Showing papers in "Journal of Epidemiology and Community Health in 2006"
TL;DR: This glossary aims to clarify some of the key concepts associated with participatory action research.
Abstract: This glossary aims to clarify some of the key concepts associated with participatory action research.
3,413 citations
Journal Article•
TL;DR: The “blue book” systematises and summarises recent knowledge on the main types of economic evaluations, thereby providing a useful overview including sources of further readings.
Abstract: M E Drummond, M J Sculpher, G W Torrance GW, et al. Oxford University Press, 2005. ISBN 0-19-852945-7
A sketchy outline to the main economic theories forms the introduction to this book. The authors skillfully invoke those theories in the end only to point out that the economic evaluation primarily serves as a pragmatic aid to decision making. The “blue book” systematises and summarises recent knowledge on the main types of economic evaluations, thereby providing a useful overview including sources of further readings. Economic evaluation is defined as a comparative analysis of alternative courses of action in terms of both their costs and consequences. The authors make clear that the subject matter of economics is the deployment of real resources whether they cost money or …
2,528 citations
TL;DR: This glossary presents a comprehensive list of indicators of socioeconomic position used in health research, with a description of what they intend to measure and how data are elicited and the advantages and limitation of the indicators.
Abstract: This glossary presents a comprehensive list of indicators of socioeconomic position used in health research. A description of what they intend to measure is given together with how data are elicited and the advantages and limitation of the indicators. The glossary is divided into two parts for journal publication but the intention is that it should be used as one piece. The second part highlights a life course approach and will be published in the next issue of the journal.
2,271 citations
TL;DR: This research shows that the percentage of green space in people’s living environment has a positive association with the perceived general health of residents, and green space seems to be more than just a luxury and consequently the development of greenspace should be allocated a more central position in spatial planning policy.
Abstract: Study objectives: To investigate the strength of the relation between the amount of green space in people's living environment and their perceived general health. This relation is analysed for different age and socioeconomic groups. Furthermore, it is analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. Design: The study includes 250 782 people registered with 104 general practices who filled in a self administered form on sociodemographic background and perceived general health. The percentage of green space (urban green space, agricultural space, natural green space) within a one kilometre and three kilometre radius around the postal code coordinates was calculated for each household. Methods: Multilevel logistic regression analyses were performed at three levels—that is, individual level, family level, and practice level—controlled for sociodemographic characteristics. Main results: The percentage of green space inside a one kilometre and a three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity. The overall relation is somewhat stronger for lower socioeconomic groups. Elderly, youth, and secondary educated people in large cities seem to benefit more from presence of green areas in their living environment than other groups in large cities. Conclusions: This research shows that the percentage of green space in people's living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.
1,611 citations
TL;DR: Moves of variation in logistic regression should be promoted in social epidemiological and public health research as efficient means of quantifying the importance of the context of residence for understanding disparities in health and health related behaviour.
Abstract: STUDY OBJECTIVE: In social epidemiology, it is easy to compute and interpret measures of variation in multilevel linear regression, but technical difficulties exist in the case of logistic regression. The aim of this study was to present measures of variation appropriate for the logistic case in a didactic rather than a mathematical way. Design and PARTICIPANTS: Data were used from the health survey conducted in 2000 in the county of Scania, Sweden, that comprised 10 723 persons aged 18-80 years living in 60 areas. Conducting multilevel logistic regression different techniques were applied to investigate whether the individual propensity to consult private physicians was statistically dependent on the area of residence (that is, intraclass correlation (ICC), median odds ratio (MOR)), the 80% interval odds ratio (IOR-80), and the sorting out index). RESULTS: The MOR provided more interpretable information than the ICC on the relevance of the residential area for understanding the individual propensity of consulting private physicians. The MOR showed that the unexplained heterogeneity between areas was of greater relevance than the individual variables considered in the analysis (age, sex, and education) for understanding the individual propensity of visiting private physicians. Residing in a high education area increased the probability of visiting a private physician. However, the IOR showed that the unexplained variability between areas did not allow to clearly distinguishing low from high propensity areas with the area educational level. The sorting out index was equal to 82%. CONCLUSION: Measures of variation in logistic regression should be promoted in social epidemiological and public health research as efficient means of quantifying the importance of the context of residence for understanding disparities in health and health related behaviour.
1,309 citations
TL;DR: Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date, which strengthens resilience and develops a positive subjective state of health.
Abstract: Study objective: The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions. Design: The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992–2003. The review includes 458 scientific publications and 13 doctoral theses. Setting: Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books. Main results: SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the SOC seems to be able to predict health. SOC is an important contributor for the development and maintenance of people’s health but does not alone explain the overall health. Conclusion: SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date.
1,250 citations
TL;DR: This article reviews a condition that permits the estimation of causal effects from observational data, and two methods—standardisation and inverse probability weighting—to estimate population causal effects under that condition.
Abstract: In ideal randomised experiments, association is causation: association measures can be interpreted as effect measures because randomisation ensures that the exposed and the unexposed are exchangeable. On the other hand, in observational studies, association is not generally causation: association measures cannot be interpreted as effect measures because the exposed and the unexposed are not generally exchangeable. However, observational research is often the only alternative for causal inference. This article reviews a condition that permits the estimation of causal effects from observational data, and two methods -- standardisation and inverse probability weighting -- to estimate population causal effects under that condition. For simplicity, the main description is restricted to dichotomous variables and assumes that no random error attributable to sampling variability exists. The appendix provides a generalisation of inverse probability weighting.
882 citations
TL;DR: Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension although correlated, they measure different phenomena and tap into different causal mechanisms.
Abstract: Study objective: Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics mea ...
611 citations
TL;DR: This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms, finding that minority mothers have the same risk of antenataland postpartums depressive symptoms as white mothers.
Abstract: Objective: Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms. Setting: 1662 participants in Project Viva, a US cohort study. Design: Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated. Main results: The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31). Conclusions: Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.
596 citations
TL;DR: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil, and existing secondary datasets provide an important tool for evaluation of the effectiveness of health services.
Abstract: Objective: To use publicly available secondary data to assess the impact of Brazil’s Family Health Program on state level infant mortality rates (IMR) during the 1990s. Design: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women’s literacy and fertility, physicians and nurses per 10 000 population, and hospital beds per 1000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections. Setting: 13 years (1990–2002) of data from 27 Brazilian states. Main results: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p Conclusions: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.
471 citations
TL;DR: Measures of mental and physical health status contribute most to the SRH construct and the part played by age, early life factors, family history, sociodemographic variables, psychosocial factors, and health behaviours in these two occupational cohorts is modest.
Abstract: Objectives: To investigate the determinants of self rated health (SRH) in men and women in the British Whitehall II study and the French Gazel cohort study. Methods: The cross sectional analyses reported in this paper use data from wave 1 of the Whitehall II study (1985–88) and wave 2 of the Gazel study (1990). Determinants were either self reported or obtained through medical screening and employer’s records. The Whitehall II study is based on 20 civil service departments located in London. The Gazel study is based on employees of France’s national gas and electricity company (EDF-GDF). SRH data were available on 6889 men and 3403 women in Whitehall II and 13 008 men and 4688 women in Gazel. Results: Correlation analysis was used to identify determinants of SRH from 35 measures in Whitehall II and 33 in Gazel. Stepwise multiple regressions identified five determinants (symptom score, sickness absence, longstanding illness, minor psychiatric morbidity, number of recurring health problems) in Whitehall II, explaining 34.7% of the variance in SRH. In Gazel, four measures (physical tiredness, number of health problems in the past year, physical mobility, number of prescription drugs used) explained 41.4% of the variance in SRH. Conclusion: Measures of mental and physical health status contribute most to the SRH construct. The part played by age, early life factors, family history, sociodemographic variables, psychosocial factors, and health behaviours in these two occupational cohorts is modest.
TL;DR: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood if these factors are controlled.
Abstract: Objectives: To investigate whether longstanding illnesses, social context, and current socioeconomic circumstances predict quality of life. Design: Secondary analysis of wave 1 of the English longitudinal study of aging. Missing data were imputed and multiple regression analyses conducted. Setting: England, 2002 Participants: Nationally representative sample of non-institutionalised adults living in England (n = 11 234, 54.5% women, age 65.1 (SD 10.2) years). Main outcome measure: Quality of life as measured by CASP-19, a 19 item Likert scaled index. Results: The quality of life was reduced by depression (β −0.265), poor perceived financial situation (β −0.157), limitations in mobility (β −0.124), difficulties with everyday activities (β −0.112), and limiting longstanding illness (β −0.112). The quality of life was improved by trusting relationships with family (β 0.105) and friends (β 0.078), frequent contacts with friends (β 0.059), living in good neighbourhoods (β 0.103), and having two cars (β 0.066). The regression models explained 48% variation in CASP-19 scores. There were slight differences between age groups and between men and women. Conclusions: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood. There is the potential for improved quality of life in early old age (the third age) if these factors are controlled.
TL;DR: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRZoL in childhood, whereas reduced access to material resources may lead to a lower HRQoL especially in adolescence.
Abstract: STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.
TL;DR: Individual level high formal bonding social capital, trust in members of one’s race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health.
Abstract: Study objective: Few studies have distinguished between the effects of different forms of social capital on health. This study distinguished between the health effects of summary measures tapping into the constructs of community bonding and community bridging social capital. Design: A multilevel logistic regression analysis of community bonding and community bridging social capital in relation to individual self rated fair/poor health. Setting: 40 US communities. Participants: Within community samples of adults (n = 24 835), surveyed by telephone in 2000–2001. Main results: Adjusting for community sociodemographic and socioeconomic composition and community level income and age, the odds ratio of reporting fair or poor health was lower for each 1-standard deviation (SD) higher community bonding social capital (OR = 0.86; 95% = 0.80 to 0.92) and each 1-SD higher community bridging social capital (OR = 0.95; 95% CI = 0.88 to 1.02). The addition of indicators for individual level bonding and bridging social capital and social trust slightly attenuated the associations for community bonding social capital (OR = 0.90, 95% CI = 0.84 to 0.97) and community bridging social capital (OR = 0.96, 95% CI = 0.89 to 1.03). Individual level high formal bonding social capital, trust in members of one’s race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health. Furthermore, significant cross level interactions of community social capital with individual race/ethnicity were seen, including weaker inverse associations between community bonding social capital and fair/poor health among black persons compared with white persons. Conclusions: These results suggest modest protective effects of community bonding and community bridging social capital on health. Interventions and policies that leverage community bonding and bridging social capital might serve as means of population health improvement.
TL;DR: Together, the two sets of findings argue for a policy toolkit that acts on the distal determinants of smoking, with interventions targeting the conditions in which future and current smokers live.
Abstract: Objectives: To investigate in older industrialised societies (a) how social disadvantage contributes to smoking risk among women (b) the role of social and economic policies in reducing disadvantage and moderating wider inequalities in life chances and living standards. Methods: Review and analysis of (a) the effects of disadvantage in childhood and into adulthood on women’s smoking status in early adulthood (b) policy impacts on the social exposures associated with high smoking risk. Main results: (a) Smoking status—ever smoking, current smoking, heavy smoking, and cessation—is influenced not only by current circumstances but by longer term biographies of disadvantage (b) social and economic policies shape key social predictors of women’s smoking status, including childhood circumstances, educational levels and adult circumstances, and moderate inequalities in the distribution of these dimensions of life chances and living standards. Together, the two sets of findings argue for a policy toolkit that acts on the distal determinants of smoking, with interventions targeting the conditions in which future and current smokers live. Conclusions: An approach to tobacco control is advocated that combines changing smoking habits with reducing inequalities in the social trajectories in which they are embedded. Policies to level up opportunities and living standards across the lifecourse should be championed as part of an equity oriented approach to reducing the disease burden of cigarette smoking.
TL;DR: Inclusion of pupil level predictors in the multilevel models should be based on theoretical considerations of how schools and communities are interconnected and how pupils and their families are influenced by school contextual factors.
Abstract: Study objective: The school environment is of importance for child outcomes. Multilevel analyses can separate determinants operating at an individual level from those operating at a contextual level. This paper aims to systematically review multilevel studies of school contextual effects on pupil outcomes. Design: Key word searching of five databases yielded 17 cross sectional or longitudinal studies meeting the inclusion criteria. Results are summarised with reference to type of school contextual determinant. Main results: Four main school effects on pupil outcomes were identified. Having a health policy or antismoking policy, a good school climate, high average socioeconomic status, and urban location had a positive effect on pupil outcomes. Outcomes under study were smoking habits, wellbeing, problem behaviour, and school achievement. Conclusions: Despite the different pupil outcomes and the variety of determinants used in the included papers, a school effect was evident. However, to improve our understanding of school effects, presentations of results from multilevel studies need to be standardised. Intraclass correlation and explained between school variance give relevant information on factors in the school environment influencing pupil outcomes, and should be included in all multilevel studies. Inclusion of pupil level predictors in the multilevel models should be based on theoretical considerations of how schools and communities are interconnected and how pupils and their families are influenced by school contextual factors.
TL;DR: The development of an innovative methodology to measure geographical access to a range of community resources that have been empirically linked to health to enable health researchers to examine with greater precision, variations in the material characteristics of neighbourhoods and the pathways through which neighbourhoods impact on specific health outcomes.
Abstract: Objective: Recent studies suggest an association between the contextual attributes of neighbourhoods and the health status of residents. However, there has been a scarcity of studies that have directly measured the material characteristics of neighbourhoods theorised to have an impact on health and health inequalities. This paper describes the development of an innovative methodology to measure geographical access to a range of community resources that have been empirically linked to health. Geographical information systems (GIS) were applied to develop precise measures of community resource accessibility for small areas at a national scale. Design: Locational access to shopping, education, recreation, and health facilities was established for all 38 350 census meshblocks across New Zealand. Using GIS, distance measures were calculated from the population weighted centroid of each meshblock to 16 specific types of facilities theorised as potentially health related. From these data, indices of community resource accessibility for all New Zealand neighbourhoods were constructed. Results: Clear regional variations in geographical accessibility to community resources exist across the country, particularly between urban and rural areas of New Zealand. For example, the average travel time to the nearest food shop ranged from less than one minute to more than 244 minutes. Noticeable differences were also apparent between neighbourhoods within urban areas. Conclusions: Recent advances in GIS and computing capacity have made it feasible to directly measure access to health related community resources at the neighbourhood level. The construction of access indices for specific community resources will enable health researchers to examine with greater precision, variations in the material characteristics of neighbourhoods and the pathways through which neighbourhoods impact on specific health outcomes.
TL;DR: The pattern of associations seen for myocardial infarction and pneumonia (strongest associations with NO2, CO, and BC) suggests that traffic exposure is primarily responsible for the association with heart attacks.
Abstract: Study Objective: Many studies have shown that ambient particulate air pollution (PM) is associated with increased risk of hospital admissions and deaths for cardiovascular or respiratory causes around the world. In general these have been analysed in association with PM 10 and ozone, whereas PM 2.5 is now the particle measure of greatest health and regulatory concern. And little has been published on associations of hospital admissions and PM components. Design: This study analysed hospital admissions for myocardial infarction (15 578 patients), and pneumonia (24 857 patients) in associations with fine particulate air pollution, black carbon (BC), ozone, nitrogen dioxide (NO 2 ), PM not from traffic, and carbon monoxide (CO) in the greater Boston area for the years 1995–1999 using a case-crossover analysis, with control days matched on temperature. Main results: A significant association was found between NO 2 (12.7% change (95% CI: 5.8, 18)), PM 2.5 (8.6% increase (95% CI: 1.2, 15.4)), and BC (8.3% increase (95% CI: 0.2, 15.8)) and the risk of emergency myocardial infarction hospitalisation; and between BC (11.7% increase (95% CI: 4.8, 17.4)), PM 2.5 (6.5% increase (95% CI: 1.1, 11.4)), and CO (5.5% increase (95% CI: 1.1, 9.5)) and the risk of pneumonia hospitalisation. Conclusions: The pattern of associations seen for myocardial infarction and pneumonia (strongest associations with NO 2 , CO, and BC) suggests that traffic exposure is primarily responsible for the association with heart attacks.
TL;DR: Current marriage is associated with longer survival, and among the not married categories, having never been married was the strongest predictor of premature mortality.
Abstract: Purpose: To investigate the relation between marital status and survival Data sources: The US 1989 national health interview survey (NHIS) merged with the 1997 US national death index Results: Among 1989 NHIS respondents, 5876 (877%) died before 1997 and 61 123 (9123%) were known to be alive Controlling for demographic and socioeconomic characteristics, the death rate for people who were unmarried was significantly higher than it was for those who were married and living with their spouses Although the effect was significant for all categories of unmarried, it was strongest for those who had never married The never married effect was seen for both sexes, and was significantly stronger for men than for women For the youngest age group (19-44), the predominant causes of early death among adults who had never married were infectious disease (presumably HIV) and external causes In the middle aged and older men and women, the predominant causes were cardiovascular and other chronic diseases Conclusion: Current marriage is associated with longer survival Among the not married categories, having never been married was the strongest predictor of premature mortality It is difficult to assess the causal effect of marital status from these observational data
TL;DR: As home was the preferred place of death for most cancer patients, effective programmes to enable the patients to remain at home should be implemented and policymakers should encourage health services to focus on ways of meeting individual preferences on place ofdeath.
Abstract: Objective: To describe actual and preferred place of death of Italian cancer patients and to analyse the preferences met regarding the place of death. Design: Mortality follow back survey of 2000 cancer deaths, identified with a two stage probability sample representative of the whole country. Information on patients’ experience was gathered from the non-professional caregiver with an interview. A section of the interview covered information on the actual and preferred place of death of the patients. Setting: 30 Italian local health districts randomly selected after stratification in four geographical areas. Participants: 1900 of 2000 (95.0%) caregivers of cancer deaths identified. Main outcome measures: Prevalence of actual and preferred places of death. Results: Valid interviews were obtained for 66.9% (n = 1271) of the caregivers. Place of death was home for 57.9% of Italian cancer patients, hospital for 34.6%, hospice for 0.7%, nursing home for 6.5%, and ambulance for 0.4%. Wide and significant differences within Italy were seen (home deaths ranged between 94.0% in the south and 28.2% in the north east). Home was the preferred place of death for 93.5% of patients that expressed a preference, with minimal differences within the country (between 89.5% and 99.0%). Overall 67.1% of the sample died in the place where they preferred to die. Conclusions: Policymakers should encourage health services to focus on ways of meeting individual preferences on place of death. As home was the preferred place of death for most cancer patients, effective programmes to enable the patients to remain at home should be implemented.
TL;DR: The risk of an ischaemia stroke is increased in men whose sleep is frequently disturbed, and daytime sleepiness is associated with a significant increase in ischaemic heart disease events.
Abstract: Objective: To test the hypothesis that sleep disorders are relevant to the risk of ischaemic stroke and ischaemic heart disease events in older men. Design: A cohort study. Setting: The Caerphilly cohort, a representative population sample of older men in South Wales, UK. Participants: 1986 men aged 55–69 years completed a questionnaire on sleep patterns with help from their partners. This asked about symptoms of disturbed sleep: insomnia, snoring, restless legs, obstructive sleep apnoea, and about daytime sleepiness. During the following 10 years 107 men experienced an ischaemic stroke and 213 had an ischaemic heart disease event. Main results: Up to one third of the men reported at least one symptom suggestive of sleep disturbance, and one third reported daytime sleepiness. Compared with men who reported no such symptoms, the adjusted relative odds of an ischaemic stroke were significantly increased in men with any sleep disturbance, the strongest association being with sleep apnoea (relative odds 1.97; 1.26 to 3.09). The association with daytime sleepiness was not significant for stroke. Relations with ischaemic heart disease events were all raised in men with symptoms of sleep disturbance, but none was significant, other than daytime sleepiness (relative odds: 1.41; 1.04 to 1.92). There were no significant relations with blood pressure. Conclusion: The risk of an ischaemic stroke is increased in men whose sleep is frequently disturbed, and daytime sleepiness is associated with a significant increase in ischaemic heart disease events.
TL;DR: This commentary argues that adverse health outcomes should be weighed up against advantages for children born to older parents, mindful that these societal advantages are likely to change over time.
Abstract: Average paternal age in the UK is increasing. The public health implications of this trend have not been widely anticipated or debated. This commentary aims to contribute to such a debate. Accumulated chromosomal aberrations and mutations occurring during the maturation of male germ cells are thought to be responsible for the increased risk of certain conditions with older fathers. Growing evidence shows that the offspring of older fathers have reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia. Adverse health outcomes should be weighed up against advantages for children born to older parents, mindful that these societal advantages are likely to change over time.
TL;DR: Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services, and results call for urgent public health interventions to increase equitable access to dental services.
Abstract: Objective: To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health.
Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves.
Participants: Swedish population-based sample of 17 362 men and 20 037 women.
Results: Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7–9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden.
Conclusions: Results call for urgent public health interventions to increase equitable access to dental care services.
TL;DR: Conventional risk factors explain the majority of absolute social inequality in CHD because conventional risk Factors explain the vast majority of CHD cases in the population, however, the role of conventional risk factors in explaining relative social inequality was modest.
Abstract: Study objectives: There are contradictory perspectives on the importance of conventional coronary heart disease (CHD) risk factors in explaining population levels and social gradients in CHD. This study examined the contribution of conventional CHD risk factors (smoking, hypertension, dyslipidaemia, and diabetes) to explaining population levels and to absolute and relative social inequalities in CHD. This was investigated in an entire population and by creating a low risk sub-population with no smoking, dyslipidaemia, diabetes, and hypertension to simulate what would happen to relative and social inequalities in CHD if conventional risk factors were removed. Design, setting, and participants: Population based study of 2682 eastern Finnish men aged 42, 48, 54, 60 at baseline with 10.5 years average follow up of fatal (ICD9 codes 410–414) and non-fatal (MONICA criteria) CHD events. Main results: In the whole population, 94.6% of events occurred among men exposed to at least one conventional risk factor, with a PAR of 68%. Adjustment for conventional risk factors reduced relative social inequality by 24%. However, in a low risk population free from conventional risk factors, absolute social inequality reduced by 72%. Conclusions: Conventional risk factors explain the majority of absolute social inequality in CHD because conventional risk factors explain the vast majority of CHD cases in the population. However, the role of conventional risk factors in explaining relative social inequality was modest. This apparent paradox may arise in populations where inequalities in conventional risk factors between social groups are low, relative to the high levels of conventional risk factors within every social group. If the concern is to reduce the overall population health burden of CHD and the disproportionate population health burden associated with the social inequalities in CHD, then reducing conventional risk factors will do the job.
TL;DR: The level of validity shown in this study throws some doubt on whether it is justifiable to use age at menarche self-reported in middle age, and researchers should be aware of these limitations and use such measures with caution.
Abstract: Objective To test the validity of age at menarche self-reported in adulthood and examine whether socioeconomic position, education, experience of gynaecological events and psychological symptoms influence the accuracy of recall. Design Prospective birth cohort study. Setting England, Scotland and Wales. Participants 1050 women from the Medical Research Council National Survey of Health and Development, with two measures of age at menarche, one recorded in adolescence and the other self-reported at age 48 years. Results By calculating the limits of agreement, kappa statistic and Pearson's correlation coefficients (r), we found that the validity of age at menarche self-reported in middle age compared with that recorded in adolescence was moderate (kappa = 0.35, r = 0.66, n = 1050). Validity was improved by categorising age at menarche into three groups: early, normal and late (kappa = 0.43). Agreement was influenced by educational level and having had a stillbirth or miscarriage. Conclusions The level of validity shown in this study throws some doubt on whether it is justifiable to use age at menarche self-reported in middle age. It is likely to introduce error and bias, and researchers should be aware of these limitations and use such measures with caution.
TL;DR: There are still widespread attitudes in the EU such as victim blaming that condone DVAW, contributing to a climate of social acceptability of DVAWs, and further efforts to reduce the acceptability are still needed.
Abstract: Study objective: The acceptability of domestic violence against women (DVAW) plays an important part in shaping the social environment in which the victims are embedded, which in turn may contribute either to perpetuate or to reduce the levels of DVAW in our societies. This study analyses correlates of the acceptability of DVAW in the European Union (EU). Design: Three level ordinal logistic regression of 13 457 people nested within 212 localities (cities), nested within 15 countries of the EU. Sampling is multistage with random probability. All interviews were face to face in people's homes. The outcome variable was acceptability of DVAW. Multiple correlates at the individual, locality, and country level were analysed. Setting: European Union, 1999. Participants: National data were used of residents 15 years old and above of all member states in 1999 (n = 13 457). Average response rate was 47%, although it varied across countries (23%-73%). Main results: Higher levels of acceptability were reported by those who perceived DVAW as less severe and less frequent. Acceptability is higher among men who know a perpetrator and lower among men who know a victim. Victim blaming attitude is associated with higher levels of acceptability. In countries with higher gender empowerment measure the difference in acceptability among those who blame and those who do not blame the victim is greater. Conclusions: There are still widespread attitudes in the EU such as victim blaming that condone DVAW, contributing to a climate of social acceptability of DVAW. Further efforts to reduce the acceptability of DVAW are still needed.
TL;DR: Assessment of prevalence of arsenic exposure through drinking water and skin lesions in Bangladesh showed sex, age, and socioeconomic differentials in both exposure andSkin lesions clearly showed the urgency of effective arsenic mitigation activities.
Abstract: Study objective: To assess prevalence of arsenic exposure through drinking water and skin lesions, and their variation by geographical area, age, sex, and socioeconomic conditions. Design, setting, and participants: Skin lesion cases were identified by screening the entire population above 4 years of age (n = 166 934) living in Matlab, a rural area in Bangladesh, during January 2002 and August 2003. The process of case identification involved initial skin examinations in the field, followed by verification by physicians in a clinic, and final confirmation by two independent experts reviewing photographs. The tubewell water arsenic concentrations (n = 13 286) were analysed by atomic absorption spectrometry. Drinking water history since 1970 was obtained for each person. Exposure information was constructed using drinking water histories and data on water arsenic concentrations. Main results: The arsenic concentrations ranged from Conclusions: The result showed sex, age, and socioeconomic differentials in both exposure and skin lesions. Findings clearly showed the urgency of effective arsenic mitigation activities.
TL;DR: In this paper, the authors examined whether area level socioeconomic disadvantage and social capital have different relations with women's and men's self-rated health and found that women may benefit more than men from higher levels of area social capital.
Abstract: Objectives: To examine whether area level socioeconomic disadvantage and social capital have different relations with women’s and men’s self rated health. Methods: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. Results: IRSD was associated with poor self rated health for women (age adjusted p Conclusions: These finding suggest that women may benefit more than men from higher levels of area social capital.
TL;DR: Socioeconomic inequality in breast screening uptake seems to persist in an established service but uptake seemed to be higher at non- health sites, and further work is needed to identify effective methods of decreasing socioeconomic inequalities in uptake and to confirm if non-health locations are associated with higher screening uptake.
Abstract: Background and aim: This study examined the association between socioeconomic deprivation, travel distance, urban-rural status, location and type of screening unit, and breast screening uptake. Screening was provided at 13 locations—1 fixed and 12 mobile (3 at non-health locations). Methods: The study examined data from 1998 to 2001 for 34 868 women aged 50–64 years, calculated road travel distance, used 1991 enumeration district level Townsend socioeconomic deprivation scores, and a ward level urban-rural classification. Results: Odds of attendance for screening decreased with increasing socioeconomic deprivation, with an adjusted odds ratio of 0.64 (95%CI 0.59 to 0.70) in the most deprived relative to the least deprived category. 87% of women lived within 8 km of their screening location. The odds ratio for a 10 km increase in distance was 0.87 (95%CI 0.79 to 0.95). The odds ratios were 1.18 (95%CI 1.08 to 1.28) for screening at a non-health relative to a health location, 1.00 (95%CI 0.94 to 1.07) for the fixed site relative to the mobile unit and 1.00 (95%CI 0.91 to 1.09) for mainly rural relative to mainly urban areas. Conclusions: Socioeconomic inequality in breast screening uptake seems to persist in an established service. There was a small decrease with increasing distance, no difference between fixed and mobile units, and no difference between urban and rural areas but uptake seemed to be higher at non-health sites. Further work is needed to identify effective methods of decreasing socioeconomic inequalities in uptake and to confirm if non-health locations are associated with higher screening uptake.
TL;DR: The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups.
Abstract: Background: A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. Aim: To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Discussion and conclusions: Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of “human flourishing” and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale.