Susan Lagaert

(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 (n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users (n = 6484; 14.7%). Dual use happened both in the direction of public to private (n = 4628; 67.3%), and of private to public (n = 1855; 32.7%). Higher income had a significant effect on dual use (p < 0.0001), suggesting a dose–response relationship, even after controlling for confounders. Significant effects were also found for region (p < 0.0001) and usual source of care (USC) (p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Employing a multilevel perspective on the health effects of social capital, this study analyzes how individual and neighborhood differences in self-rated health in Ghent (Belgium), relate to individual and collective social mechanisms, when taking demographic and socioeconomic characteristics of individuals into account. This study estimates the health effects of social trust, informal social control and disorder at the neighborhood level and social support and network size at the individual level, using indicators indebted to both the normative and resource-based approaches to social capital. Instead of the mere aggregation of individual indicators of social capital, this study uses the key informant technique as a methodologically superior measurement of neighborhood social capital, which combined with a multilevel analysis strategy, allows to disentangle the health effects of individual and neighborhood social capital. The analysis highlights the health benefits of individual social capital, i.e., individual social support and network size. The study indicates that controlling for individual demographic and socioeconomic characteristics reduces the effect of the neighborhood-level counterparts and the neighborhood characteristics social trust and neighborhood disorder have significant, but small health effects. In its effects on self-rated health, social capital operates on the individual level, rather than the neighborhood level.

Existing individual-level research links women’s higher participation in high-status cultural activities to their position in work and family spheres. This article studies how cross-national variation in women’s and men’s cultural participation relates to societal care- and work-related gender equality and development. Multilevel analyses on Eurobarometer data (2013) indicate that male engagement in the feminine domain of care and societal development stimulates frequent participation in highbrow culture, but more for men than for women, thus partly explaining gender gap variation in highbrow cultural participation across European Union countries. We conclude that men play an important but underestimated role in the explanation of the gender gap.

This paper studies the gender gap in sport event attendance – characterized by higher male and lower female participation – using a macro-sociological and cross-national comparative approach. We argue that because gender is produced and justified in the realm of sport, gender gaps in sport event attendance may be more pronounced in some societies than others, depending on the position women and men have in the particular context in which someone ‘does’ his/her gender. So, in addition to individual attributes, one has to consider the societal, macro-level gender equality in order to understand the individual-level gender inequalities in sport event attendance. Using multilevel analyses on Eurobarometer data (2007), we evaluate whether the size of the gender gap in sport event attendance varies across European Union (EU) countries and how this variation relates to societal gender equality, as measured by the Gender Equality Index of the European Institute for Gender Equality. We find higher male than female attendance in all EU countries, but also conclude that higher levels of macro-level gender equality are associated with smaller gender gaps in sport event attendance.

Op basis van data van de derde ronde van de European Social Survey (2006) onderzoekt deze studie de invloed van opleidingsniveau en overkwalificatie op symptomen van depressiviteit. Daarbij wordt nagegaan of aangeleerde effectiviteit deze relaties medieert. Hiermee is deze bijdrage een van de eerste sociologische studies die bestudeert of en hoe overeducatie een effect heeft op de mentale gezondheid. Uit de analyses blijkt dat overgekwalificeerde werknemers meer symptomen van depressiviteit rapporteren dan werknemers die niet overgekwalificeerd zijn. Tertiair opgeleiden vertonen minder symptomen van depressiviteit dan personen die geen tertiair diploma hebben. Aangeleerde effectiviteit medieert beide relaties. Deze studie gaat in tegen het ‘educatie als fundamentele oorzaak’-paradigma. Aanhangers daarvan stellen immers (impliciet of expliciet) dat educatie enkel positieve gevolgen voor de mentale gezondheid heeft, maar de grotere prevalentie van overkwalificatie bij hooggeschoolden en de negatieve effecten van overeducatie op de mentale gezondheid zijn hiermee in strijd.

In this paper we explore whether and how ‘sport’ can be an adequate and valid sociological concept considering the multitude of contested meanings and definitions attached to ‘sport’ by different stakeholders in the sports field. Firstly, we argue that essentialist definitions of ‘sport’ too often one-sidedly focus on physical exertion and neglect the socially distinguishing nature of sportive practices as part of a lifestyle. Secondly, survey questions reflect this physical definition of ‘sport’ and assume that ‘sport’ has an obviously similar meaning to respondents. However, reflecting the struggle to define ‘sport’ in the sports field, people with different socio-demographic backgrounds differ in their understanding of the concept. Because current measurement of ‘sport’ does not adequately deal with the open and contested nature of the concept, suggestions on how to collect survey data on sport participation are presented.