 2023 年初完成的一系列对初级保健医疗专业人员、医疗服务管理人员和政策制定者的访谈，解读 AMR 在医疗保健劳动过程中的关系共性及其所包含的（生物）物质性和致病性。参与者的叙述揭示了初级保健劳动过程的再生产是如何凸显（生物）物质关系的，在这种关系中，抗菌药耐药性找到了适时、适当的共生社会再生产条件。反过来，研究结果强调了工作强度如何与稀缺性经济、团队合作的强制性、AMR 的毒性和致病性相关联，在结构和临床实践的相互关系中破坏生态（生物）物质性的稳定性。在卫生政治经济学的新唯物主义基础上，我提出了一种方法，通过在卫生干预措施和理论中灌输对象的关系张力线，反对将其实用化，从而复杂化对抵抗关系相互关联性的理解。

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引用次数: 0

Debates over the role of Traditional Chinese Medicine on COVID-19: A computational comparison between professionals and laypersons in Chinese online knowledge community COVID-19上关于中医药作用的争论：中文在线知识社区中专业人士和非专业人士的计算比较

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

Social Science & Medicine

Pub Date : 2024-09-24 DOI: 10.1016/j.socscimed.2024.117366

Leveraging a large collection of textual data (N = 21,539) from a Chinese online community, we employed structural topic modeling to investigate the thematic disparities between professionals and laypersons, regarding the effectiveness of Traditional Chinese Medicine (TCM) on COVID-19. Findings reveal that laypersons are the dominant communicators in terms of discussion volume, who often focus on relevant news events, societal or political aspects of TCM. In contrast, professionals keep concentrating on issues related to medical expertise, and do not shift attentions as frequent as laypersons. Despite the dominant influence of professionals on laypersons’ agenda, two-way agenda interactions identified confirm that lay public is empowered to negotiate with elite professionals under certain topics. Our results provide novel insights into the dynamic nature of attentions, behaviors, and relations among prominent communication actors, and encourage future research to examine the individual-level and societal-level impacts of these constructs in the emerging online media landscape.

利用来自中文在线社区的大量文本数据（N = 21,539），我们采用结构主题建模的方法，研究了专业人士和非专业人士在 COVID-19 上关于中医（TCM）疗效的主题差异。研究结果显示，就讨论量而言，非专业人士是主要的传播者，他们通常关注中医药的相关新闻事件、社会或政治方面。与此相反，专业人士一直专注于与医学专业相关的问题，不像非专业人士那样频繁地转移注意力。尽管专业人士在非专业人士的议程中占主导地位，但双向议程互动证实了非专业人士在某些议题上有能力与精英专业人士进行谈判。我们的研究结果提供了有关关注、行为和重要传播参与者之间关系动态性质的新见解，并鼓励未来的研究在新兴的网络媒体环境中考察这些建构在个人层面和社会层面的影响。

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引用次数: 0

Performance feedback in healthcare organizations: The role of accountability measures and competition 医疗机构的绩效反馈：问责措施和竞争的作用。

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

Social Science & Medicine

Pub Date : 2024-09-24 DOI: 10.1016/j.socscimed.2024.117362

This study examines the impact of accountability arrangements in the form of performance feedback on organizational behaviors among healthcare organizations. Specifically, it evaluates the effectiveness of a performance management program implemented in South Korean healthcare settings, focusing on antibiotic prescription patterns. The study presents three key findings. First, significant performance improvement occurred mainly among low performing organizations. Second, public healthcare organizations exhibited greater performance enhancements compared to their private counterparts. Third, organizational responses to performance feedback were more pronounced when robust competition prevailed among the assessed healthcare institutions. This synergy between performance management and competitive environments was primarily evident in private organizations.

本研究探讨了以绩效反馈为形式的问责安排对医疗机构组织行为的影响。具体而言，它评估了在韩国医疗机构实施的绩效管理计划的有效性，重点关注抗生素处方模式。研究提出了三个主要发现。首先，绩效明显改善的主要是绩效较低的医疗机构。其次，与私营医疗机构相比，公立医疗机构的绩效提升幅度更大。第三，当被评估的医疗机构之间竞争激烈时，组织对绩效反馈的反应更为明显。绩效管理与竞争环境之间的协同作用主要体现在私营机构中。

引用次数: 0

Does receipt of social housing impact mental health? Results of a quasi-experimental study in the Greater Toronto Area 获得社会住房会影响心理健康吗？大多伦多地区准实验研究的结果。

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

Social Science & Medicine

Pub Date : 2024-09-24 DOI: 10.1016/j.socscimed.2024.117363

Affordable housing is commonly described as an important determinant of health, but there are relatively few intervention studies of the effects of housing on health. In this paper, we describe the results of a quasi-experimental, longitudinal study investigating the impacts of receiving social housing among a cohort of 502 people on waitlists for social housing in the Greater Toronto Area, Canada. Specifically, we sought to determine if adults who received housing were more likely than a control group to show improvements in depression, psychological distress, and self-rated mental health 6, 12 and 18 months after moving to housing. Amongst the participants, 137 received social housing and completed at least one follow-up interview; 304 participants did not receive housing and completed at least one follow-up interview and were treated as a control group (47 people provided data to both groups). The difference-in-differences technique was used to estimate the effect of receiving housing by comparing changes in the outcomes over time in the housed (intervention) group and the group that remained on the waitlist for social housing (control group). Adjusted mixed effects linear models showed that receiving housing resulted in significant decreases in psychological distress and self-rated mental health between the groups. Improvements in self-rated mental health between the groups were observed 6, 12 and 18 months after receiving housing (6 months, +2.9, p < 0.05; 12 months, +2.6, p < 0.05; 18 months, +3.0, p < 0.05). Reductions in psychological distress (−1.4, p < 0.05) were observed 12 months after receiving housing. Overall findings suggest that receiving subsidized housing improves mental health over a 6-to-18-month time horizon. This has policy and funding implications suggesting a need to reduce wait times and expand access to subsidized housing.

经济适用房通常被描述为健康的重要决定因素，但有关住房对健康影响的干预研究却相对较少。在本文中，我们介绍了一项准实验性纵向研究的结果，该研究调查了加拿大大多伦多地区 502 名社会住房轮候者接受社会住房的影响。具体来说，我们试图确定与对照组相比，获得住房的成年人是否更有可能在搬入住房 6 个月、12 个月和 18 个月后在抑郁、心理困扰和自我心理健康方面有所改善。在参与者中，137 人获得了社会住房，并完成了至少一次后续访谈；304 人没有获得住房，但完成了至少一次后续访谈，被视为对照组（两组均有 47 人提供数据）。通过比较有住房者（干预组）和仍在等待社会住房者（对照组）随着时间推移的结果变化，我们采用了差分法来估计获得住房的效果。调整后的混合效应线性模型显示，获得住房后，两组之间的心理困扰和自评心理健康水平显著下降。在获得住房 6 个月、12 个月和 18 个月后，各组之间的自评心理健康状况均有所改善（6 个月，+2.9，P＜0.05）。

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引用次数: 0