Understanding how market demand influences academic research is crucial for comprehending the innovation process and informing policy decisions. This study examines the impact of the 2003 Medicare Part D legislation on biomedical journal article production across diseases. Using a difference-in-differences framework, together with a sample of over 2 million original research articles published between 1987 and 2015 sourced from PubMed database, I find a relatively 18.5% increase in academic publications on diseases more common among Medicare beneficiaries, indicating responsiveness to market demand. Further analysis shows that non-government funding significantly contributed to this increase. However, these additional publications tend to be of lower quality, as measured by citations, patent citations, and journal impact factors. This suggests a trade-off between the quantity and quality of research outputs. Overall, this paper highlights how market demand influences academic production, demonstrating that healthcare policy changes, such as Medicare Part D, can spur academic research output and reshape research focus. Policymakers should consider these spillover effects to balance research quantity and quality while ensuring equitable benefits.

Despite extensive research on the impact of grandchild care on grandparents' well-being, no studies have examined the frequency of activities that grandparents engage in with their grandchildren or the reasons for care using nationally representative data. We address this gap using waves 8 (2016/2017) and 9 (2018/19) of the English Longitudinal Study of Ageing, a nationally representative study of English older adults. We employ hybrid regression models to distinguish between within- and between-individual effects on grandparents' subjective wellbeing, as captured by quality of life and depressive symptoms. Our findings show that the mostly positive relationships between frequency of grandparental activities and reasons for care and well-being are largely due to between-grandparent differences rather than within-grandparent changes over time. Within-grandparent analyses show a mostly non-significant impact of increased grandparental activities on well-being, except for a detrimental effect when grandchildren stay overnight or are cared for when sick. The influence of reasons for care are more nuanced. Changes in reasons, such as giving parents a break or allowing them to go out in the evening, are significantly associated with a worsening of elevated depressive symptoms. Conversely, changes such as helping grandchildren develop as people or feeling engaged with young people improve the quality of life for the same grandparents over time. When grandparental care is provided because it is difficult to refuse we find a negative association with well-being between grandparents. Overall, our findings highlight the importance of more detailed information on grandparent-grandchild interactions and reasons for care to better understand well-being outcomes.

Chronic pain, as a barometer of population health, remains understudied from a socio-structural lens. This study adopts a life course perspective and integrates hukou as a potential institutional arrangement shaping pain, aiming to advance the understanding of health inequalities in China. Specifically, we examine urban-rural disparities in pain prevalence and investigate how these disparities evolve across the life course by using generalized estimating equations and the China Health and Retirement Longitudinal Study 2011-2020 (N = 16479). Our findings indicate that rural hukou holders experience more pain than their urban counterparts. Among rural hukou holders, urban dwelling is associated with a reduced pain risk. Furthermore, we observe that pain prevalence increases with age, yet such pain trajectories vary across urban and rural populations, showing a converging trend in pain over the life course. This study extends the literature on health inequalities by demonstrating how institutional and geographic characteristics jointly shape urban-rural gradients in pain prevalence. Moreover, it provides novel evidence for the age-as-leveler hypothesis in a non-Western context.

Economic and material hardship, including housing insecurity - limited or uncertain availability or access to safe, quality, and affordable housing - is strongly linked to negative physical and mental health outcomes among adolescents and adults. However, data limitations and the inherent selectivity of housing insecurity have hindered comprehensive analysis of its long-term effects on physiological and mental health. This study uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to construct a sample of participants who experienced housing insecurity between the ages of 18-26 (Wave III) to a suitable control group using propensity score matching. We assess the effects of housing insecurity on (1) material hardship at Wave IV (ages 24-32), (2) allostatic load (AL) and depression symptoms at Waves IV and V (ages 33-43), and (3) the change in allostatic load and depression symptoms from Wave IV to V. Further, we evaluate whether effects differ by sex. Experiencing housing insecurity is associated with a significantly higher likelihood of experiencing material hardship at Wave IV and significantly worse depressive symptoms at both Waves IV and V. The treatment effects are more pronounced among women, with housing insecurity being linked to a significant increase in allostatic load from Wave IV to Wave V exclusively for women. Our results provide crucial support that housing insecurity is not just an outcome of economic hardship but a cause of it in the future, with downstream effects on health and well-being, particularly for women.

In Pakistan, a setting with high gender inequality, the relationship between female agency and mental health has not been studied longitudinally or beyond a defined life stage like pregnancy. Using data from the Bachpan cohort of mother-infant dyads in Pakistan, we investigated female agency and depression at two life stages: perinatal (third trimester to 6-months postpartum; n = 1154) and beyond (3- to 4-years postpartum). Modified Poisson models estimated adjusted prevalence ratios (PR) for probable depression (PHQ-9) associated with female agency (freedom of movement and participation in household decision-making) at the two life stages. Among 1154 mothers (average age 26.6 years), female agency was substantially lower during pregnancy than it was at 3-years and depression was more common during postpartum than at 4-years. Low freedom of movement during pregnancy nominally increased the likelihood of postpartum depression (PR: 1.33; 95% CI: 0.98, 1.80). The risk of depression was higher for low- (PR: 1.01; 95% CI: 0.72-1.41) and high- (PR: 1.24; 95% CI: 0.65-2.36) participation in household decision-making compared to moderate, but estimates were imprecise. Results from beyond the perinatal period indicated a stronger relationship between low freedom of movement and subsequent depression (PR: 1.89; 95% CI: 1.12, 3.20; Table 3). Low- (PR: 1.19; 95% CI: 0.67-2.12) and high- (PR: 1.21; 95% CI: 0.67-2.17) decision-making continued to demonstrate a nominal U-shaped relationship with depression, but estimates were imprecise. Overall, restricted freedom of movement beyond the perinatal period, may increase the likelihood of depression. Future research should explore the nuances of participation in decision-making and how it impacts women's mental health.

To understand place-based drivers of racial disparities in stroke mortality in the United States by investigating the relationship between county-level measures of structural racism and racial disparities in stroke mortality.

Limited standardized empirical research exists in France on the psychosocial implications of albinism, prompting an investigation into how affected persons adapt to their disabilities. Recent advancements in health psychology have led researchers to adopt a systemic approach, considering disabilities and involving close relatives in the adaptation process. The aim of this study was to explore the mediating role of dyadic coping within family dyads, where one is a person with albinism (PWA) and the other is a close relative.

Primary care is characterised by a broad understanding of health and illness. Due to the high degree of diagnostic uncertainty in primary care, medical tests play a lesser role in this domain than in specialist medicine. However, medical testing is also becoming increasingly important in primary care, raising questions about how these technologies are integrated into everyday practice. Drawing on qualitative interviews with Austrian doctors, this article shows that the use of medical tests in primary care is often interwoven with practices of care. Doctors engage in care around the use of medical tests by assessing the impact of diagnostic knowledge and addressing patients' needs before and after testing. They also demonstrate care through the use of medical tests, such as administering them to comfort patients rather than for strictly clinical reasons. Situating these findings within the sociology of diagnosis, I argue that diagnostic processes not only guide medical care provision but are also closely intertwined with practices of care.

Leading up to the 2020 U.S. presidential elections, the scientific consensus on hydroxychloroquine's ineffectiveness in treating COVID-19 was dismissed by Executive branch scientists, who promoted it as both a therapeutic solution and a political tool. This article examines how experimental pharmaceuticals were rationalized even before the pandemic declaration, aligning with medical advocacy groups linked to Donald Trump, who criticized the crisis management capacity of existing health institutions. Framing the emergency as requiring extraordinary measures, White House researchers advocated for executive unilateralism and eventually sought to securitize public health by replacing key health authorities with operational medicine specialists. The most controversial case involved an attempt of planned pharmaceutical intervention aimed at saving lives and restoring public confidence in the administration's pandemic response before the 2020 election. The article draws on confidential documents released by the 2022 House Select Subcommittee on the Coronavirus Crisis.

This article explores the often-overlooked tragedy of promising happiness through overcoming disability. It draws on qualitative interviews and focus groups with 36 adults with cerebral palsy to explore how medical discourse shapes the ways in which individuals are encouraged to pursue a good life, leading to unintended consequences. Sara Ahmed's theory of happiness is used to understand the dialectics of pursuing a good life through overcoming disability, revealing how medical interventions and discourse during childhood inadvertently contribute to feelings of inferiority and social alienation. The article highlights the need to reconsider how individuals with disabilities are encouraged to pursue a good life, emphasizing the paradox of disabling effects arising from attempts to minimize and overcome disability.

The medical encounter represents a site where patients may be harmed, with intersecting vulnerabilities shaping the risk and nature of this harm. Sexual and reproductive healthcare is an important site for exploring this dynamic. Questions concerning how immigrant women experience sexual and reproductive healthcare abound, with researchers and practitioners calling for greater attention to a population whose experiences are underrepresented in existing literature. As a case site, Spain is a high migration country with a stressed healthcare system where 'good' biomedical outcomes are complicated by institutional and routinised failures in patient care. Semi-structured interviews were conducted with 121 respondents concerning health experiences since immigrating to Spain. This paper draws from 69 respondents, primarily from the Philippines, the Americas, and Europe. Overarching themes included: 1) practitioners expressing dismissive attitudes; 2) practitioners behaving inappropriately and with prejudice; 3) practitioners failing to respect patient autonomy and consent; 4) practitioners mistreating patients during procedures. These issues recurred across treatment contexts, including diagnosis, routine examinations, preventative care, pre-natal care, abortion, pregnancy loss, and childbirth. Consequences include delayed and missed care, physical and psychological harm, and implications regarding migratory, medical, and reproductive futures. Informed by feminist scholarship, this study considers the identities, relations, and practices which contour this institutionally produced harm. The study provides recommendations for improvements in medical training and clinical practice based on identified failures in the care of immigrant patients.

Neonatal expertise and technologies have been perfected over the last decades, improving preterm infants' survival rates and allowing a gradual reduction in the gestational age limits of fetal viability. Using the concept of viability as a starting point, we analyze decision-making processes regarding extremely preterm newborns at the limits of viability. Drawing on extensive ethnographic fieldwork in a public hospital in Barcelona between March and November 2023, we examine the knowledge forms, rationalities and values that healthcare workers employ when guiding families in decisions about infants' viability. In this respect, we thoroughly analyze the actors involved and the extent of their agency. The findings point out that although neonatal decisions in Spain are embedded in an ethos of "individual responsible choice," they are in practice collectively produced and shaped by two main (sometimes conflicting) drivers: the perceived means of families to face the challenges posed by infants with high chances of severe sequelae (the 'viability of families'), and the preterm patients' perceived "will to live" ('fetal viability'). The study highlights how viability in this context needs to be understood within the structural socioeconomic constraints and struggles to make and raise families in Spain.

There has been a recent influx in the development of novel measures of structural forms of discrimination, including structural racism, xenophobia, sexism, heterosexism, and cisgenderism. These systems of power and oppression are inherently interdependent and mutually constitutive, yet a paucity of research has investigated their joint impacts; this gap is likely reflective of the limited guidance that exists regarding how to effectively combine multiple measures of structural discrimination to examine their joint impacts on population health and health inequities. In this commentary, we seek to redress this by describing conceptual and methodologic considerations for population health researchers interested in conducting quantitative structural intersectionality research - an intersectionality-informed research approach focused on examining how systems of power and oppression intersect to shape population health and health inequities. Developing best practices for measuring and analyzing the joint impacts of structural forms of discrimination is crucial for effectively describing and quantifying their impacts on population health and health inequities, and for informing interventions, laws, and policies to advance health equity and social justice.

This paper evidences how many rural poor Cambodians are sick of debt. Based on original, mixed-method data (2020-2022), exploring credit provisioning in this context, the aim of this paper is to illuminate some of the conditions leading to rural Cambodians taking on debt to bolster their health, and the effects this is having on borrowers' physical, psychological, emotional and social health. Specifically, we show how the health of our participants is constrained by a range of major illnesses that many suffer from and their poor food conditions, both exacerbated by the effects of climate change. Against this backdrop, many resort to debt-taking from multiple sources, including microfinance, as a coping strategy to pay for out-of-pocket health expenses and to cover food costs. While such loans offer a short-term means of sustaining health, we show that the extent of debt needed is leading to over-indebtedness which ultimately undermines health in the longer-term. Debtors are pushed to make further undue sacrifices to their food, treatment options and living conditions, specifically to service debt. We show how they are then rendered vulnerable to being exposed to, and experiencing, the negative effects of health and economic shocks, as well as to different forms of psychological, physical, emotional, social, and moral suffering to meet payments. Being sick of debt is especially acute for overindebted women who take on an increased double shift of productive and reproductive work to pay loans. While some of the adverse effects of over-indebtedness are made visible here, we warn that other forms of suffering potentially remain hidden, and will likely be expressed as longer-term population patterns of ill-health. In this context, over-indebtedness is hampering the government's aim of achieving universal health coverage and interventions are needed that reduce the debt crisis among the rural poor in order to improve health.

This study intends to examine how women's empowerment directly or indirectly impacts their children's well-being. Since prior research primarily focussed on the effects of maternal empowerment on specific domains of child well-being, such as healthcare or education, this study seeks to explore a more comprehensive understanding of child well-being, where child well-being is quantified using four domains, viz., physical well-being, psycho-social well-being, educational well-being and awareness of safety. For the study, a primary sample of 416 married women who have a child aged between 6 and 18 years was collected using a multistage purposive sampling method from the Barak Valley of Assam, India. Then, exploratory factor analysis is employed to construct two indices, one on women empowerment and the other on child well-being. The index of child well-being was then used as the regressand, and the women empowerment index, along with other children, mother and household characteristics, were used as the regressors in multiple linear regressions. Besides, the moderating role of women's empowerment on child well-being is also studied by creating interactions between the women's empowerment index and other mothers, children, and household characteristics. The study finds that women's empowerment has a strong and positive direct impact on the well-being of children aged 6 to 18. The study also reveals that women's empowerment indirectly impacts child well-being as it moderates between child well-being and other attributes, viz., the mother's working status, child's age, place of residence, and standard of living. A key implication of our study is that maternal empowerment is essential for enhancing child well-being during the early developmental years. We also find that maternal empowerment, when interacted with paid employment, profoundly uplifts their child's well-being.

For several decades, British Columbia (BC), Canada, has been experiencing a housing crisis marked by a shortage of safe and affordable housing, which coincides with a severe drug poisoning epidemic in the region. We explore the impact of housing instability on mortality (all-cause, drug-related) among a cohort of people with HIV (PWH) in BC.

The COVID-19 pandemic created significant challenges for healthcare professionals and the provision of hospital care, leading to immense stress and rapidly changing conditions. Hospitals had to constantly adapt their organizational structures and strategies to manage the crisis. This study examines the organizational responses of Danish emergency hospitals during the first COVID-19 surge, focusing on resilience in anticipation, coping, and learning. We conducted a study involving interviews with healthcare professionals and managers from the five emergency hospitals in the Central Denmark Region. The interview guides were based on multi-contingency theory for organizational design, with open-ended discussions to compare key organizational components across hospitals. Topics covered included hospital configuration, task design, resources, information systems, leadership, and coordination during the first surge. Interviews were cross-validated with administrative documents. Results showed that hospitals responded differently to national and regional directives, continuously adjusting their governance structures and strategies to meet the demands for new procedures and information sharing. The ability to introduce, learn from, and adapt organizational changes as the pandemic unfolded was crucial to building resilience. This study provides insights into organizational resilience in healthcare and highlights practical lessons for managing future crises.

Planning research involving people in prison raises concerns based on past abuses of incarcerated people amongst other factors. Despite the development of guidelines for the ethical conduct of research in prisons, researchers and advocates have questioned whether current approaches aimed at protecting incarcerated persons from unethical research unfairly exclude this group from participating in and benefitting from research. Discussion of these issues comes mostly from expert opinion. An absent voice is that of people in prison. This study identifies the key ethical issues according to people in prison for health research involving people in prison. Using a deliberative approach, citizens' juries were conducted in six Australian prisons (three men's and three women's) between January and May 2019. A total of fifty participants were selected following an expression of interest process. Pre-recorded information by experts was shown to participants who subsequently deliberated for almost 4 h before collectively agreeing on key ethical issues. Reoccurring issues selected were: 1. Participants receive study results; 2. Involve individuals with lived experience in assessing what research should happen in prison; 3. Ensure access to research opportunities is equal to those in the community; 4. Address recruitment bias by preventing custodial staff selection of participants; 5. Protect the confidentiality of participant responses; 6. Recognize the capacity of people in prison to give informed consent; and 7. Prevent conflicts of interest that could result in research findings censorship by prison authorities. Focal points within identified issues are described and suggest that if we are to genuinely consider the voices of people in prison, then it may be time to incorporate ways for research participation to be more accessible to incarcerated citizens.

The mental and physical health consequences of loneliness are well documented. However, loneliness's socio-political ramifications have been largely unexplored. We theorize that loneliness, due to its physiologically dysregulating impact on the nervous system, facilitates greater susceptibility towards populist radical right parties.

In this paper, we apply a measurement science perspective to explore both the epidemiologic and psychometric frameworks for the conceptualization, operationalization and assessment of self-reported adverse childhood experiences (srACEs). The epidemiologic paradigm suggests that srACEs are 'exposures', while the psychometric paradigm views responses on srACEs instrumentation as 'indicators'. It is the central premise of this paper that srACEs cannot be both exposures and indicators of scales. We review issues of reliability and validity from both perspectives, examine the degree of agreement between objective and subjective reports of childhood maltreatment and the implications of poor agreement, and conclude that the for the assessment of ACEs via self-report, the epidemiologic paradigm is not a good fit. We then review a number of reflexive and formative latent variable models that might be usefully fit to srACEs data for purposes of modeling structural properties of assessments, and/or to model ACE-health relationships. We highlight the mismatch and limitations of the reflexive measurement model for srACEs and conclude by endorsing either a formative latent variable model or application of latent class analyses. We emphasize the importance of considering and potentially formally testing competing measurement models and conducting both rationale analysis, conceptualization and hypothesis-testing to assess the fit of these models.