Assess the impact of heavy drinking on homicide and suicide mortality in Russia between 1956 and 2002. MEASURES AND DESIGN: Alcohol-related mortality was used as a proxy for heavy drinking. We used autoregressive integrated moving average techniques to model total and sex-specific alcohol-homicide and alcohol-suicide relationships at the population level.
We found a positive and significant contemporaneous association between alcohol and homicide and between alcohol and suicide. We found no evidence of lagged relationships. These results held for overall and sex-specific associations.
Our results lend convergent validity to the alcohol-suicide link in Russia found by Nemtsov and to the alcohol-homicide associations found in cross-sectional analyses of Russia. Levels of alcohol consumption, homicide and suicide in Russia are among the highest in the world, and the mounting evidence of the damaging effects of consumption on the social fabric of the country reveals the need for intervention at multiple levels.
Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas. Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of possible causes. American Indians joined these debates, often suggesting different explanations. Europeans and Americans also struggled to respond to the disparities, sometimes working to relieve them, sometimes taking advantage of the ill health of American Indians. Economic and political interests have always affected both explanations of health disparities and responses to them, influencing which explanations were emphasized and which interventions were pursued. Tensions also appear in ongoing debates about the contributions of genetic and socioeconomic forces to the pervasive health disparities. Understanding how these economic and political forces have operated historically can explain both the persistence of the health disparities and the controversies that surround them.
Institute of Work, Health & Organisations, University of Nottingham, 8 William Lee Buildings, Nottingham Science and Technology Park, University Boulevard, Nottingham NG7 2RQ, UK. email@example.com
Prior studies on social capital and health have assessed social capital in residential neighbourhoods and communities, but the question whether the concept should also be applicable in workplaces has been raised. The present study reports on the psychometric properties of an 8-item measure of social capital at work.
Data were derived from the Finnish Public Sector Study (N = 48,592) collected in 2000-2002. Based on face validity, an expert unfamiliar with the data selected 8 questionnaire items from the available items for a scale of social capital. Reliability analysis included tests of internal consistency, item-total correlations, and within-unit (interrater) agreement by rwg index. The associations with theoretically related and unrelated constructs were examined to assess convergent and divergent validity (construct validity). Criterion-related validity was explored with respect to self-rated health using multilevel logistic regression models. The effects of individual level and work unit level social capital were modelled on self-rated health.
The internal consistency of the scale was good (Cronbach's alpha = 0.88). The rwg index was 0.88, which indicates a significant within-unit agreement. The scale was associated with, but not redundant to, conceptually close constructs such as procedural justice, job control, and effort-reward imbalance. Its associations with conceptually more distant concepts, such as trait anxiety and magnitude of change in work, were weaker. In multilevel models, significantly elevated age adjusted odds ratios (ORs) of poor self-rated health (OR = 2.42, 95% confidence interval (CI): 2.24-2.61 for the women and OR = 2.99, 95% CI: 2.56-3.50 for the men) were observed for the employees in the lowest vs. highest quartile of individual level social capital. In addition, low social capital at the work unit level was associated with a higher likelihood of poor self-rated health.
Psychometric techniques show our 8-item measure of social capital to be a valid tool reflecting the construct and displaying the postulated links with other variables.
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Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of 'community' presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments' responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.
This article reviews evolution of the recovery paradigm in Canadian mental health. We first trace the origins and development of the recovery concept through the literature, followed by an examination of how the recovery concept has been implemented in national and provincial mental health policy since publication of the 2006 Kirby Commission Report. Based on consultations with Canadian policymakers, and an examination of available policy documents, we explore how the dual theme of 'recovery' and 'well-being', adopted by the Mental Health Commission of Canada in its 2009 strategy: Toward Recovery and Well-being - A Framework For a Mental Health Strategy has subsequently played out in mental health policymaking at the provincial level. Findings reveal mixed support for recovery as a guiding principle for mental health reform in Canada. While policies in some provinces reflect widespread support for recovery, and strong identification with the aspirations of the consumer movement; other provinces have shifted to population-based, wellness paradigms that privilege evidence-based services and professional expertise. The recognition of social equality for people who experience mental illness emerges as an important value in Canadian mental health policy, cutting across the conceptual divide between recovery and well-being.
Drawing on self-prediction theory and the positive benefits of increasing health service user participation in risk assessments, the Transition Inventory (TI) was developed. It is an aid to the assessment of areas that people anticipate will be of difficulty in the next stage of transition, for example from open hospital to the community.
The aim of this paper is to determine reliability and convergent/discriminant validity data for the TI and its subscales, including behavioral impulsivity, social pressure, substance misuse, financial/employment, leisure, negative affect, interpersonal and family concerns and social alienation.
Eighty-eight male offenders coming towards the end of a period of imprisonment were asked to complete the TI. Their results were compared with the staff-rated Measures of Criminal Attitudes and Associates (MCAA) scale, alcohol blame and causation of crime items. Comparisons with the MCAA's antisocial intent scale, which is a future-orientated scale, and the associates scale allowed for convergent/discriminant validity to be examined with TI scales. With a community offender sample, TI results were used to predict researcher ratings.
The TI scales demonstrated adequate internal consistency. Overall, the MCAA's antisocial intent scale had higher correlations with the TI than with a nonfuture-orientated scale. TI scales also demonstrated convergent validity with other measures and preliminary predictive validity with researcher ratings.
The TI provides a way to increase service user involvement in the assessments that determine when and how they transfer to settings where they will have more independence.
Agency and communion are fundamental human motives, often conceptualized as being in tension. This study examines the notion that moral exemplars overcome this tension and adaptively integrate these 2 motives within their personality. Participants were 25 moral exemplars-recipients of a national award for extraordinary volunteerism-and 25 demographically matched comparison participants. Each participant responded to a life review interview and provided a list of personal strivings, which were coded for themes of agency and communion; interviews were also coded for the relationship between agency and communion. Results consistently indicated that exemplars not only had both more agency and communion than did comparison participants but were also more likely to integrate these themes within their personality. Consistent with our claim that enlightened self-interest is driving this phenomenon, this effect was evident only when agency and communion were conceptualized in terms of promoting interests (of the self and others, respectively) and not in terms of psychological distance (from others) and only when the interaction was observed with a person approach and not with the traditional variable approach. After providing a conceptual replication of these results using different measures elicited in different contexts and relying on different coding procedures, we addressed and dismissed various alternative explanations, including chance co-occurrence and generalized complexity. These results provide the first reliable evidence of the integration of motives of agency and communion in moral personality.
Non-Western cleaners have been shown to have poorer health than their Danish colleagues. One reason could be a poorer psychosocial work environment. However, it is unknown if differences in self-reported psychosocial work environment exist between non-Western and Danish workers within the same social class. The aim of this study was to investigate such differences among cleaners with the hypothesis that the non-Western compared with Danish cleaners would report a generally poorer psychosocial work environment.
Two hundred and eighty-five cleaners (148 Danes and 137 non-Western immigrants) from 9 workplaces in Denmark participated in this cross-sectional study. The cleaners' immigrant status was tested for association with psychosocial work environment scales from the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ) using ordinal logistic regression.
Models adjusted for age, sex, BMI, smoking, workplace, and perceived physical work exertion showed that non-Western cleaners compared with Danish cleaners reported significantly higher scores with regard to Predictability (OR = 3.97), Recognition (OR = 1.92), Quality of Leadership (OR = 1.81), Trust Regarding Management (OR = 1.72), and Justice (OR = 2.14).
This study showed that non-Western immigrant cleaners reported a statistically significantly better psychosocial work environment than Danish cleaners on a number of scales. Therefore, the hypothesis of non-Western immigrants reporting worse psychosocial work environment than their Danish colleagues was not supported.
The aim of the present paper is to present the development of the second version of the Copenhagen Psychosocial Questionnaire (COPSOQ II).
The development of COPSOQ II took place in five main steps: (1) We considered practical experience from the use of COPSOQ I, in particular feedback from workplace studies where the questionnaire had been used; (2) All scales concerning workplace factors in COPSOQ I were analyzed for differential item functioning (DIF) with regard to gender, age and occupational status; (3) A test version of COPSOQ II including new scales and items was developed and tested in a representative sample of working Danes between 20 and 59 years of age. In all, 3,517 Danish employees participated in the study. The overall response rate was 60.4%; (4) Based on psychometric analyses, the final questionnaire was developed; and (5) Criteria-related validity of the new scales was tested.
The development of COPSOQ II resulted in a questionnaire with 41 scales and 127 items. New scales on values at the workplace were introduced including scales on Trust, Justice and Social inclusiveness. Scales on Variation, Work pace, Recognition, Work-family conflicts and items on offensive behaviour were also added. New scales regarding health symptoms included: Burnout, Stress, Sleeping troubles and Depressive symptoms. In general, the new scales showed good criteria validity. All in all, 57% of the items of COPSOQ I were retained in COPSOQ II.
The COPSOQ I concept has been further developed and new validated scales have been included.
This ethnographic study describes the results of a collaborative journaling process that occurred between a student and his instructor of a second-year social work communications course. Many questions from the student's and the instructor's perspectives are raised regarding accommodating the student with a severe speech impairment in a course that specifically focuses on communication skills. Preliminary recommendations are made for social work students and professionals with communication limitations, and for social work educators.
Considerations of equity in the context of health care systems are often related closely to the presence or level of prices incurred by users of health care services. Some politicians and commentators have suggested that the removal of user charges under the Canadian health care system has led to equal access to care. But it is not clear that the equity principle inferred from these claims corresponds to the equity goals of current Canadian health policy. In this article the authors identify the precise equity principle that lies behind current health policy in Canada and consider the extent to which that principle is reflected in the performance of the system. They then consider other approaches to equity in health care in the context of the stated objectives of Canadian health policy and identify the implications of pursuing reasonable access in future health policy. The authors suggest that the implications of the current equity goals have not been recognized by policy makers, and if they were to be recognized it is not clear that they would be acceptable to Canadian populations and/or policy makers. Moreover, some of the implications would appear to be incompatible with other stated objectives of public policy.
Comment In: Int J Health Serv. 1994;24(2):373-58034399
Comment In: Int J Health Serv. 1994;24(2):371-28034398
Healthcare benefits are provided universally to all Canadians through a national healthcare system with provincial differences. A history of the manner in which healthcare issues have been understood in different historical and constitutional periods reveals the ever present inequalities in many aspects of healthcare delivery.
This study examined the relationship between potential childhood risk factors and social phobia in an epidemiological sample. Identifying risk factors such as childhood adversities can often uncover important clues as to the aetiology of a disorder. This information also enables health care providers to predict which individuals are most likely to develop the disorder.
Data came from the Mental Health Supplement to the Ontario Health Survey of a survey of 8116 Canadian respondents, aged 15-64. Social phobia was diagnosed using the Composite International Diagnostic Interview (CIDI). Childhood risk factors were assessed by a series of standardized questions.
A positive relationship was observed between social phobia and lack of close relationship with an adult, not being first born (in males only), marital conflict in the family of origin, parental history of mental disorder, moving more than three times as a child, juvenile justice and child welfare involvement, running away from home, childhood physical and sexual abuse, failing a grade, requirement of special education before age 9 and dropping out of high school. Many of these variables remained significant after controlling for phobias, major depressive disorder and alcohol abuse. The data also suggest that some childhood risk factors may interact with gender to influence the development of social phobia.
Although an association was detected between social phobia and childhood risk factors, naturalistic prospective studies are needed to clarify the aetiological importance of these and other potential risk factors for the disorder.
During the past several years, budget cuts have forced hospitals in several countries to change the way they deliver care. Gilson (Gilson, L. (1998).
In defence and pursuit of equity. Social Science & Medicine, 47(12), 1891-1896) has argued that, while health reforms are designed to improve efficiency, they have considerable potential to harm equity in the delivery of health care services. It is essential to monitor the impact of health reforms, not only to ensure the balance between equity and efficiency, but also to determine the effect of reforms on such things as access to care and the quality of care delivered. This paper proposes a framework for monitoring these and other indicators that may be affected by health care reform. Application of this framework is illustrated with data from Winnipeg, Manitoba, Canada. Despite the closure of almost 24% of the hospital beds in Winnipeg between 1992 and 1996, access to care and quality of care remained generally unchanged. Improvements in efficiency occurred without harming the equitable delivery of health care services. Given our increasing understanding of the weak links between health care and health, improving efficiency within the health care system may actually be a prerequisite for addressing equity issues in health.
An overview of the role that social determinants of health play in influencing health is provided. Emphasis is on the impact of economic inequality in creating health inequities among Americans. Economic inequality is seen as impacting health in three ways: increasing economic inequality weakens population health by creating poverty; weakening communal social structures that support health such as social and health services; and decreasing social cohesion and civil commitment. Documentation is provided of the growing degree of economic inequality in the USA and complicating issues of racial segregation are considered. Specific recommendations for addressing economic inequality, from USA, British, and Canadian sources, are presented. These recommendations indicate the need to move from epidemiologic research to public health action, from demonstrating the major impact of economic inequality on community health to the development and implementation of specific policies and programs to reverse the continuing increase in economic inequality.
Swedish welfare has for decades served as a role model for universalistic welfare. When the economic recession hit Swedish economy in the beginning of the 1990s, a period of more than 50 years of continuous expansion and reforms in the welfare sector came to an end. Summing up the past decade, we can see that the economic downturn enforced rationing measures in most parts of the welfare state, although most of this took place in the beginning of the decade. Today, most of the retrenchment has stopped and in some areas we can see tendencies of restoration--but more so in financial benefits than in the caring sectors. In the article this process is discussed as a process of reallocation where general principles of solidarity become manifest. Various levels of decision making are discussed within the context of socio-political action. Current transitions in Swedish health care are described with respect to coverage rates, content, marketization and distribution. Basic principles of distribution are highlighted in order to analyse the meaning of social solidarity in a concrete allocative setting. The significance of popular opinion--it's shifts and determinants--is also considered. The article concludes with a discussion of how the (once salient) features of universalism in welfare and health care provision have been affected by the developments in the past decade in Sweden.