Seeing social position: visualizing class in life and death

Outpatients satisfaction and perceptions toward pharmaceutical services in public and private hospitals in Palestine: a cross-sectional study

BACKGROUND

Pharmaceutical care is an essential component of healthcare services, and patient satisfaction with these services is crucial for improving overall health outcomes. We aimed to evaluate patient satisfaction and perception with pharmaceutical care services provided at public and private hospitals for outpatient pharmacies. This study can provide insights into the quality of pharmaceutical services provided in both settings and identify areas for improvement.

MATERIALS AND METHODS

A cross-sectional 1-month study was conducted in three hospitals in Nablus city in the Northern District of West Bank, Palestine. Participants were a convenience sample of outpatients who attended the study-selected hospitals (two public and one private). A sample of 30 patients from each hospital was selected with a total of 90 patients. A self-administered questionnaire was used to assess socio-demographics pharmacist-related issues, waiting and working time, and medication availability.

RESULTS

A total of 90 patients were recruited. The overall level of patient satisfaction with pharmaceutical health services was moderate with a mean of 3.24 out of 5. Females represented 58.9%. The most prevalent age was (30-39) years (30%). There was a statistically significant difference in patient satisfaction with pharmaceutical services regarding working time between the morning and evening shifts (p value = 0.009) in favor of morning shift. No statistically significant differences in satisfaction with pharmaceutical treatments based on socio-demographics (age, gender, marital status, education level, family income, employment status, and living place), were found. Nearly, 70% of patients indicated having problems getting the medicine on their last visit to the hospital pharmacy. Only 66.7% of patients expressed satisfaction with the pharmacies' operating (working) hours.

CONCLUSIONS

Patient satisfaction with pharmaceutical care services could be enhanced by involving pharmacists in patient-oriented training and informing patients about the role of pharmacists. Patient satisfaction in the evening shift might be improved by establishing a system for continuous evaluation and improvement of pharmaceutical care services in hospitals to ensure the highest quality of care for patients in addition to implementing technology such as electronic prescribing and medication management systems that can improve the accuracy and efficiency of pharmaceutical services in hospitals.

Tombstone size and life expectancy: a cross-sectional analysis of cemetery data before the turn of the century

The extent to which socioeconomic status was associated with life expectancy in the 19^th and early part of the twentieth century is poorly understood. We sought to determine the association between a deceased individual's tombstone size, a potential marker of socioeconomic status, and their age of death in the late modern period. We conducted a cross-sectional study of 276 deceased individuals buried between 1820 and 1992 in a large cemetery in Quebec, Canada. The main outcome measure was age of death. We used generalized linear models adjusted for sex, marital status, and year of death to determine whether tombstone height and volume were associated with a greater number of years lived. Tombstone height and volume were associated with an older age of death in adjusted regression models. Individuals with tall tombstones lived 9.6 years longer than those with short tombstones (95% confidence interval, CI 3.9 to 15.4). Individuals with large volume tombstones lived 6.2 years longer than those with small tombstones (95% CI 1.7 to 10.8). Our findings indicate that in the 1800s and early 1900s, tombstone size was strongly associated with age of death. A possible explanation for this occurrence is that wealthy individuals, capable of purchasing more sizeable tombstones, were more likely to live a longer and healthier life.

Patient satisfaction with pharmaceutical services in Brazilian primary health care

OBJECTIVE

To evaluate patient satisfaction with pharmaceutical services in Brazilian primary health care.

METHODS

This is a cross-sectional, exploratory, and evaluative study on a representative sample from the five Brazilian geopolitical regions resulting from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The outcome was the patient's satisfaction, obtained using the item response theory. Associations were tested using Pearson's Chi-square test with sociodemographic and health variables, and multiple logistic regression analyses were carried out. The Hosmer-Lemeshow test was used to verify the adequacy of the final model. Logistic regression results were presented as odds ratio.

RESULTS

The overall percentage of patients satisfied with these services was 58.4% (95%CI 54.4-62.3). The "opportunity/convenience" aspect had the lowest satisfaction percentage (49.5%; 95%CI 46.4-52.6) and "interpersonal aspects," the highest percentage (90.5%; 95%CI 88.9-91.8), significantly higher than other aspects. Sex, age group, limitations due to disease, and self-perception of health remained associated in the final multiple logistic model regarding general satisfaction.

CONCLUSIONS

Most of the interviewed users were satisfied with pharmaceutical services in Brazilian cities, and the satisfaction with the customer's service was determinant in the patient's overall satisfaction.

The social brain meets the reactive genome: neuroscience, epigenetics and the new social biology

The rise of molecular epigenetics over the last few years promises to bring the discourse about the sociality and susceptibility to environmental influences of the brain to an entirely new level. Epigenetics deals with molecular mechanisms such as gene expression, which may embed in the organism "memories" of social experiences and environmental exposures. These changes in gene expression may be transmitted across generations without changes in the DNA sequence. Epigenetics is the most advanced example of the new postgenomic and context-dependent view of the gene that is making its way into contemporary biology. In my article I will use the current emergence of epigenetics and its link with neuroscience research as an example of the new, and in a way unprecedented, sociality of contemporary biology. After a review of the most important developments of epigenetic research, and some of its links with neuroscience, in the second part I reflect on the novel challenges that epigenetics presents for the social sciences for a re-conceptualization of the link between the biological and the social in a postgenomic age. Although epigenetics remains a contested, hyped, and often uncritical terrain, I claim that especially when conceptualized in broader non-genecentric frameworks, it has a genuine potential to reformulate the ossified biology/society debate.

Income-related health inequalities: does perceived discrimination matter?

OBJECTIVES

Because of their meritocratic ideology, Western countries might promote the belief that every individual is responsible for his or her socioeconomic position. These beliefs might enhance discrimination which, in turn, might affect health. Therefore, the aim of the study was to investigate the role of perceived discrimination within income-related health inequalities.

METHODS

Two-year follow-up data (2008-2010) from the Dutch Longitudinal Internet Studies for the Social sciences panel (N = 2,139) were used to examine the relation between income, perceived discrimination, and self-rated health and feeling hindered by health problems.

RESULTS

Results showed that poor health was more prevalent in the low income and in the discriminated group. Participants from the low income group were also more likely to perceive discrimination (OR = 1.57, 95 % CI = 1.03-2.42). However, there was no substantial evidence for a mediating effect of perceived discrimination on the income-health association.

CONCLUSIONS

The results emphasise the importance of a more in-depth study of discrimination in relation to socioeconomic health inequalities. Since ethnicity was a major confounder, it is recommended to take account of the complex interplay between discrimination and both the socioeconomic and ethnic background.

Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: a fundamental cause of disease approach

Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one's access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival. Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced. Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994-1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.

Body mass index in urban Canada: neighborhood and metropolitan area effects

OBJECTIVES

We investigated the influence of neighborhood and metropolitan area characteristics on body mass index (BMI) in urban Canada in 2001.

METHODS

We conducted a multilevel analysis with data collected from a cross-sectional survey of men and women nested in neighborhoods and metropolitan areas in urban Canada during 2001.

RESULTS

After we controlled for individual sociodemographic characteristics and behaviors, the average BMIs of residents of neighborhoods in which a large proportion of individuals had less than a high school education were higher than those BMIs of residents in neighborhoods with small proportions of such individuals (P< .01). Living in a neighborhood with a high proportion of recent immigrants was associated with lower BMI for men (P<.01), but not for women. Neighborhood dwelling density was not associated with BMI for either gender. Metropolitan sprawl was associated with higher BMI for men (P=.02), but the effect was not significant for women (P= .09).

CONCLUSIONS

BMI is strongly patterned by an individual's social position in urban Canada. A neighborhood's social condition has an incremental influence on the average BMI of its residents. However, BMI is not influenced by dwelling density. Metropolitan sprawl is associated with higher BMI for Canadian men, which supports recent evidence of this same association among American men. Individuals and their environments collectively influence BMI in urban Canada.

Desempenho do PSF no Sul e no Nordeste do Brasil: avaliação institucional e epidemiológica da Atenção Básica à Saúde

A pesquisa, desenvolvida dentro dos Estudos de Linha de Base do Proesf analisou o desempenho do Programa Saúde da Família (PSF) em 41 municípios dos Estados de Alagoas, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, Rio Grande do Sul e Santa Catarina. Utilizou delineamento transversal, com grupo de comparação externo (atenção básica tradicional). Entrevistou 41 presidentes de Conselhos Municipais de Saúde, 29 secretários municipais de Saúde e 32 coordenadores de Atenção Básica. Foram caracterizados a estrutura e o processo de trabalho em 234 Unidades Básicas de Saúde (UBS), incluindo 4.749 trabalhadores de saúde; 4.079 crianças; 3.945 mulheres; 4.060 adultos e 4.006 idosos. O controle de qualidade alcançou 6% dos domicílios amostrados. A cobertura do PSF de 1999 a 2004 cresceu mais no Nordeste do que no Sul. Menos da metade dos trabalhadores ingressaram por concurso público e o trabalho precário foi maior no PSF do que em UBS tradicionais. Os achados sugerem um desempenho da Atenção Básica à Saúde (ABS) ainda distante das prescrições do SUS. Menos da metade da demanda potencial utilizou a UBS de sua área de abrangência. A oferta de ações de saúde, a sua utilização e o contato por ações programáticas foram mais adequados no PSF.

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

Both subjective and objective measures of lower social position have been shown to be associated with poorer health. A psychosocial, as opposed to material, aetiology of health inequalities predicts that subjective social status should be a stronger determinant of health than objective social position. In a workplace based prospective study of 5232 Scottish men recruited in the early 1970s and followed up for 25 years we examined the association between objective and subjective indices of social position, perceived psychological stress, cardiovascular disease risk factors and subsequent health. Lower social position, whether indexed by more objective or more subjective measures, was consistently associated with an adverse profile of established disease risk factors. Perceived stress showed the opposite association. The main subjective social position measure used was based on individual perceptions of workplace status (as well as their actual occupation, men were asked whether they saw themselves as "employees", "foremen", or "managers"). Compared to foremen, employees had a small and imprecisely estimated increased risk of all cause mortality, whereas managers had a more marked decreased risk. The strongest predictors of increased mortality were father's manual as opposed to non-manual occupation; lack of car access and shorter stature, (an indicator of material deprivation in childhood). In the fully adjusted analyses, perceived work-place status was only weakly associated with mortality. In this population it appears that objective material circumstances, particularly in early life, are a more important determinant of health than perceptions of relative status. Conversely, higher perceived stress was not associated with poorer health, presumably because, in this population, higher stress was not associated with material disadvantage. Together these findings suggest that, rather than targeting perceptions of disadvantage and associated negative emotions, interventions to reduce health inequalities should aim to reduce objective material disadvantage, particularly that experienced in early life.