ABSTRACT:In epidemiological studies, inequitable access to breast cancer care aligns with such variables as income, age, education, ethnicity and residential location. These variables correspond to structural patterns of advantage and disadvantage, which in turn may constrain or facilitate timely access to care. The purpose of this study was to understand the complexities of women's pathways to diagnosis. Thirty-five women from diverse backgrounds and who had clinically detectable breast symptoms at time of diagnosis participated in semi-structured interviews. All were receiving or completing treatment when they participated. Data were analyzed using the strategies of induction, comparison and abduction. All of the participants described a variety of activities involved in seeking care for breast cancer. The findings illustrate how the social relations of health care, rather than simply patient or provider delay, may contribute barriers to timely diagnosis. We illustrate how women's widely differing social and material contexts offer opportunities and barriers to access. RESUMO:Em estudos epidemiológicos, acessos desiguais para o cuidado ao câncer de mama alinham-se a outras variáveis como salário, idade, educação, etnia e local de moradia. Estas variáveis correspondem aos padrões estruturais de vantagens e desvantagens, as quais por sua vez podem restringir ou facilitar o tempo de acesso ao cuidado. A proposta deste estudo foi entender a complexidade da trajetória das mulheres para o diagnóstico. Trinta e cinco mulheres de diversos meios e que tinham sintomas clinicamente identificados no momento do diagnóstico, participaram de entrevistas semi-estruturadas. Os dados foram analisados utilizando-se estratégias de indução, comparação e abdução. Todas as participantes descreveram uma variedade de atividades envolvidas na busca do cuidado para o câncer de mama. Os achados ilustram como as relações sociais do cuidado a saúde, ao invés de simplificar para a paciente ou retardar o processo, podem se constituir em barreiras ao diagnóstico em tempo adequado. Nós ilustramos como os diferentes contextos sociais e materiais oferecem oportunidades e barreiras para o acesso às mulheres. RESUMEN:De acuerdo a los estudios epidemiológicos, la falta de equidad en el acceso a los servicios de cuidado y tratamiento del cáncer de mama se acompaña de variables tales como renta, edad, nivel de estudios, etnia y lugar de residencia. Estas variables corresponden a patrones estructurales favorecidos o desfavorecidos, que pueden por tanto facilitar o limitar el tiempo de acceso a dichos servicios. El objetivo de este estudio fue el de comprender la complejidad de las trayectorias de las mujeres hacia el diagnóstico. Treinta y cinco mujeres con experiencias diversas y con síntomas de cáncer de mama clínicamente detectables en el momento del diagnóstico, participaron en entrevistas parcialmente estructuradas. Todas ellas recibían y/o habían completado su tratamiento en el momento de su participación. Los datos fueron analizados mediante el...
This article examines several noteworthy initiatives that were implemented following the deadly 2013 Rana Plaza disaster in Bangladesh. They broke new ground in transnational labour law. The ILO‐backed initiatives were largely successful but remain insufficient to achieve lasting change in the ready‐made garment industry, where global brands’ supply chain buying practices constrain investment in occupational safety and health. A proposed United Nations treaty on business and human rights now seeks to enhance corporate accountability. Although promising, as part of a smart mix of multi‐level public and private solutions, the treaty needs fine‐tuning in the light of lessons learned from post‐Rana Plaza experiments.
Germany faces several challenges in fully applying the Decent Work for Domestic Workers Convention, 2011 (No. 189), in force for it since 2014. This article examines the situation in the light of (1) the Government’s assertion that ratification did not entail any need for legislative change; (2) domestic work in the context of the country’s overall demographic and labour market context, along with recommendations of a Government-appointed panel of experts on gender equality, and (3) the 2017 direct request to Germany concerning implementation of the Convention, made by the International Labour Organization (ILO) Committee of Experts on the Application of Conventions and Recommendations. The article argues that although much – but not all – of German labour law already applies to domestic workers on an equal footing with other workers, the Government still needs to take a number of steps to apply the Convention in full. The Government’s blanket exemption of ‘live-ins’ from the Convention’s scope concerns primarily those who come from Central and Eastern European countries, under various legal constructs, to care for older persons at home without maximum hours protection. The country’s exclusion of all domestic workers from the main health and safety laws is also problematic, as are some constraints on access to justice. In addition, the widespread phenomenon of undeclared paid domestic work calls for strengthened enforcement of existing legislation. Addressing these and other issues will be important not only for improving the lot of domestic workers in Germany, in line with the Convention, but also for ensuring sustainable quality care provision in a rapidly aging society while promoting greater labour market participation for women.
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