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This article analyzes the link between men's and women's perceptions of health and the demand for health goods and services. The study examines access to the health care system in a community characterized by social and economic variance. The data have been taken from a health survey carried out in a suburb of the city of Zaragoza in Spain. The sample (1,032 people over the age of 15) was selected according to specifications of sex, age, and place of residence. The sample shows a confidence interval of 95.5 percent with a [+ or -] 3 margin of error. Descriptive and inferential statistical techniques are used. Sex differences are reflected in social conditions, lifestyles, health perception, and health care behaviors. The research describes how differences in health attitudes can be contextualized by the neighborhood. The results of this type of research are essential for the design of preventive strategies that are better adapted to need.

More and faster information will transform our experience of healthcare, according to policymakers, while social theorists have argued that medicine has become 'informatized': a new medical paradigm is being shaped. We question both the policy-led conflation of 'information' and 'healthcare' and ideas about the extent of the informatization of medicine, by exploring how these ideas resonate in medical wok revisiting our studies of expertise in two clinical domains where information technologies are central to practice. The projection of new information programmes as creating knowledge which is independent of space and time runs the risk of devaluing the experiential, haptic and affective knowledge of both apprentices and practitioners. Information, we argue, cannot underpin medicine unless it is recognized and defined as generative, dynamic and intimate, rather than storable and deliverable. KEY WORDS human--machine relations / information / intimacy / labour / medicine / mythology / practice

Calls have been issued for understanding the 'contexts' or 'environment' shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social network have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within 'big science' to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point.

This exploratory 2003 study of 261 women in WIC addresses depression and mental-health service utilization in six race/ethnic-immigrant/migrant groups and factors amenable to change. Using the PrimeMD-PHQ, island-born Puerto Rican women had the highest prevalence of subthreshold depressive syndrome (27.8%); African American women had the highest prevalence of major depressive syndrome (21.3%); proportionately more White women used mental-health services (41.9%). The odds for major depressive syndrome among those with no one to help with childcare were almost four times greater than those with help. The odds of mental-health service use among those with indirect exposure to mental-health care were four times greater than those without such exposure. Implications for intervention and further research are discussed. KEYWORDS. Depression, mental-health service utilization, race and ethnicity, immigrant, WIC

Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an 'emergent characteristic' of those areas that predicts the ability of residents to obtain health care.

In 1999-2000, a pilot study was conducted to assess the feasibility of using local historical archives and oral histories to map historical factors that may be important in understanding contemporary variations in health. Focusing on housing clearances in the 1950s, 1960s and 1970s, the pilot study drew on a wide range of materials (documentary and oral) to explore now changes to local housing impacted upon the local social and psychological landscape. This research note considers methodological issues relevant to the use of documentary and oral history resources and illustrates the value of the historical resources we identified, We suggest that, on the basis of this pilot research, future explorations of the link between places and inequalities in health should incorporate an historical analysis. KEY WORDS health inequalities / historical research methods / housing / social capital

Response to domestic violence must be culturally competent and treatment protocols need to be developed for children witnessing domestic violence. Relevant issues include clinical responses to violence in Native American, Latina immigrant, and lesbian, bisexual, and transgender communities.

Methods to develop, implement, and share successful intervention and prevention strategies about domestic violence must become part of public health professionals' training. The Boston University School of Public Health has developed such a course and its results are under ongoing scrutiny.

Lifetime abuse can take the form of past intimate partner violence, recent intimate partner violence, or child abuse. Recently abused women can receive less support from partners than nonabused women, although they have reported comparable support levels from others.

The first obstacle survivors of family violence face is overcoming the psychological barriers to disclosure. A hospital-based domestic violence program has been shown to provide emotional and practical support in such cases.

Domestic violence needs to be recognized and treated in the health care system, preferably through evidence-based care. Issues to confront include legal and ethical issues, prevention, public health, designing relevant research protocols, and outcome measurement.

Welfare states are highly innovative when it comes to dealing with care. The range of policies in place across nations is striking as is the degree to which making provision for care cuts across long-standing principles of social provision. This article focuses on care as a policy good, identifying care as an inherently social activity and linking it with different manifestations in and anticipated outcomes of public policy. Care is developed here as one of the key activities connecting state and society. Making provision for care, it is argued, affects a whole series of societal settlements. A consideration of a number of such settlements helps to identify factors which must be taken into account when we assay the relationship between public policy, care and society. The following are primary considerations: choices around receiving care, the choice to give care, gender equity, the legitimising of care, the welfare mix, public as against private expenditure, the demand for and supply of paid and unpaid labour. Having considered some of the main variations which are to be found in European welfare states' handling of care, the article goes on to conjecture about possible outcomes of a range of policy responses on the basis of the above considerations. All provisions have particular strengths and weaknesses but `quality', understood in a broad sense, is elusive to any single measure.

The development of health services in England is currently shaped by three key factors: the active involvement of front-line health professionals (particularly family doctors--general practitioners) in decisions about resource allocation and service development priorities; the promotion of `partnerships' between health and other organisations in order to deliver `joined-up' services; and the close performance management of organisations and professionals to ensure that they meet externally prescribed objectives and targets. This paper considers the implications and impact of these factors on the development of services for older people. It discusses whether, under these circumstances, health service developments are likely to address some of the most pressing needs of older people. KEY WORDS--Primary care, partnerships, National Service Framework, performance management.

This article discusses health care rationing practices. The authors, exploring power relations, economics, and social practices within the health care system, argue the allocation of limited health care resources can be used to support certain interests against others and maintain rationing is a socially constructed reality.

This article examines the medical treatment of a young Arab girl from an affluent Arab community who was suffering from a severe congenital defect. The author, exploring the social aspects of medical treatment, maintains that even though the family was able to afford sophisticated treatment the girl's illness created conflict between her, her family, and the physicians, resulting in the girl's preference of the care of the staff over being with her family.

This article examines the treatment of the impoverished ill, focusing on a homeless tuberculosis patient who was placed on directly observed therapy. The author, analyzing the notes of a Chicago public health worker, argues that even culturally sensitive and individualized health care cannot overcome the negative health effects of poverty and social inequality.

This study of reports of physical abuse by women in medical clinics identified the barriers to reporting abuse, including time constraints and providers' and patients' attitudes and help-seeking patterns, and the responses that women find most helpful. Feminist principles of organizing - consciousness raising, bottom-up organizing, respect for women's definition of the solution, and awareness of the impact of the political - can help guide interventions with these women.

When older peoples' troubles are categorised as social rather than medical, hospital care can be denied them. Drawing on an ethnography of older people admitted as emergencies to an acute medical unit, the article demonstrates how medical categories can provide shelter for older people. By holding their clinical identity on medical rather than social grounds, physicians who specialise in gerontology in the acute medical domain can help prevent the over-socialising of an older person's health troubles. As well as helping the older person to draw certain resources to themselves, such as treatment and care, this inclusion in positive medical categories can provide shelter for the older person, to keep at bay their effacement as 'social problems'. These findings suggest that contemporary sociological critique of biomedicine may underestimate how medical categorising, as the obligatory passage through which to access important resources and life chances, can constitute a process of social inclusion.

Two measures of social stratification in the UK, the Registrar-General's Social Class schema and the Cambridge Scale, are compared in relation to inequalities in health and mortality. Topics include the conceptualization and measurement of social stratification and the correlations among stratification, lifestyle and disease.

Social work has historically played an important role in the community clinic movement, and the current re-emergence of this movement is re-creating and redefining a pertinent role for social work. In the current managed care era, community care clinics can offer services to those who may otherwise be overlooked. There are two major roles for the social work interdisciplinary team member: biopsychosocial screening and activating the community to meet its members' needs. The concept of interdisciplinary care can be positively used under managed care systems. The Vine Hill Clinic has accomplished both of these goals through the creative and appropriate use of social work expertise. Key words: community clinic; health; interdisciplinary teams; managed care; primary care, Managed care, as a cost-containing system of health care administration, is here to stay. However, this system can leave the most vulnerable populations - poor people, people of color, women [...]

This paper offers an analysis of the events surrounding the suspension of the licence for the widely used sleeping tablet Halcion (triazolam) by the British Licensing Authority in October 1991. It is argued that these events highlight a growing crisis in modern medical treatments and in the social relations of health care. This is illustrated by focusing on four elements which have contributed to Halcion becoming a public issue and to its suspension and subsequent banning, namely the claims-making activities of medical experts, the development of legal challenges to medicine, the role of the media and the response of the state.

Objective. Prior research has identified a number of barriers to health access for Hispanics, including socioeconomic factors, language and cultural differences, and constraints on access. Yet, despite these problems, Hispanic health as reflected in low birthweight and infant mortality rates compares favorably with more socioeconomically advantaged groups. The purpose of this research is to provide additional understanding of why this occurs. Methods. This issue is addressed by using national linked birth/infant death records to assess the influence of a set of sociodemographic and medical care variables on prematurity, low birthweight, and mortality for five Hispanic subgroups: Cubans, Mexicans, Puerto Ricans, Central/South Americans, and others. Results. Hispanic subgroups differ significantly on these measures of suboptimal birth outcomes. The most consistent finding relates to the relatively advantaged position of Cuban Americans and the relatively disadvantaged position of Puerto Ricans. Multivariate models indicate that while some of these differences are due, in part, to sociodemographic profiles, important differences remain even when controlling for these factors. Conclusions. These findings suggest that the groups require separate treatment in future research both because of differences in outcomes and because the predictors of those outcomes vary from one group to another.

UK welfare policies have a significant impact on carework, caregiving work and professional care. Feminists say the celebration of masculinity in medical care limits the potential of public carework. In this analysis, it is suggested that dichotomies in medical care can be transcended. Masculine managerialism must give way to feminine care to give the public more competent health care.

We use the 1990 National Health Interview Survey supplement on Family Resources to examine the health care utilization patterns of immigrant and native-born adults in the United States. We modify a standard health care utilization framework by including duration of residence in the United States and measures of immigrant adaptation and family health context to model both the probability and number of physician contacts in the previous year. We find that duration of residence has a strong effect. Recently-arrived immigrants are much less likely to have had a contact in the previous year and had fewer contacts than either native-born or longer-term immigrant adults. Once the measures of adaptation - age at immigration and language of survey interview - are included, immigrants who have been in the United States for 10 years or more are not statistically different from the native-born. Family characteristics, including measures of exposure to the formal health care system, slightly reduce the size of the effects but do not alter the basic relationship between duration of residence and health care utilization. These results suggest that, net of socioeconomic characteristics, access to health insurance, and differences in morbidity, recent immigrants are much less likely than both the native-born and those immigrants of longer duration, to receive timely health care.

Recent government policy in the UK National Health Service (NHS) has carried with it an implicit assumption that greater consumer involvement in health care is both desirable and beneficial. This may be the case in theory, but in practice there are substantial barriers to consumers becoming more involved in health care. Following a consideration of the role the government envisages for consumers in the NHS, the extent to which it is possible for consumers to fulfil this role, and more fundamentally whether they want to fulfil it, are discussed. It is argued that because of the extent of the breakdown of consumer sovereignty in health care, the doctor-patient (agency) relationship assumes a particularly important role. The theory of agency and its application to health care is then discussed and a number of important issues highlighted. A review of the literature on the extent of consumer involvement in health care precedes the conclusion in which the key issues raised in the article are brought together.

Health Care Financing Administration (HCFA) is planning to further empower its beneficiaries by increasing the choices available to them and by providing more information. HCFA is the biggest customer of the Health Maintenance Organization (HMO) services because it enrolls more than 5 mil people through Medicare and Medicaid. This marks a 30% increase since 1992. Managed care organizations and HCFA should work together to provide the maximum possible services to elderly beneficiaries.

In this paper I investigate emotional labour in the field of nursing. I show how new ideologies of health promotion have become attached to the prior agenda and already-embedded relationships which structure health provision. Beginning with an outline of health promotion principles and policies the paper goes on to trace how the radical dimensions of health promotion philosophies are subverted in practice by discussing data from a research project into nursing roles in health promotion. I present the data to show how nursing's focus on relationships and relationship skills create divisions of knowledge and information between 'expert' discourses located in the institutions of health provision and the everyday agenda of the populations using their services. In the final section of the paper I argue that a focus on the deployment of emotion work in specific social and institutional contexts provides a perspective on emotions as resources that are consciously drawn upon by actors in order to achieve socio-cultural and wider political ends.

What economists can learn from sociologists with regard to the economic theory of agency in health care is considered. Whilst the concept of agency has become widely accepted in health economics, its application to the doctor-patient relationship remains somewhat limited. Research is needed on the nature of the patient's and doctor's utility functions before an efficient outcome in health care can be achieved. Economists have much to learn from sociologists concerning the nature of patient's and doctor's utility functions. Only when economists take account of this literature will moves towards an efficient outcome in health care be achieved.

The consumer health movement has its roots in the general consumer movement started by Ralph Nader in the late 1960s and the women's health movement of the early 1970s. But [...]

The satisfaction with the amount as well as quality of the fee-based medical services provided the potential for increasing the market of these services. The most important criteria for choosing a particular medical institution are presented based on a study of the population of twenty large cities in Krasnodar Krai.

The article examines ways in which the home is changed when health care practices and standards are introduced via long-term home care. Main themes identified are the maintenance of cleanliness and order, politics of aesthetics, and transcending a home's limitations.

The development and implementation process of the program, which emphasizes the effectiveness of rural generalist practice in enhancing service delivery in the rural environment, is described. The generalist social worker is skilled in providing opportunities for preventative supports, education to clients and health care professionals regarding behavioral health needs, stressors, and systems, and early intervention and treatment options.

This study is based on transcriptions of twenty-one audiotaped encounters between patients with breast cancer and their oncologists. Using a conversation analytic approach, findings reveal how oncologists invoke a clinical agenda to postpone response to certain patient questions or to mark them retroactively as 'out of order.' These deferral actions take the shape of 'pre-insert expansions' in which the physician mentions an activity to be performed (e.g. the physical exam) prior to actually initiating the activity. Once this clinical exigency has been invoked, patients do not pursue their questions further. They thereby relinquish their request for information and 'accept' that answers will be forthcoming. Thus, the oncologist uses the clinical agenda as a resource for managing the direction of the talk, and patients orient collaboratively to that agenda.

Research is presented describing the economic and social study of the US medical care system and the role played by the US Department of Veteran Affairs, which operates medical centers for vulnerable patients who are often excluded from medical cover through the use of patient dumping practices.