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Dalsgaard S, McGrath J, Østergaard SD, Wray NR, Pedersen CB, Mortensen PB, Petersen L. Association of Mental Disorder in Childhood and Adolescence With Subsequent Educational Achievement. JAMA Psychiatry 2020; 77:797-805. [PMID: 32211833 PMCID: PMC7097843 DOI: 10.1001/jamapsychiatry.2020.0217] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Onset of mental disorders during childhood or adolescence has been associated with underperformance in school and impairment in social and occupational life in adulthood, which has important implications for the affected individuals and society. OBJECTIVE To compare the educational achievements at the final examination of compulsory schooling in Denmark between individuals with and those without a mental disorder. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted in Denmark and obtained data from the Danish Civil Registration System and other nationwide registers. The 2 cohorts studied were (1) all children who were born in Denmark between January 1, 1988, and July 1, 1999, and were alive at age 17 years (n = 629 622) and (2) all children who took the final examination at the end of ninth grade in both Danish and mathematics subjects between January 1, 2002, and December 31, 2016 (n = 542 500). Data analysis was conducted from March 1, 2018, to March 1, 2019. EXPOSURES Clinical diagnosis by a psychiatrist of any mental disorder or 1 of 29 specific mental disorders before age 16 years. MAIN OUTCOMES AND MEASURES Taking the final examination at the end of ninth grade and mean examination grades standardized as z scores with differences measured in SDs (standardized mean grade difference). RESULTS Of the total study population (n = 629 622; 306 209 female and 323 413 male), 523 312 individuals (83%) took the final examination before 17 years of age and 38 001 (6%) had a mental disorder before that age. Among the 542 500 individuals (274 332 female and 268 168 male), the mean (SD) age was 16.1 (0.33) years for the females and 16.2 (0.34) years for the males. Among the 15 843 female and 22 158 male students with a mental disorder, a lower proportion took the final examination (0.52; 95% CI, 0.52-0.53) compared with individuals without a mental disorder (0.88; 95% CI, 0.88-0.88). Mental disorders affected the grades of male individuals (standardized mean grade difference, -0.30; 95% CI, -0.32 to -0.28) more than the grades of their female peers (standardized mean grade difference, -0.24; 95% CI, -0.25 to -0.22) when compared with same-sex individuals without mental disorders. Most specific mental disorders were associated with statistically significantly lower mean grades, with intellectual disability associated with the lowest grade in female and male students (standardized mean grade difference, -1.07 [95% CI, -1.23 to -0.91] and -1.03 [95% CI, -1.17 to -0.89]; P = .76 for sex differences in the mean grades). Female and male students with anorexia nervosa achieved statistically significantly higher grades on the final examination (standardized mean grade difference, 0.38 [95% CI, 0.32-0.44] and 0.31 [95% CI, 0.11-0.52]; P = .54 for sex differences in the mean grades) compared with their peers without this disorder. For those with anxiety, attachment, attention-deficit/hyperactivity, and other developmental disorders, female individuals attained relatively lower standardized mean grades compared with their male counterparts. CONCLUSIONS AND RELEVANCE Results of this study suggest that, in Denmark, almost all mental disorders in childhood or adolescence may be associated with a lower likelihood of taking the final examination at the end of ninth grade; those with specific disorders tended to achieve lower mean grades on the examination; and female, compared with male, individuals with certain mental disorders appeared to have relatively more impairment. These findings appear to emphasize the need to provide educational support to young people with mental disorders.
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Affiliation(s)
- Søren Dalsgaard
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - John McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Queensland, Australia
| | - Søren Dinesen Østergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Department of Affective Disorders, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Naomi R. Wray
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Carsten Bøcker Pedersen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Centre for Integrated Register-Based Research at Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Centre for Integrated Register-Based Research at Aarhus University, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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Jay MA, Arat A, Wijlaars L, Ajetunmobi O, Fitzpatrick T, Lu H, Lei S, Skerritt C, Goldfeld S, Gissler M, Gunnlaugsson G, Hrafn Jónsson S, Hjern A, Guttmann A, Gilbert R. Timing of paediatric orchidopexy in universal healthcare systems: international administrative data cohort study. BJS Open 2020; 4:1117-1124. [PMID: 32706149 PMCID: PMC7709362 DOI: 10.1002/bjs5.50329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND International guidelines in 2008 recommended orchidopexy for undescended testis at 6-12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. METHODS All boys born in 2003-2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. RESULTS Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study period. By 2011, from 7·6 per cent (Sweden) to 27·9 per cent (Scotland) of boys had undergone orchidopexy by their first birthday and 71·5 per cent (Sweden) to 90·4 per cent (Scotland) by 3 years of age. There was limited evidence of socioeconomic inequities for orchidopexy before the introduction of guidelines (2008). Across all jurisdictions for boys born after 2008, there was consistent evidence of inequities in orchidopexy by the first birthday, favouring higher socioeconomic position. Absolute differences in these proportions between the highest and lowest socioeconomic groups ranged from 2·5 to 5·9 per cent across jurisdictions. CONCLUSION Consistent lack of adherence to the guidelines across jurisdictions questions whether the guidelines are appropriate.
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Affiliation(s)
- M. A. Jay
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - A. Arat
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - L. Wijlaars
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - O. Ajetunmobi
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | | | - S. Lei
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
| | - C. Skerritt
- Bristol Royal Hospital for ChildrenBristolUK
| | - S. Goldfeld
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - M. Gissler
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Information Services DepartmentFinnish Institute for Health and WelfareHelsinkiFinland
| | - G. Gunnlaugsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - S. Hrafn Jónsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - A. Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - A. Guttmann
- Child Health Evaluative SciencesCanada
- Division of Paediatric Medicine, Hospital for Sick ChildrenCanada
- ICESCanada
- Dalla Lana School of Public HealthCanada
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - R. Gilbert
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
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153
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Gupta N, Dencker-Larsen S, Lund Rasmussen C, McGregor D, Rasmussen CDN, Thorsen SV, Jørgensen MB, Chastin S, Holtermann A. The physical activity paradox revisited: a prospective study on compositional accelerometer data and long-term sickness absence. Int J Behav Nutr Phys Act 2020; 17:93. [PMID: 32690043 PMCID: PMC7370435 DOI: 10.1186/s12966-020-00988-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background The ‘physical activity paradox’ advocates that leisure physical activity (PA) promotes health while high occupational PA impairs health. However, this paradox can be explained by methodological limitations of the previous studies—self-reported PA measures, insufficient adjustment for socioeconomic confounding or not addressing the compositional nature of PA. Therefore, this study investigated if we still observe the PA paradox in relation to long-term sick absence (LTSA) after adjusting for the abovementioned limitations. Methods Time spent on moderate-to-vigorous physical activity (MVPA) and remaining physical behaviors (sedentary behavior, standing, light PA and time in bed) at work and in leisure was measured for 929 workers using thigh accelerometry and expressed as isometric log-ratios (ilrs). LTSA was register-based first event of ≥6 consecutive weeks of sickness absence during 4-year follow-up. The association between ilrs and LTSA was analyzed using a Cox proportional hazards model adjusted for remaining physical behaviors and potential confounders, then separately adjusting for and stratifying by education and type of work. Results During the follow-up, 21% of the workers experienced LTSA. In leisure, more relative MVPA time was negatively associated with LTSA (20% lower risk with 20 min more MVPA, p = 0.02). At work, more relative MVPA time was positively associated with LTSA (15% higher risk with 20 min more MVPA, p = 0.02). Results remained unchanged when further adjusted for or stratified by education and type of work. Conclusion These findings provide further support to the ‘PA paradox’.
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Affiliation(s)
- Nidhi Gupta
- National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark.
| | - Sofie Dencker-Larsen
- National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark.,Business Information & Analytics, Copenhagen Business School, Solbjerg Plads 3, DK-2000, Frederiksberg, Denmark
| | - Charlotte Lund Rasmussen
- National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Duncan McGregor
- School of Health and Life Science, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland.,Biomathematics and Statistics Scotland, JCMB, The King's Buildings, Peter Guthrie Tait Road, Edinburgh, EH9 3FD, Scotland, UK
| | | | - Sannie Vester Thorsen
- National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark
| | - Marie Birk Jørgensen
- Occupational Health and Safety, Department of Ergonomic and Technical Counselling, Municipality of Copenhagen, Copenhagen, Denmark
| | - Sebastien Chastin
- School of Health and Life Science, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland.,Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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154
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Mira-Iglesias A, López-Labrador FX, Baselga-Moreno V, Tortajada-Girbés M, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J, On Behalf Of The Valencia Hospital Network For The Study Of Influenza And Respiratory Viruses Disease. Influenza vaccine effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, Spain, 2017/18 influenza season. ACTA ACUST UNITED AC 2020; 24. [PMID: 31387672 PMCID: PMC6685101 DOI: 10.2807/1560-7917.es.2019.24.31.1800461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Influenza immunisation is recommended for elderly people each season. The influenza vaccine effectiveness (IVE) varies annually due to influenza viruses evolving and the vaccine composition. Aim To estimate, in inpatients ≥ 60 years old, the 2017/18 trivalent IVE, overall, by vaccine type and by strain. The impact of vaccination in any of the two previous seasons (2016/17 and 2015/16) on current (2017/18) IVE was also explored. Methods This was a multicentre prospective observational study within the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI, Spain). The test-negative design was applied taking laboratory-confirmed influenza as outcome and vaccination status as main exposure. Information about potential confounders was obtained from clinical registries and/or by interviewing patients; vaccine information was only ascertained by registries. Results Overall, 2017/18 IVE was 9.9% (95% CI: −15.5 to 29.6%), and specifically, 48.3% (95% CI: 13.5% to 69.1%), −29.9% (95% CI: −79.1% to 5.8%) and 25.7% (95% CI: −8.8% to 49.3%) against A(H1N1)pdm09, A(H3N2) and B/Yamagata lineage, respectively. For the adjuvanted and non-adjuvanted vaccines, overall IVE was 10.0% (95% CI: −24.4% to 34.9%) and 7.8% (95% CI: −23.1% to 31.0%) respectively. Prior vaccination significantly protected against influenza B/Yamagata lineage (IVE: 50.2%; 95% CI: 2.3% to 74.6%) in patients not vaccinated in the current season. For those repeatedly vaccinated against influenza A(H1N1)pdm09, IVE was 46.4% (95% CI: 6.8% to 69.2%). Conclusion Our data revealed low vaccine effectiveness against influenza in hospitalised patients ≥60 years old in 2017/18. Prior vaccination protected against influenza A(H1N1)pdm09 and B/Yamagata-lineage.
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Affiliation(s)
- Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - F Xavier López-Labrador
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | | | - Mario Carballido-Fernández
- Universidad CEU Cardenal Herrera, Castellón, Spain.,Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Joan Puig-Barberà
- Centro de Salud Pública de Castellón, Castellón, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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155
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De Moraes ACF, Carvalho HB, McClelland RL, Diez-Roux AV, Szklo M. Sex and ethnicity modify the associations between individual and contextual socioeconomic indicators and ideal cardiovascular health: MESA study. J Public Health (Oxf) 2020; 41:e237-e244. [PMID: 30137558 DOI: 10.1093/pubmed/fdy145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/13/2018] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is associated with cardiovascular disease (CVD) risk, but its association with different markers of SES may be heterogeneous by sex and race/ethnicity. METHODS We have examined the relationships of four SES markers (education, family income, occupation and neighborhood SES) to ideal cardiovascular health (ICH), an index formed by seven variables. A total of 6792 cohort participants from six regions in the USA: Baltimore City and Baltimore County, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; New York, NY; and St. Paul, MN of the Multi-Ethnic Study of Atherosclerosis (MESA) (52.8% women) were recruited at baseline (2000-2) and included in the present analysis. RESULTS ICH was classified as poor, intermediate or ideal. Level of education was significantly and inversely associated with ICH in non-Hispanic White men and women, in Chinese-American and Hispanic American men and African-American women. Family income was inversely and significantly associated with poor ICH in African-American men only. CONCLUSIONS We conclude that the strength of the associations between some SES markers and ICH differ between sexes and race/ethnic groups.
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Affiliation(s)
- Augusto César Ferreira De Moraes
- YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heráclito Barbosa Carvalho
- YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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156
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Cermakova P, Pikhart H, Ruiz M, Kubinova R, Bobak M. Socioeconomic position in childhood and depressive symptoms in later adulthood in the Czech Republic. J Affect Disord 2020; 272:17-23. [PMID: 32379611 DOI: 10.1016/j.jad.2020.03.099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 01/29/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression risk may partly originate from socioeconomic hardship in childhood. We investigated the association of childhood socioeconomic position with depressive symptoms in later adulthood in a Central and Eastern European country. METHODS We analyzed data from the Czech arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. We estimated the associations of three indicators of childhood socioeconomic position (access to household amenities at age of 10 years, father´s education and mother´s education) with high depressive symptoms, operationalized as ≥16 points on the Center for Epidemiological Studies - Depression 20 scale, controlling for age and sex, current socioeconomic position and other social and health-related factors. RESULTS The analytical sample included 4,213 individuals (mean age 58 years, 54% women). All three indicators of childhood socioeconomic position were inversely associated with depressive symptoms in age-sex adjusted models (p for trends: access to household amenities p<0.001; mother´s education p<0.001; father´s education p=0.03). Adjustment for current socioeconomic position attenuated the associations of depressive symptoms with access to household amenities (p for trend 0.04) and mother´s education (p for trend 0.05) and virtually eliminated the association with father´s education (p for trend 0.82). LIMITATIONS Individuals with higher depressive symptoms and more adverse socioeconomic position are likely to be underrepresented in the study sample. Data on childhood socioeconomic position may be reported inaccurately. CONCLUSIONS Socioeconomic hardship in childhood may have long-lasting consequences on mental health in later adulthood.
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Affiliation(s)
- Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hynek Pikhart
- University College London, Research Department of Epidemiology and Public Health, London, United Kingdom
| | - Milagros Ruiz
- University College London, Research Department of Epidemiology and Public Health, London, United Kingdom; Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | | | - Martin Bobak
- University College London, Research Department of Epidemiology and Public Health, London, United Kingdom.
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157
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Lehne G, Bolte G. Socioeconomic status and change in sports activity among middle-aged and older men and women: evidence from the German Ageing Survey. J Public Health (Oxf) 2020; 41:689-699. [PMID: 30346565 DOI: 10.1093/pubmed/fdy188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 09/16/2018] [Accepted: 10/04/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sports activity (SA) behavior is unequally distributed across socioeconomic status (SES) groups. However, little is known about the impact of SES on change in SA over time. METHODS Based on data from the German Ageing Survey, we examined the role of objective (education, occupational prestige, household equivalent income, composite SES-index) and subjective (self-rated standard of living) SES indicators on negative and positive changes in SA during a follow-up of 6 years among adults aged 40+ years using logistic regression analysis. RESULTS Among active individuals at baseline, 32.1% of males and 24.8% of females experienced a negative change in SA. Among inactive individuals, 25.8 and 29.9% experienced a positive change. In the multivariate analysis, males and females with low SES were about twice as likely to experience a negative change and half as likely to experience a positive change. These patterns were observed regardless which SES indicator was examined. CONCLUSIONS This study provides comprehensive evidence for socioeconomic inequalities in negative and positive changes in SA behavior among middle-aged and older adults in Germany. To reduce socioeconomic inequalities, future SA interventions should address the mechanisms leading to differential probabilities of change in SA behavior by SES.
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Affiliation(s)
- Gesa Lehne
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.,University of Bremen, Health Sciences Bremen, Bremen, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.,University of Bremen, Health Sciences Bremen, Bremen, Germany
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158
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Delgado-Angulo EK, Alshehri R, Scambler S, Bernabé E. Is grandparents' social class associated with adult grandchildren's oral health? Analysis of two British cohorts. Community Dent Oral Epidemiol 2020; 48:402-408. [PMID: 32463137 DOI: 10.1111/cdoe.12545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES No studies have taken a multigenerational approach to the study of oral health inequalities. This study investigated whether grandparents' social class was associated with adult grandchildren's oral health. METHODS Data from the 1958 National Child and Development Study (NCDS) and the 1970 British Cohort Study (BCS) were analysed. Cohort members' occupational social class and persistent trouble with mouth, teeth or gums in the past 12 months were reported at ages 33 years in the NCDS and 26 years in the BCS. Information on grandparents' and parents' social class was reported by the cohort members' mothers during childhood. The association between grandparents' social class and cohort members' report of persistent trouble with mouth, teeth or gums was tested in marginal structural models (MSMs). RESULTS Data from 9853 NCDS and 6487 BCS participants were analysed. Grandparents' social class was not associated with cohort members' report of persistent trouble with teeth, gums or mouth in the NCDS sample (odds ratios of 1.25 [95% Confidence Interval: 0.95-1.65] for social class IV/V and 1.12 [95% CI: 0.76-1.64] for social class IIINM-M relative to social class I/II) or the BCS sample (odds ratios of 0.98 [95% CI: 0.68-1.43] for social class IV/V and 0.88 [95% CI: 0.67-1.16] for social class IIINM-M relative to social class I/II). CONCLUSION This study provided no support for an independent association between grandparents' social class and adult grandchildren's oral health.
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Affiliation(s)
- Elsa K Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Facultad de Estomatología Roberto Beltrán Neira, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Reem Alshehri
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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159
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Gender differences in the association between socioeconomic status and hypertension in France: A cross-sectional analysis of the CONSTANCES cohort. PLoS One 2020; 15:e0231878. [PMID: 32311000 PMCID: PMC7170232 DOI: 10.1371/journal.pone.0231878] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension prevalence increases when socioeconomic status decreases but gender differences in the relationship between socioeconomic status and hypertension have been less studied. This work aimed to explore the pattern of associations between three indicators of socioeconomic status at individual, household, and municipal levels with hypertension across genders in a large sample of French adults from the CONSTANCES cohort. Methods Using data at inclusion from 59 805 participants (52% women) aged 25–69 years and recruited between 2012 and 2015, multilevel log-Poisson regressions with robust variance estimates were used to assess the associations of Relative Index of Inequality in education, monthly income per consumption unit and residential deprivation with hypertension. Modifying effects of gender and age in those associations were tested. Results Hypertension prevalence was higher in men than in women. Steep socioeconomic gradients of hypertension were observed for the three socioeconomic indicators in both genders and from the youngest to the oldest age class. Socioeconomic inequalities, especially educational inequalities, were larger among women than men: Relative Index of Inequality for highest versus lowest education among the 25–34 years were 0.43 [95%-confidence interval = 0.28–0.67] in women and 0.70 [95%-confidence interval = 0.53–0.92] in men. With increasing age, socioeconomic gradients of hypertension eased in men and even more in women so that gender differences decreased. Conclusions In this cross-sectional analysis of a large sample of adults, prevalence of hypertension was higher in men than in women. Moreover, socioeconomic status and especially education displayed a stronger association with hypertension prevalence in women compared to men. Reducing inequalities in hypertension may require gender-specific approaches.
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160
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Bonaccio M, Di Castelnuovo A, Costanzo S, Tabolacci C, Iacoviello L. Reply. J Am Coll Cardiol 2020; 75:1866-1867. [DOI: 10.1016/j.jacc.2020.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
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Measuring Child Socio-Economic Position in Birth Cohort Research: The Development of a Novel Standardized Household Income Indicator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051700. [PMID: 32150940 PMCID: PMC7084936 DOI: 10.3390/ijerph17051700] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
The assessment of early life socioeconomic position (SEP) is essential to the tackling of social inequalities in health. Although different indicators capture different SEP dimensions, maternal education is often used as the only indicator in birth cohort research, especially in multi-cohort analyses. Household income, as a direct measure of material resources, is one of the most important indicators, but one that is underused because it is difficult to measure through questionnaires. We propose a method to construct a standardized, cross-cohort comparable income indicator, the “Equivalized Household Income Indicator (EHII)”, which measures the equivalized disposable household income, using external data from the pan-European Union Statistics on Income and Living Conditions (EUSILC) surveys, and data from the cohorts. We apply this method to four studies, Piccolipiù and NINFEA from Italy and ELFE and EDEN from France, comparing the distribution of EHII with other SEP-related variables available in the cohorts, and estimating the association between EHII and child body mass index (BMI). We found that basic parental and household characteristics may be used, with a fairly good performance, to predict the household income. We observed a strong correlation between EHII and both the self-reported income, whenever available, and other individual socioeconomic-related variables, and an inverse association with child BMI. EHII could contribute to improving research on social inequalities in health, in particular in the context of European birth cohort collaborative studies.
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162
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Pelders J, Nelson G. Socio-demographic contributors to health and safety of mine workers in South Africa. Work 2020; 64:67-76. [PMID: 31561403 DOI: 10.3233/wor-192969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mine workers in South Africa face various health and safety risks, and socioeconomic challenges. OBJECTIVE This study aimed to assess the associations between socio-demographic factors and health, safety and wellness in the South African mining industry. METHODS Qualitative and quantitative data were collected from 64 interviews with mine management and labour representatives, 14 focus groups with mine workers, and 875 questionnaires completed by mine workers from three platinum, two gold, one coal, one diamond, and one manganese mine in South Africa. RESULTS Health challenges included non-communicable diseases, HIV/AIDS, tuberculosis (TB), and respiratory diseases, while safety challenges included worker behaviour, stress and fatigue. Socio-demographic factors associated with disease, sick leave, fatigue, accidents and job satisfaction included age, length of service, race, nationality, education, mining sector, work status, income, housing, domestic crowding, sleep, exercise, alcohol use, and perceived quality of life. CONCLUSION Socio-demographic factors should be taken into consideration when developing workplace health and safety programmes.
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Affiliation(s)
- Jodi Pelders
- Mining and Mineral Resources, Natural Resources and the Environment, CSIR, Pretoria, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gill Nelson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institute for Global Health, University College London, London, UK
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163
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Socioeconomic Status and Ovarian Cancer Stage at Diagnosis: A Study Nested Within UKCTOCS. Diagnostics (Basel) 2020; 10:diagnostics10020089. [PMID: 32046189 PMCID: PMC7168054 DOI: 10.3390/diagnostics10020089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Tubo-ovarian cancer (OC) continues to be the most lethal of all gynaecological cancers. Over half of women are diagnosed with late stage (III/IV) disease, which has a five-year survival rate of 11%. Socioeconomic status (SES) has been shown to have an impact on outcomes of several cancer types, including OC. This study aims to investigate any potential association between SES and stage at diagnosis of OC. Methods: Women from the non-screening arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) with a confirmed diagnosis of OC prior to 01 January 2015 and an English index of multiple deprivation (IMD) score were eligible for the study. The association between IMD and OC stage (FIGO) was analysed using an ordinal logistic regression model adjusted for age at diagnosis and BMI. Results: Four-hundred and fifty seven women were eligible for inclusion in the primary analysis. The odds of being diagnosed with the higher dichotomization of stage (I vs. II/III/IV; I/II vs. III/IV; I/II/III vs. IV) was 1.29 (p = 0.017; 95% CI: 1.048–1.592) per unit SD (standard deviation) increase in IMD. This translates to a 29% increase in odds of being diagnosed at the higher stage per each unit SD increase in IMD. Conclusion: Increased deprivation is consistently associated with a higher probability of being diagnosed with later stage OC.
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164
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Raedkjaer M, Maretty-Kongstad K, Baad-Hansen T, Safwat A, Mørk Petersen M, Keller J, Vedsted P. The association between socioeconomic position and tumour size, grade, stage, and mortality in Danish sarcoma patients - A national, observational study from 2000 to 2013. Acta Oncol 2020; 59:127-133. [PMID: 31702424 DOI: 10.1080/0284186x.2019.1686536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Survival in sarcoma patients depends on a range of prognostic factors. An association between cancer survival and socioeconomic position is known for several other cancers. We therefore examined the relations between three socioeconomic factors and risk of presenting with known tumour related prognostic factors, and the overall mortality of the different socioeconomic and prognostic factors in 1919 patients diagnosed with sarcoma in Denmark 2000-2013.Material and methods: Patients with sarcoma in extremities or trunk wall aged 30 years or more at diagnosis were identified in the Danish Sarcoma Registry and linked on an individual level to Danish national registries. We obtained data on educational level, disposable income and cohabitation status. Odds ratios (ORs) were estimated for the association between the socioeconomic factors and grade, stage and tumour size. Hazard ratios (HRs) were estimated using Cox proportional hazard models.Results: In adjusted analyses, educational level, income and cohabitation status were not associated with high grade or dissiminated stage at time of diagnosis. However, living alone was statistically significantly associated with having a large soft tissue sarcoma (≥5 cm) at time of diagnosis (OR 1.51; CI1.12-2.03). The overall mortality was statistically significantly increased in the group of patients with ≤10 years of education (HR 1.27; CI 1.02-1.57), in patients with the 20% lowest income (HR 1.30; CI 1.00-1.67) and nearly in patients living alone (HR 1.16; CI 0.99-1.36).Conclusion: In this nationwide, multicentre, population-based study, soft tissue sarcoma patients living alone had greater risk of having a large tumour at time of diagnosis. Soft tissue and bone sarcoma patients with a short education, low income, or living alone, had a higher mortality. This might indicate that the social differences in mortality might be related to treatment aspects and the biology of the disease rather that the diagnostic process.
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Affiliation(s)
- Mathias Raedkjaer
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark Copenhagen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Thomas Baad-Hansen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Akmal Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Mørk Petersen
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark Copenhagen
| | - Johnny Keller
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vedsted
- The Research Unit of General Practice, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Silkeborg Hospital, Aarhus University, Aarhus, Denmark
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165
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Svane-Petersen AC, Holm A, Burr H, Framke E, Melchior M, Rod NH, Sivertsen B, Stansfeld S, Sørensen JK, Virtanen M, Rugulies R, Madsen IEH. Psychosocial working conditions and depressive disorder: disentangling effects of job control from socioeconomic status using a life-course approach. Soc Psychiatry Psychiatr Epidemiol 2020; 55:217-228. [PMID: 31506742 DOI: 10.1007/s00127-019-01769-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Job control, the combination of skill discretion and decision authority, is considered a central component of the psychosocial working environment. This longitudinal study examines the relation between job control and risk of incident depressive disorder using a life-course approach. METHODS We analyze data from The Danish Work Life Course Cohort study, including all Danish individuals aged 15-30 who entered the Danish labor market during 1995-2009 and were free from depressive disorder at entry (955,573 individuals). We measured job control using a job exposure matrix. Depressive disorders were measured using information from nationwide registers of psychiatric in- and outpatient admissions. Using Cox regression models we estimated the prospective association between job control and risk of incident depressive disorders. Analyses accounted for a range of potential confounders prior to workforce entry including socioeconomic status in adolescence and parental psychiatric and somatic diagnoses prior to labor market entry, together with potential confounders in adulthood including income, education, and demographics. RESULTS Lower levels of past year job control were associated with a higher risk of depressive disorder after adjustment for all covariates (HR = 1.27, 95% CI 1.16-1.38). Results stratified by gender showed associations for both men (HR = 1.38, 95% CI 1.19-1.61) and women (HR = 1.19, 95% CI 1.08-1.32). CONCLUSIONS Our findings suggest that the level of job control at work affects the risk of clinically diagnosed depressive disorder, and that this association is not due to confounding by socioeconomic status.
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Affiliation(s)
| | - Anders Holm
- Department of Sociology, University of Western Ontario, London, Canada
| | - Hermann Burr
- Department of Work and Health, Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Elisabeth Framke
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stephen Stansfeld
- Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark.
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166
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Leone SS, Lokman S, Boon B, van der Poel A, Smit F, Zijlstra-Vlasveld M, Smeets O. Implementing complaint-directed mini-interventions for depressive complaints in primary care to increase participation among patients with a lower socioeconomic status: design of a cluster randomised controlled trial. Trials 2020; 21:64. [PMID: 31924275 PMCID: PMC6954579 DOI: 10.1186/s13063-019-3890-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a major public health concern. E-health interventions for preventing and reducing depressive complaints have proven to be effective, and have the potential to make (mental) health care more accessible and efficient. However, the reach of these interventions needs to be improved, especially among people with a lower socioeconomic status (SES). Stimulating and supporting implementation of e-health in primary care, and offering guidance from general practice nurses (GP nurses) may be important strategies to achieve this. METHODS/DESIGN The online 'Complaint Directed Mini-Interventions' (CDMIs) for stress, sleep and worry complaints, which were found to be (cost-)effective in a self-guided format, will be implemented in the primary care setting using a blended care format (i.e. combining e-health with face-to-face sessions) with minimal guidance provided by the GP nurse. The main aim is to evaluate whether a SES-sensitive implementation strategy improves the participation rate (i.e. reach) of lower-SES patients in the blended online CDMIs as compared to a regular implementation strategy in a cluster randomised controlled trial. Randomisation will occur at the level of the GP nurse, and 228 patients will be included in the study. The primary outcome is the participation rate (completing at least one face-to-face session and two online exercises) of the lower-SES target group. It is hypothesised that this percentage will be higher in the SES-sensitive group as compared to the regular group. Secondary objectives are to evaluate the implementation process, to monitor and evaluate psychological complaints (depression, sleep, stress, worry and anxiety) and well-being over time. Patient assessments will take place at baseline, 3 and 12 months post baseline. DISCUSSION This study should contribute to our knowledge of reaching the lower-SES groups with a brief and complaint-specific blended approach for depressive complaints in primary care. It should also further our knowledge on successful strategies to implement depression prevention in primary care. TRIAL REGISTRATION Netherlands Trial Register, ID: NL6595. Registered on 12 November 2017.
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Affiliation(s)
- Stephanie S Leone
- Department of Public Mental Health, Trimbos Institute: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Suzanne Lokman
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Brigitte Boon
- Academy Het Dorp, Arnhem, The Netherlands.,Siza, Arnhem, The Netherlands
| | | | - Filip Smit
- Department of Public Mental Health, Trimbos Institute: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Epidemiology and Biostatistics and Department of Clinical, Neuro and Developmental Psychology, Public Health research institute, University Medical Centers Amsterdam, Amsterdam, Netherlands
| | - Moniek Zijlstra-Vlasveld
- ZonMw, the Netherlands Organisation for Health Research and Development, The Hague, The Netherlands
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167
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Blodgett JM, Kuh D, Hardy R, Davis DHJ, Cooper R. Childhood Cognition and Age-Related Change in Standing Balance Performance From Mid to Later Life: Findings From a British Birth Cohort. J Gerontol A Biol Sci Med Sci 2020; 75:155-161. [PMID: 30535263 PMCID: PMC6909897 DOI: 10.1093/gerona/gly275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cognitive processing plays a crucial role in the integration of sensory input and motor output that facilitates balance. However, whether balance ability in adulthood is influenced by cognitive pathways established in childhood is unclear, especially as no study has examined if these relationships change with age. We aimed to investigate associations between childhood cognition and age-related change in standing balance between mid and later life. METHODS Data on 2,380 participants from the MRC National Survey of Health and Development were included in analyses. Repeated measures multilevel models estimated the association between childhood cognition, assessed at age 15, and log-transformed balance time, assessed at ages 53, 60-64, and 69 using the one-legged stand with eyes closed. Adjustments were made for sex, death, attrition, anthropometric measures, health conditions, health behaviors, education, other indicators of socioeconomic position (SEP), and adult verbal memory. RESULTS In a sex-adjusted model, 1 standard deviation increase in childhood cognition was associated with a 13% (95% confidence interval: 10, 16; p < .001) increase in balance time at age 53, and this association got smaller with age (cognition × age interaction: p < .001). Adjustments for education, adult verbal memory, and SEP largely explained these associations. CONCLUSIONS Higher childhood cognition was associated with better balance performance in midlife, with diminishing associations with increasing age. The impact of adjustment for education, cognition and other indicators of SEP suggested a common pathway through which cognition is associated with balance across life. Further research is needed to understand underlying mechanisms, which may have important implications for falls risk and maintenance of physical capability.
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Affiliation(s)
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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168
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Amr RA, Al-Smadi AM, Akasheh RT, Deiranieh RA, Gammoh OS, Hammouh FG, Amr RA, Dababneh BF. Mood and demographical factors as predictors of body mass index among Syrian and Iraqi refugees in Jordan. J Health Psychol 2019; 26:1988-1998. [PMID: 31830806 DOI: 10.1177/1359105319893108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We studied whether mood and demographics are related to body mass index in a population of Syrian and Iraqi refugees residing in Jordan. Questionnaires and Brunel Mood Scale were used to collect demographical data. Data were analyzed using t-test and analysis of variance. A high prevalence of overweight and obesity was observed in this population (60.5%). Mood subscales were not associated with body mass index categories. However, body mass index as a continuous variable was associated with anger, depression, and fatigue scores. Linear regression revealed that age, ethnicity, unemployment, chronic illnesses, and physical activity level, but not mood, are associated with body mass index.
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Affiliation(s)
- Rula A Amr
- American University of Madaba (AUM), Jordan
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169
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Van Stappen V, De Lepeleere S, Huys N, Latomme J, Verloigne M, Cardon G, Androutsos O, Manios Y, De Bourdeaudhuij I, De Craemer M. Effect of integrating a video intervention on parenting practices and related parental self-efficacy regarding health behaviours within the Feel4Diabetes-study in Belgian primary schoolchildren from vulnerable families: A cluster randomized trial. PLoS One 2019; 14:e0226131. [PMID: 31826024 PMCID: PMC6905545 DOI: 10.1371/journal.pone.0226131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effect of integrating a video intervention "Movie Models" within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children's physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents. METHODS Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The "Movie Models" videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects. RESULTS Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children's eating behaviours, however almost no effects were found on parenting-related factors regarding children's physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them. CONCLUSION The integration of "Movie Models" within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children's health behaviours, however most parenting-related factors could not be improved. The implementation of "Movie Models" as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families. TRIAL REGISTRATION ClinicalTrials.gov NCT02278809.
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Affiliation(s)
- Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- * E-mail:
| | - Sara De Lepeleere
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Nele Huys
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Julie Latomme
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Maïté Verloigne
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Kallithea, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Kallithea, Athens, Greece
| | | | - Marieke De Craemer
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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170
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Salway RE, Emm-Collison L, Sebire S, Thompson JL, Jago R. Associations between socioeconomic position and changes in children's screen-viewing between ages 6 and 9: a longitudinal study. BMJ Open 2019; 9:e027481. [PMID: 31826887 PMCID: PMC6924727 DOI: 10.1136/bmjopen-2018-027481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To explore socioeconomic differences in screen-viewing at ages 6 and 9, and how these are related to different media uses. DESIGN Longitudinal cohort study. SETTING Children recruited from 57 state-funded primary schools in Southwest England, UK. PARTICIPANTS 1299 children at ages 5-6, 1223 children at ages 8-9, including 685 children at both time points. OUTCOME MEASURES Children's total screen-viewing time (parent-reported) and time spent using multiple screen devices simultaneously (multiscreen viewing), for weekdays and weekends. METHODS Negative binomial regression was used to model associations between socioeconomic variables (highest household education and area deprivation) and total screen-viewing at age 6 and the change from age 6 to 9. We additionally adjusted for child characteristics, parental influences and media devices in the home. Multiscreen viewing was analysed separately. RESULTS Household education was associated with children's screen-viewing at age 6 with lower screen-viewing in higher socioeconomic groups (21%-27% less in households with a Degree or Higher Degree, compared with General Certificate of Secondary Education: GCSE). These differences were explained by the presence of games consoles, parental limits on screen-viewing and average parent screen-viewing. Between ages 6 and 9, there were larger increases in screen-viewing for children from A level and Degree households (13% and 6%, respectively, in the week) and a decrease in Higher Degree households (16%), compared with GCSE households. Differences by household education remained when adjusting for media devices and parental factors. CONCLUSIONS Children's screen-viewing patterns differ by parental education with higher levels of viewing among children living in households with lower educational qualifications. These differences are already present at age 6, and continue at age 9. Strategies to manage child sedentary time, and particularly screen-viewing, may need to take account of the socioeconomic differences and target strategies to specific groups.
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Affiliation(s)
- Ruth E Salway
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Lydia Emm-Collison
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Simon Sebire
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Janice L Thompson
- School of Sport and Exercise Sciences, The University of Birmingham, Birmingham, UK
| | - Russ Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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171
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Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Drogue S, Amiot MJ, Méjean C. Socioeconomic inequalities in metabolic syndrome in the French West Indies. BMC Public Health 2019; 19:1620. [PMID: 31795991 PMCID: PMC6888917 DOI: 10.1186/s12889-019-7970-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/19/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region. We investigated the association between socioeconomic position and metabolic syndrome (MetS) prevalence and explored the contribution of diet quality to explain this association, among adults in the French West Indies. METHODS This cross-sectional analysis included 1144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. MetS prevalence was assessed using the Joint Interim Statement. Dietary intakes were estimated from 24 h-dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and MetS prevalence, and the potential contribution of diet quality in this association were assessed using multivariable logistic regression models, adjusted for sociodemographic characteristics. RESULTS MetS prevalence adjusted for age and sex was 21 and 30% among Guadeloupean and Martinican, respectively. Compared to high-educated participants, low-educated subjects were more likely to be at risk of MetS (OR = 2.4; 95%CI = [1.3-4.4], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.0; 95%CI = [1.0-4.0]). The DQI-I explained 10.5% of the overall variation in MetS due to education. CONCLUSIONS Socioeconomic inequalities in MetS prevalence, reflected by education and social assistance benefits, were found. However, diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial. Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Further prospective studies are needed to improve our understanding of the mechanisms of social inequalities in MetS in a high poverty rates context.
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Affiliation(s)
- Zoé Colombet
- UMR 1110 MOISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRA, Montpellier SupAgro, 2 place Pierre Viala, F-34000, Montpellier, France.
| | - Marlène Perignon
- UMR 1110 MOISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRA, Montpellier SupAgro, 2 place Pierre Viala, F-34000, Montpellier, France
| | - Benoît Salanave
- Nutritional Surveillance and Epidemiology Team (ESEN), French Public Health Agency, Paris-13 University, Centre de recherche en épidémiologie et statistiques, COMUE Sorbonne Paris Cité, Bobigny, France
| | - Edwige Landais
- UMR204-Nutripass, French National Research Institute for Sustainable Development (IRD), Université de Montpellier, Montpellier, France
| | - Yves Martin-Prevel
- UMR204-Nutripass, French National Research Institute for Sustainable Development (IRD), Université de Montpellier, Montpellier, France
| | - Benjamin Allès
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Paris Nord, Inserm (U1153), Inra (U1125), Cnam, Université Paris 5, Université Paris 7, F-93017, Bobigny, France
| | - Sophie Drogue
- UMR 1110 MOISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRA, Montpellier SupAgro, 2 place Pierre Viala, F-34000, Montpellier, France
| | - Marie Josèphe Amiot
- UMR 1110 MOISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRA, Montpellier SupAgro, 2 place Pierre Viala, F-34000, Montpellier, France
| | - Caroline Méjean
- UMR 1110 MOISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRA, Montpellier SupAgro, 2 place Pierre Viala, F-34000, Montpellier, France
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Mao F, Astell-Burt T, Feng X, Liu Y, Dong J, Liu S, Wang L, Jiang Y, Dong W, Zhou M, Wang L. Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study. BMJ Open 2019; 9:e031366. [PMID: 31784439 PMCID: PMC6924714 DOI: 10.1136/bmjopen-2019-031366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China. DESIGN Multilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015. SETTING All 31 provinces in China, not including Hong Kong, Macao or Taiwan. PARTICIPANTS 96 466 ≥ 18 years old (women=54.3%). EXPOSURES Person-level educational attainment and mean years of education in counties. OUTCOME AL was measured using clinical guidelines for nine biomarkers: body mass index; waist circumference; systolic blood pressure; diastolic blood pressure; fasting blood glucose; total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol. RESULTS Multilevel logistic regressions adjusted for sex, age, marital status, person-level education, county mean years of education and urban/rural reported ORs of 1.22 (95% CI 1.08 to 1.38) for 5-year all-cause mortality (n=3284) and 1.20 (1.04-1.37) for deaths from non-communicable diseases (n=2891) among people in AL quintile 5 (high) compared with quintile 1 (low). The median rate ratio estimated from unadjusted multilevel negative binomial regression showed AL clustered geographically (province=1.14; county=1.12; town=1.11; village=1.14). After adjusting for aforementioned confounders, AL remained higher with age (rate ratio 1.02, 95% CI 1.02 to 1.02), higher in women compared with men (1.17, 1.15 to 1.19), lower among singletons (0.83, 0.81 to 0.85) and widowers (0.96, 0.94 to 0.98). AL was lower among people with university-level compared with no education (0.92, 0.89 to 0.96), but higher in counties with higher mean education years (1.03, 1.01 to 1.05). A two-way interaction suggested AL was higher (1.04, 1.02 to 1.06) among those with university-level compared with no education within counties with higher mean years of education. Similar results were observed for alternative constructions of AL using 75th and 80th percentile cut-points. CONCLUSIONS AL in China is patterned geographically. The degree of association between AL and person-level education seems to be dependent on area-level education, which may be a proxy for other contextual factors that warrant investigation.
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Affiliation(s)
- Fan Mao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yunning Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianqun Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yingying Jiang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenlan Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Norman Å, Nyberg G, Berlin A. School-based obesity prevention for busy low-income families-Organisational and personal barriers and facilitators to implementation. PLoS One 2019; 14:e0224512. [PMID: 31689329 PMCID: PMC6830752 DOI: 10.1371/journal.pone.0224512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little research has targeted multiple-level barriers and facilitators in school-based parental support programmes. This qualitative study aims to describe barriers and facilitators, at organisational and personal levels, that teachers and parents in disadvantaged settings in Sweden perceived as influencing the implementation of the Healthy School Start II (HSS II) intervention. METHODS Data collection, analysis and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups and interviews were conducted with 14 parents and ten teachers within the HSS II trial. Data were analysed using qualitative content analysis in a deductive step using the three CFIR domains-inner and outer setting, and personal characteristics-followed by an inductive analysis. RESULTS The theme 'being on the same page-getting burdened teachers and parents to work on common ground' was found. Among teachers, barriers and facilitators were related to the structure of the schoolwork and curriculum, involvement from other staff and school management, the practical school workday, perception of high family needs but low parental interest, insufficient resources in the families, and teacher's personal knowledge, interests, and opinions about health and food. For parents, barriers and facilitators were related to the perceived family needs and resources, parents' health knowledge, consensus about healthy behaviours and ability to cooperate, and school involvement in health issues and the intervention. CONCLUSION Interventions should facilitate parents' and teachers' work on common ground, with activities suitable for a stressful and burdensome workday and everyday life. This could be achieved by integrating evidence-based practices within school routines, and including activities that are practicable despite parents' stressful lives, and that increase parental consensus about promoting health. Strategies to increase involvement of parents in families with high needs are necessary. Also, this study suggests an expansion of the CFIR to capture the interface between different micro-level organisations, and account for several delivering/receiving organisations.
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Affiliation(s)
- Åsa Norman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Anita Berlin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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174
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Yao Q, Li X, Luo F, Yang L, Liu C, Sun J. The historical roots and seminal research on health equity: a referenced publication year spectroscopy (RPYS) analysis. Int J Equity Health 2019; 18:152. [PMID: 31615528 PMCID: PMC6792226 DOI: 10.1186/s12939-019-1058-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/23/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health equity is a multidimensional concept that has been internationally considered as an essential element for health system development. However, our understanding about the root causes of health equity is limited. In this study, we investigated the historical roots and seminal works of research on health equity. METHODS Health equity-related publications were identified and downloaded from the Web of Science database (n = 67,739, up to 31 October 2018). Their cited references (n = 2,521,782) were analyzed through Reference Publication Year Spectroscopy (RPYS), which detected the historical roots and important works on health equity and quantified their impact in terms of referencing frequency. RESULTS A total of 17 pronounced peaks and 31 seminal works were identified. The first publication on health equity appeared in 1966. But the first cited reference can be traced back to 1801. Most seminal works were conducted by researchers from the US (19, 61.3%), the UK (7, 22.6%) and the Netherlands (3, 9.7%). Research on health equity experienced three important historical stages: origins (1800-1965), formative (1966-1991) and development and expansion (1991-2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899). The concept of health equity originated from the disciplines of public health, sociology and political economics and has been a major research area of social epidemiology since the early nineteenth century. Studies on health equity evolved from evidence gathering to the identification of cost-effective policies and governmental interventions. CONCLUSION The development of research on health equity is shaped by multiple disciplines, which has contributed to the emergence of a new stream of social epidemiology and political epidemiology. Past studies must be interpreted in light of their historical contexts. Further studies are needed to explore the causal pathways between the social determinants of health and health inequalities.
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Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 Hubei China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Xin Li
- School of Information Management, Wuhan University, Wuhan, 430072 Hubei China
| | - Fei Luo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei China
| | - Lianping Yang
- School of Public Heath, Sun Yat-sen University, Guangzhou, 510275 Guangdong China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 Hubei China
- Institute of Health, Wuhan University, Wuhan, 430071 Hubei China
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175
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Quick V, Eck KM, Delaney C, Lewis R, Byrd-Bredbenner C. Stability of Differences in Weight-Related Characteristics of Mothers across Economic, Cultural, Social, and Environmental-Health Indicators of Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3866. [PMID: 31614823 PMCID: PMC6843972 DOI: 10.3390/ijerph16203866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 11/16/2022]
Abstract
This study explored the differences in weight-related characteristics when socioeconomic status (SES) was assessed by economic, cultural, social, and environmental-health capital individually and as a composite with the goal of determining the stability of differences across types of capital and to ascertain whether single or a combination of capital indicators of SES should be used in nutrition and public health studies. Mothers (n = 557) of young children completed a survey assessing capital and weight-related characteristics. Mothers with higher economic, cultural, and social capital and composite SES had fewer sugar-sweetened beverage servings, fewer meals in front of the TV, more food security, and greater neighborhood space/supports for physical activity than comparators. Few differences occurred among environmental-health capital groups. Composite SES performed similarly to individual economic, cultural, and social capital measures. Findings suggest single SES indicators may be sufficiently stable to capture differences in weight-related characteristics. Each capital type captures a unique aspect of SES; thus, assessing an array of capital types could advance understanding of SES aspects on weight-related characteristics.
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Affiliation(s)
- Virginia Quick
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08520, USA.
| | - Kaitlyn M Eck
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08520, USA.
| | - Colleen Delaney
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08520, USA.
| | - Ryan Lewis
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08520, USA.
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08520, USA.
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Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173195. [PMID: 31480561 PMCID: PMC6747170 DOI: 10.3390/ijerph16173195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.
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177
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Chavehpour Y, Rashidian A, Woldemichael A, Takian A. Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran. BMC Health Serv Res 2019; 19:614. [PMID: 31470849 PMCID: PMC6717334 DOI: 10.1186/s12913-019-4443-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 08/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background This study aims to assess geographical distribution of hospitals and extent of inequalities in hospital beds against socioeconomic status (SES) of residents of five metropolitan cities in Iran. Methods A cross-sectional analysis was conducted to measure geographical inequality in hospital and hospital bed distributions of 68 districts in five metropolitan cities during 2016 using geographic information system (GIS), and Gini and Concentration indices. Correlation analysis was performed to show the relationship between the SES and inequality in hospital beds densities. Results The study uncovered marked inequalities in hospitals and hospital beds distributions. The Gini indices for hospital beds were greater than 0.55. The aggregated concentration indices for public and private hospital beds were 0.33 and 0.49, respectively. The GIS revealed that 216 (70.6%) hospitals were located in two highest socioeconomic status classes in the cities. Only 29 (9.5%) hospitals were located in the lowest class. The public, private, and the cumulative hospitals beds distributions in Tehran and Esfahan showed significant (p < 0.05) positive correlation with SES of the residents. Conclusions The high inequalities in hospital and hospital beds distributions in our study imply an overlooked but growing concern for geographical access to healthcare in rapidly urbanizing metropolitan cities in Iran. Thus, regardless of ownership, decision-makers should emphasize the disadvantaged areas in metropolitan cities when need arises for the establishment of new healthcare facilities in order to ensure fairness in healthcare. The metropolitan cities and rapid urbanization settings in other countries could learn lessons to reduce or prevent similar issues which might have hampered access to healthcare.
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Affiliation(s)
- Yousef Chavehpour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abraha Woldemichael
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
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178
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Salway R, Emm-Collison L, Sebire SJ, Thompson JL, Lawlor DA, Jago R. The association of school-related active travel and active after-school clubs with children's physical activity: a cross-sectional study in 11-year-old UK children. Int J Behav Nutr Phys Act 2019; 16:72. [PMID: 31438985 PMCID: PMC6704690 DOI: 10.1186/s12966-019-0832-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/13/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Physical activity is associated with improved physical and mental health among children, but many children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to investigate participation in active after-school clubs and active travel to and from school at age 11 and estimate the average daily minutes of MVPA associated with active club attendance and active travel. METHODS Accelerometer data were collected on three weekdays for 1296 11-year-old children in a cross-sectional study. Children reported attendance at active after-school clubs and how they travelled to and from school for each day of the week. To account for repeat days within child and clustering within schools we used multilevel models with random effects at the school and child level, and fixed effects for all covariates. We calculated odds ratios for participation in active after-school clubs and active travel for gender, measures of socio-economic position and BMI category. We also explored the association between active club attendance, active travel and daily average MVPA. RESULTS Boys and girls were equally likely to attend active after-school clubs. Boys were more likely to travel to school using active modes. Attendance at active after-school clubs and active travel home were not associated with each other. Attending an active after-school club was associated with an additional 7.6 min (95% CI: 5.0 to 10.3) average MVPA on that day among both boys and girls. Active travel was associated with an additional 4.7 min (95% CI: 2.9 to 6.5) average MVPA per journey for boys and 2.4 min (95% CI: 1.0 to 3.7) for girls. CONCLUSIONS Both active after-school clubs and active travel are associated with greater physical activity on the day that children participate in these, and we saw no evidence that those attending active clubs do so at the expense of active travel home afterwards. While the increased daily MVPA is small to moderate, active after-school clubs and active travel on multiple days of the week could make important contributions as part of complex interventions aimed at increasing population levels of physical activity in children.
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Affiliation(s)
- Ruth Salway
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Lydia Emm-Collison
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Simon J. Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PS UK
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
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Husbands' and wives' discordant self-reports on couple-level variables: implications for data analysis. Porto Biomed J 2019; 4:e53. [PMID: 31893250 PMCID: PMC6924978 DOI: 10.1097/j.pbj.0000000000000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Using the couple as unit of analysis raises methodological challenges. This study aims to discuss the appropriate proxy to use in statistical analyses when couples provide discordant answers on the following couple-level variables: household monthly income and length of marital relationship. Methods: During 12 months (July 2013–June 2014), parents of very preterm infants admitted at all level III Neonatal Intensive Care Units of the North of Portugal were consecutively and systematically invited to participate in this study. Mothers and fathers were surveyed separately, 15 to 22 days after birth. In the current analysis, 82 couples living in the same household were included. A socioeconomic position factor score was computed through a principal component analysis. To seek the most appropriate proxy of the couple's value, the association between the individual answers and the summary measures of couple-level variables, and the factor's score was estimated using generalized linear models. Results: Almost 40% of couples gave discordant answers about household monthly income [weighted kappa = 0.68 (95% confidence interval: 0.58–0.79)], with no association with sex. Approximately 19% of couples disagreed regarding the length of marital relationship [weighted kappa = 0.95 (95% confidence interval: 0.92–0.98)], with men declaring longer relationships. No associations were observed between women's and men's answers or the summary measures with the socioeconomic position score. Conclusions: Suggestions regarding how to handle the methodological problems related with spousal discrepancies include the collection of individual variables through separate interviews alongside couple-level variables using joint interviews.
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Abstract
BACKGROUND The complex interrelationship among physical health, mental health, and social health has gained the attention of the medical community in recent years. Poor social health, also called social deprivation, has been linked to more disease and a more-negative impact from disease across a wide variety of health conditions. However, it remains unknown how social deprivation is related to physical and mental health in patients presenting for orthopaedic care. QUESTIONS/PURPOSES (1) Do patients living in zip codes with higher social deprivation report lower levels of physical function and higher levels of pain interference, depression, and anxiety as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) at initial presentation to an orthopaedic provider than those from less deprived areas; and if so, is this relationship independent of other potentially confounding factors such as age, sex, and race? (2) Does the relationship between the level of social deprivation of a patient's community and that patient's physical function, pain interference, depression, and anxiety, as measured by PROMIS remain consistent across all orthopaedic subspecialties? (3) Are there differences in the proportion of individuals from areas of high and low levels of social deprivation seen by the various orthopaedic subspecialties at one large, tertiary orthopaedic referral center? METHODS This cross-sectional evaluation analyzed 7500 new adult patients presenting to an orthopaedic center between August 1, 2016 and December 15, 2016. Patients completed PROMIS Physical Function-v1.2, Pain Interference-v1.1, Depression-v1.0, and Anxiety-v1.0 Computer Adaptive Tests. The Area Deprivation Index, a composite measure of community-level social deprivation, based on multiple census metrics such as income, education level, and housing type for a given nine-digit zip code was used to estimate individual social deprivation. Statistical analysis determined the effect of disparate area deprivation (based on most- and least-deprived national quartiles) for the entire sample as well as for patients categorized by the orthopaedic subspecialty providing care. Comparisons of PROMIS scores among these groups were based on an MCID of 5 points for each PROMIS domain (Effect size 0.5). RESULTS Patients living in zip codes with the highest levels of social deprivation had worse mean scores across all four PROMIS domains when compared with those living in the least-deprived quartile (physical function 38 +/- 9 versus 43 +/- 9, mean difference 4, 95% CI, 3.7-5.0; p < 0.001; pain interference 64 +/- 8 versus 60+/-8, mean difference -4, 95% CI, -4.8 to -3.7; p < 0.001; depression 50+/-11 versus 45+/-8, mean difference -5, 95% CI, -6.0 to -4.5; p < 0.001; anxiety 56+/-11 versus 50 +/-10, mean difference -6, 95% CI, -6.9 to -5.4; p < 0.001). There were no differences in physical function, pain interference, depression, or anxiety PROMIS scores between patients from the most- and least-deprived quartiles who presented to the subspecialties of spine (physical function, mean 35+/-7 versus 35+/-7; p = 0.872; pain interference, 67+/-7 versus 66+/-7; p = 0.562; depression, 54+/-12 versus 51 +/-10; p = 0.085; and anxiety, 60+/-11 versus 58 +/-9; p = 0.163), oncology (physical function, mean 33+/-9 versus 38 +/-13; p = 0.105; pain interference, 68+/-9 versus 64+/-10; p = 0.144; depression, 51+/-10 versus 52+/-13; p = 0.832; anxiety, 59+/-11 versus 59+/-10 p = 0.947); and trauma (physical function, 35+/-11 versus 32+/-10; p = 0.268; pain interference, 66+/-7 versus 67+/-6; p = 0.566; depression, 52+/-12 versus 53+/-11; p = 0.637; and anxiety, 59+/-12 versus 60+/-9 versus; p = 0.800). The social deprivation-based differences in all PROMIS domains remained for the subspecialties of foot/ankle, where mean differences ranged from 3 to 6 points on the PROMIS domains (p < 0.001 for all four domains), joint reconstruction where mean differences ranged from 4 to 7 points on the PROMIS domains (p < 0.001 for all four domains), sports medicine where mean differences in PROMIS scores ranged from 3 to 5 between quartiles (p < 0.001 for all four domains), and finally upper extremity where mean differences in PROMIS scores between the most- and least-deprived quartiles were five points for each PROMIS domain (p < 0.001 for all four domains). The proportion of individuals from the most- and least-deprived quartiles was distinct when looking across all seven subspecialty categories; only 11% of patients presenting to sports medicine providers and 17% of patients presenting to upper extremity providers were from the most-deprived quartile, while 39% of trauma patients were from the most-deprived quartile (p < 0.001). CONCLUSIONS Orthopaedic patients must be considered within the context of their social environment because it influences patient-reported physical and mental health as well as has potential implications for treatment and prognosis. Social deprivation may need to be considered when using patient-reported outcomes to judge the value of care delivered between practices or across specialties. Further studies should examine potential interventions to improve the perceived health of patients residing in communities with greater social deprivation and to determine how social health influences ultimate orthopaedic treatment outcomes. LEVEL OF EVIDENCE Level II, prognostic study.
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Food Consumption in Adolescents and Young Adults: Age-Specific Socio-Economic and Cultural Disparities (Belgian Food Consumption Survey 2014). Nutrients 2019; 11:nu11071520. [PMID: 31277444 PMCID: PMC6683246 DOI: 10.3390/nu11071520] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 12/16/2022] Open
Abstract
A key issue in nutritional public health policies is to take into account social disparities behind health inequalities. The transition from adolescence toward adulthood is a critical period regarding changes in health behaviors. This study aimed to determine how consumption of four emblematic food groups (two to favor and two to limit) differed according to socio-economic and cultural characteristics of adolescents and young adults living in Belgium. Two non-consecutive 24-h dietary recalls were carried out in a nationally representative sample of 10–39 year old subjects (n = 1505) included in the Belgian food consumption survey 2014. Weighted daily mean consumption of “fruits and vegetables”, “whole grain bread and cereals”, “refined starchy food”, and “sugary sweetened beverages” (SSB) was calculated and explored in multivariable linear regressions stratified into four age groups. After adjustment, 10–13 year old adolescents living in less educated households daily consumed lower amounts of “fruits and vegetables” (adjusted mean: 165.6 g/day (95% CI: 125.3–206.0)) and “whole grain bread and cereals” (40.4 g/day (22.9–58.0)), and higher amounts of SSB (309.7 g/day (131.3–488.1) than adolescents of same ages living in more educated households (220.2 g/day (179.8–260.7); 59.0 g/day (40.3–77.8); and 157.8 g/day (1.7–314.0), respectively). The same trends were observed in older groups, along with strong consumption disparities according to region of residency, country of birth, and occupation, with specificities according to age. Our findings suggest the need to better explore such disparities by stage of transition to adulthood, and to adapt nutritional health programs.
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Lamy S, Molinié F, Daubisse-Marliac L, Cowppli-Bony A, Ayrault-Piault S, Fournier E, Woronoff AS, Delpierre C, Grosclaude P. Using ecological socioeconomic position (SEP) measures to deal with sample bias introduced by incomplete individual-level measures: inequalities in breast cancer stage at diagnosis as an example. BMC Public Health 2019; 19:857. [PMID: 31266476 PMCID: PMC6604477 DOI: 10.1186/s12889-019-7220-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND When studying the influence of socioeconomic position (SEP) on health from data where individual-level SEP measures may be missing, ecological measures of SEP may prove helpful. In this paper, we illustrate the best use of ecological-level measures of SEP to deal with incomplete individual level data. To do this we have taken the example of a study examining the relationship between SEP and breast cancer (BC) stage at diagnosis. METHODS Using population based-registry data, all women over 18 years newly diagnosed with a primary BC in 2007 were included. We compared the association between advanced stage at diagnosis and individual SEP containing missing data with an ecological level SEP measure without missing data. We used three modelling strategies, 1/ based on patients with complete data for individual-SEP (n = 1218), or 2/ on all patients (n = 1644) using an ecological-level SEP as proxy for individual SEP and 3/ individual-SEP after imputation of missing data using an ecological-level SEP. RESULTS The results obtained from these models demonstrate that selection bias was introduced in the sample where only patients with complete individual SEP were included. This bias is redressed by using ecological-level SEP to impute missing data for individual SEP on all patients. Such a strategy helps to avoid an ecological bias due to the use of aggregated data to infer to individual level. CONCLUSION When individual data are incomplete, we demonstrate the usefulness of an ecological index to assess and redress potential selection bias by using it to impute missing individual SEP.
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Affiliation(s)
- Sébastien Lamy
- Laboratory of Epidemiology and Analyses in Public Health, Faculté de Médecine, UMR 1027 Inserm - Université Toulouse 3 Paul Sabatier, Equipe EQUITY labellisée par le Ligue nationale contre le cancer, 37 allées Jules Guesde, F-31000, Toulouse, France.
| | - Florence Molinié
- French network of Cancer registries (Francim), F-31000, Toulouse, France.,Loire-Atlantique / Vendée Cancer Registry, F-44093, Nantes, France.,SIRIC ILIAD, Nantes University Hospital, F-44093, Nantes, France
| | - Laetitia Daubisse-Marliac
- Laboratory of Epidemiology and Analyses in Public Health, Faculté de Médecine, UMR 1027 Inserm - Université Toulouse 3 Paul Sabatier, Equipe EQUITY labellisée par le Ligue nationale contre le cancer, 37 allées Jules Guesde, F-31000, Toulouse, France.,French network of Cancer registries (Francim), F-31000, Toulouse, France.,Tarn Cancer Registry, University Cancer Institute of Toulouse - Oncopole (IUCT-O), F-31000, Toulouse, France
| | - Anne Cowppli-Bony
- French network of Cancer registries (Francim), F-31000, Toulouse, France.,Loire-Atlantique / Vendée Cancer Registry, F-44093, Nantes, France.,SIRIC ILIAD, Nantes University Hospital, F-44093, Nantes, France
| | - Stéphanie Ayrault-Piault
- French network of Cancer registries (Francim), F-31000, Toulouse, France.,Loire-Atlantique / Vendée Cancer Registry, F-44093, Nantes, France.,SIRIC ILIAD, Nantes University Hospital, F-44093, Nantes, France
| | - Evelyne Fournier
- French network of Cancer registries (Francim), F-31000, Toulouse, France.,Doubs and Belfort territory Cancer Registry, Besançon University Hospital, F-25000, Besançon, France.,Resarch Unit EA3181, Universiy of Franche-Comté, F-25000, Besançon, France
| | - Anne-Sophie Woronoff
- French network of Cancer registries (Francim), F-31000, Toulouse, France.,Doubs and Belfort territory Cancer Registry, Besançon University Hospital, F-25000, Besançon, France.,Resarch Unit EA3181, Universiy of Franche-Comté, F-25000, Besançon, France
| | - Cyrille Delpierre
- Laboratory of Epidemiology and Analyses in Public Health, Faculté de Médecine, UMR 1027 Inserm - Université Toulouse 3 Paul Sabatier, Equipe EQUITY labellisée par le Ligue nationale contre le cancer, 37 allées Jules Guesde, F-31000, Toulouse, France
| | - Pascale Grosclaude
- Laboratory of Epidemiology and Analyses in Public Health, Faculté de Médecine, UMR 1027 Inserm - Université Toulouse 3 Paul Sabatier, Equipe EQUITY labellisée par le Ligue nationale contre le cancer, 37 allées Jules Guesde, F-31000, Toulouse, France.,French network of Cancer registries (Francim), F-31000, Toulouse, France.,Tarn Cancer Registry, University Cancer Institute of Toulouse - Oncopole (IUCT-O), F-31000, Toulouse, France
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183
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Jay MA, Mc Grath-Lone L. Educational outcomes of children in contact with social care in England: a systematic review. Syst Rev 2019; 8:155. [PMID: 31253197 PMCID: PMC6599338 DOI: 10.1186/s13643-019-1071-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England, the state intervenes in the lives of children through Children's Social Care (CSC) services with the aim of supporting and maintaining their welfare. It is known from government cross-sectional data that children who experience these CSC interventions (such as state care) have consistently poorer educational outcomes than the general population. However, these data are limited in providing crude estimates of association and in ignoring longitudinal histories. This systematic review aimed to appraise the extant research evidence from longitudinal studies and answer the question: how do educational outcomes differ between children in contact with CSC and the general population in the UK? METHODS According to a pre-defined protocol, we searched 16 health, social care, education and legal databases for population-level quantitative studies conducted on UK children with exposure to CSC, a general population comparison group and an educational outcome. We also conducted snowball searches and searches of Google Scholar and grey literature. Data on whether each study met inclusion criteria were extracted, and findings of included studies were synthesised narratively. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS In total, 5482 sources were screened which resulted in seven studies being included in the narrative synthesis. Only three were published in peer-reviewed journals. All but one used administrative education data and five used administrative data from CSC services. In all studies, exposure to CSC interventions was measured crudely, ignoring heterogeneity in the experiences of children. All agreed that children in contact with CSC services perform worse than their peers on all outcomes (variously: exam results, absences, exclusions, school moves, being missing from school, higher education aspirations and quality of school). CONCLUSIONS Despite employing a search across 16 databases supplemented with additional searches of other online sources, we found only seven studies that met our inclusion criteria. This review throws into sharp relief the urgent need to conduct more population-level research into the educational prospects of children in contact with CSC services. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018089755.
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Affiliation(s)
- Matthew A. Jay
- UCL Legal Epidemiology Group, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
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184
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185
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Knaappila N, Marttunen M, Fröjd S, Lindberg N, Kaltiala-Heino R. Changes in delinquency according to socioeconomic status among Finnish adolescents from 2000 to 2015. Scand J Child Adolesc Psychiatr Psychol 2019; 7:52-59. [PMID: 33520768 PMCID: PMC7709941 DOI: 10.21307/sjcapp-2019-008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Scientific literature suggests that the prevalence of delinquency amongst adolescents has decreased internationally in past decades. However, whether this change is consistent across all socioeconomic groups has not yet been studied. Objective: The aim of this study was to examine changes in delinquency amongst Finnish adolescents according to socioeconomic status between 2000 and 2015. Method: A population-based school survey was conducted biennially amongst 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for delinquency and socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year) were calculated using crosstabs. Associations between delinquency, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95 % confidence intervals. Results: Delinquency was positively associated with all three socioeconomic adversities studied and cumulative socioeconomic adversity. Although the prevalence of delinquency varied only slightly between 2000 and 2015 in the overall population, it increased significantly amongst adolescents with most socioeconomic adversities. Conclusions: The findings indicate that socioeconomic differences in delinquency have increased amongst Finnish adolescents in past decades. Delinquency prevention and intervention programs should take socioeconomic adversities into account.
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Affiliation(s)
- Noora Knaappila
- University of Helsinki and Helsinki University Hospital, Adolescent Psychiatry, Helsinki, Finland
| | - Mauri Marttunen
- University of Helsinki and Helsinki University Hospital, Adolescent Psychiatry, Helsinki, Finland
| | - Sari Fröjd
- University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Nina Lindberg
- Helsinki University Central Hospital, Dep. of Adolescent Psychiatry, Helsinki, Finland
| | - Riittakerttu Kaltiala-Heino
- University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa Finland
- Tampere University Hospital, Dep. of Adolescent Psychiatry, Pitkäniemi, Finland
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186
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Kriegbaum M, Hougaard CØ, Andersen I, Brønnum-Hansen H, Lund R. Life course analysis on income and incident AMI: a Danish register-based cohort study. J Epidemiol Community Health 2019; 73:810-816. [PMID: 31142610 DOI: 10.1136/jech-2018-212043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Social inequality in ischaemic heart disease has been related to socioeconomic position in childhood, early adulthood and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences have not been investigated. The aim was to investigate the association between relative level of accumulated income across the life course and acute myocardial infarction (AMI) from age 60+ years and to study if the associations differ by gender and in different age groups (30-39 years, 40-49 years and 50-59 years). METHODS All Danes born 1935-1954 (N=1 235 139) were followed up in registers for incident AMI (42 669 cases). The accumulated proportional deviation from median equivalised income (APDMEI) for each gender/age/calendar year strata was constructed and divided in quartiles. The associations were analysed by means of Cox's proportional hazard models. RESULTS Among men, those in the lowest APDMEI quartile had an HR 1.40 (1.35-1.45) of AMI compared with the highest quartile. Those in the second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women, the lowest quartile had an HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age groups. CONCLUSION The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ingelise Andersen
- Institute of Public Health, Section of Social Medicine, Copenhagen University, Copenhagen, Denmark
| | | | - Rikke Lund
- Institute of Public Health, Section of Social Medicine, Copenhagen University, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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187
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Wami WM, Dundas R, Molaodi OR, Tranter M, Leyland AH, Katikireddi SV. Assessing the potential utility of commercial 'big data' for health research: Enhancing small-area deprivation measures with Experian™ Mosaic groups. Health Place 2019; 57:238-246. [PMID: 31125848 PMCID: PMC6686722 DOI: 10.1016/j.healthplace.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/21/2019] [Accepted: 05/03/2019] [Indexed: 12/21/2022]
Abstract
In contrast to area-based deprivation measures, commercial datasets remain infrequently used in health research and policy. Experian collates numerous commercial and administrative data sources to produce Mosaic groups which stratify households into 15 groups for marketing purposes. We assessed the potential utility of Mosaic groups for health research purposes by investigating their relationships with Indices of Multiple Deprivation (IMD) for the British population. Mosaic groups showed significant associations with IMD quintiles. Correspondence Analysis revealed variations in patterns of association, with Mosaic groups either showing increasing, decreasing, or some mixed trends with deprivation quintiles. These results suggest that Experian's Mosaics additionally measure other aspects of socioeconomic circumstances to those captured by deprivation measures. These commercial data may provide new insights into the social determinants of health at a small area level. Mosaic groups showed a significant association with IMD quintiles. Trend patterns varied between different Mosaic groups across IMD quintiles. Mosaic groups have potential to enhance routinely used socioeconomic measures in research.
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Affiliation(s)
- Welcome M Wami
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK.
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK
| | - Oarabile R Molaodi
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK
| | - Mette Tranter
- Directorate of Public Health and Health Policy, Lothian National Health Service (NHS) Board, Edinburgh, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK
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188
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Taylor M, Rode L, Bjørngaard J, Taylor AE, Bojesen SE, Åsvold BO, Gabrielsen ME, Lewis G, Nordestgaard BG, Romundstad PR, Hickman M, Munafò MR. Is smoking heaviness causally associated with alcohol use? A Mendelian randomization study in four European cohorts. Int J Epidemiol 2019; 47:1098-1105. [PMID: 29509885 PMCID: PMC6124618 DOI: 10.1093/ije/dyy027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background Observational studies have shown that tobacco and alcohol use co-occur, but it is not clear whether this relationship is causal. Methods Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and UK Biobank, we used observational methods to test the hypothesis that smoking heaviness increases alcohol consumption. Mendelian randomization (MR) analyses were then used to test the causal relationship between smoking heaviness and alcohol consumption using 55 967 smokers from four European studies [ALSPAC, The Nord-Trøndelag Health Study (HUNT), the Copenhagen General Population Study (CGPS) and UK Biobank]. MR analyses used rs1051730/rs16969968 as a genetic proxy for smoking heaviness. Results Observational results provided evidence of an association between cigarettes per day and weekly alcohol consumption (increase in units of alcohol per additional cigarette smoked per day = 0.10, 95% confidence interval (CI) 0.05 to 0.15, P ≤ 0.001 in ALSPAC; and 0.48, 95% CI 0.45 to 0.52, P ≤ 0.001 in UK Biobank). However, there was little evidence for an association between rs1051730/rs16969968 and units of alcohol consumed per week across ALSPAC, HUNT, CGPS and UK Biobank (standard deviation increase in units of alcohol per additional copy of the risk allele = –0.004, 95% CI –0.023 to 0.016, P=0.708, I2 = 51.9%). We had 99% and 88% power to detect a change of 0.03 and 0.02 standard deviation units of alcohol per additional copy of the risk allele, respectively. Conclusions Previously reported associations between smoking and alcohol are unlikely to be causal, and may be the result of confounding and/or reverse causation. This has implications for public health research and intervention research.
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Affiliation(s)
- Michelle Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Line Rode
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Johan Bjørngaard
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Forensic Department and Research Centre Brøset St Olav's University Hospital Trondheim, Trondheim, Norway
| | - Amy E Taylor
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Stig E Bojesen
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn O Åsvold
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,KG Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maiken E Gabrielsen
- KG Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pål R Romundstad
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
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189
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Mira-Iglesias A, López-Labrador FX, Guglieri-López B, Tortajada-Girbés M, Baselga-Moreno V, Cano L, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Díez-Domingo J, Puig-Barberà J. Influenza vaccine effectiveness in preventing hospitalisation of individuals 60 years of age and over with laboratory-confirmed influenza, Valencia Region, Spain, influenza season 2016/17. ACTA ACUST UNITED AC 2019; 23. [PMID: 29486829 PMCID: PMC5829534 DOI: 10.2807/1560-7917.es.2018.23.8.17-00318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Seasonal influenza vaccination is widely recommended for people with risk factors, especially for people who are elderly. However, influenza vaccine effectiveness (IVE) varies year after year because of the variable antigenic composition of the circulating viruses and the vaccine composition. Methods: We summarise the results of IVE and the impact of previous vaccination among subjects 60 years of age and over in a multicentre prospective study in the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI) in Spain. We applied the test-negative design taking laboratory-confirmed influenza as outcome and vaccination status as exposure. Information about potential confounders was obtained from clinical registries or directly from patients. Results: Adjusted IVE was 19% (95% confidence interval (CI): −15 to 43). For patients vaccinated in the current season but not in the two previous seasons, effectiveness was 49% (95% CI: −20 to 78) and for patients vaccinated in the current and any of two previous seasons, effectiveness was 29% (95% CI: −3 to 52). For those patients not vaccinated in the current season but vaccinated in any of the two previous seasons, effectiveness was 53% (95% CI: 8 to 76). Conclusions: Our data show a low vaccine effectiveness for the 2016/17 influenza season.
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Affiliation(s)
- Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - F Xavier López-Labrador
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Beatriz Guglieri-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Laura Cano
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Mario Carballido-Fernández
- Universidad CEU Cardenal Herrera, Castellón, Spain.,Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Joan Puig-Barberà
- Centro de Salud Pública de Castellón, Castellón, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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190
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Gad KT, Johansen C, Duun-Henriksen AK, Krøyer A, Olsen MH, Lassen U, Mau-Sørensen M, Oksberg Dalton S. Socioeconomic Differences in Referral to Phase I Cancer Clinical Trials: A Danish Matched Cancer Case-Control Study. J Clin Oncol 2019; 37:1111-1119. [DOI: 10.1200/jco.18.01983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In this nationwide registry study, we investigated socioeconomic and structural patterns in referral to phase I cancer trials in a case-control study design. METHODS Personal identification numbers on all Danish patients referred to the Danish Phase I Unit at Rigshospitalet from 2005 to 2016, and a control group matched on age, sex, type of cancer, year of diagnosis, and time from diagnosis to referral ensured individual-level linkage between several registries. We examined the association between nonclinical factors—indicators of socioeconomic position and distance to the Phase I Unit—and referral using a conditional logistic regression analysis adjusted for several clinical factors. Association between nonclinical factors and enrollment once referred was examined with a Cox proportional hazards regression analysis in an historical cohort study design. RESULTS Complete data were available for 1,026 (84%) of 1,220 referred patients. Significantly decreased odds for referral were identified for patients with long distance to the Phase I Unit compared with short distance (adjusted odds ratio [OR], 0.35; 95% CI, 0.30 to 0.41), for less education (less than 9 years) compared with more (more than 12 years; OR, 0.69; 95% CI, 0.56 to 0.91), and for belonging to the lowest income quintile compared with the highest (OR, 0.78; 95% CI, 0.62 to 0.97). Medium education (9 to 12 years) compared with more, being outside the workforce compared with being within, and living alone compared with living with a partner were also negatively associated with referral. Among patients referred, 252 enrolled in a trial. Nonclinical factors were not associated with enrollment. CONCLUSION On the basis of individual long-term registry data from an unselected cohort, novel anticancer therapies seem to be tested on a socially selected group of patients with cancer.
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Affiliation(s)
| | - Christoffer Johansen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Anja Krøyer
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Ulrik Lassen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Oksberg Dalton
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Zealand University Hospital, Næstved, Denmark
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191
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Qi Y, Koster A, van Boxtel M, Köhler S, Schram M, Schaper N, Stehouwer C, Bosma H. Adulthood Socioeconomic Position and Type 2 Diabetes Mellitus-A Comparison of Education, Occupation, Income, and Material Deprivation: The Maastricht Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1435. [PMID: 31018480 PMCID: PMC6517950 DOI: 10.3390/ijerph16081435] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/10/2019] [Accepted: 04/20/2019] [Indexed: 01/24/2023]
Abstract
In an effort to better quantify the impact of adulthood socioeconomic circumstances on prediabetes and type 2 diabetes (T2DM), we set out to examine the relative importance of four adulthood socioeconomic indicators. Using cross-sectional data from The Maastricht Study on 2011 middle-aged older men and women, our findings indicate that low educational level (OR = 1.81, 95% CI = 1.24-2.64), low occupational level (OR = 1.42, 95% CI = 0.98-2.05), and material deprivation (OR = 1.78, 95% CI = 1.33-2.38) were independently associated with T2DM. Low income (OR = 1.28, 95% CI = 0.88-1.87) was the strongest, albeit not significant, SEP (socioeconomic position) correlate of prediabetes. This association confirms SEP as a multifaceted concept and indicates the need to measure SEP accordingly. In order to tackle the social gradient in prediabetes and T2DM, one should, therefore, address multiple SEP indicators and their possible pathways.
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Affiliation(s)
- Yuwei Qi
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands.
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Miranda Schram
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Nicolaas Schaper
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG Maastricht, The Netherlands.
| | - Coen Stehouwer
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
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192
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Norman Å, Zeebari Z, Nyberg G, Elinder LS. Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial. BMC Pediatr 2019; 19:104. [PMID: 30975106 PMCID: PMC6458763 DOI: 10.1186/s12887-019-1467-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/22/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Effects of obesity prevention interventions in early childhood are only meaningful if they are sustained over time, but long-term follow-up studies are rare. The school-based cluster-randomised Healthy School Start (HSS) trial aimed at child health promotion and obesity prevention through parental support was carried out in 31 pre-school classes (378 families) in disadvantaged areas in Sweden during 2012-2013. Post-intervention results showed intervention effects on intake of unhealthy foods and drinks, and lower BMI-sds in children with obesity at baseline. This study aimed to evaluate the long-term effectiveness 4 years post-intervention. METHODS Data were collected from 215 children in March-June 2017. Child dietary intake, screen time, and physical activity were measured through parental-proxy questionnaires. Child height and weight were measured by the research group. Group effects were examined using Poisson, linear, logistic, and quantile regression for data on different levels. Analyses were done by intention to treat, per protocol, and sensitivity analyses using multiple imputation. RESULTS No between-group effects on dietary intake, screen time, physical activity, or BMI-sds were found for the entire group at the four-year follow-up. In girls, a significant subgroup-effect was found favouring intervention compared to controls with a lower intake of unhealthy foods, but this was not sustained in the sensitivity analysis. In boys, a significant sub-group effect was found where the boys in the intervention group beyond the 95th percentile had significantly higher BMI-sds compared to boys in the control group. This effect was sustained in the sensitivity analysis. Analyses per protocol showed significant intervention effects regarding a lower intake of unhealthy foods and drinks in the children with a high intervention dose compared to controls. CONCLUSIONS Four years after the intervention, only sub-group effects were found, and it is unlikely that the HSS intervention had clinically meaningful effects on the children. These results suggest that school-based prevention programmes need to be extended for greater long-term effectiveness by e.g. integration into school routine practice. In addition, results showed that children with a high intervention dose had better long-term outcomes compared to controls, which emphasises the need for further work to increase family engagement in interventions. TRIAL REGISTRATION ISRCTN, ISRCTN39690370, retrospectively registered March 1, 2013, http://www.isrctn.com/ISRCTN39690370 .
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Affiliation(s)
- Åsa Norman
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Zangin Zeebari
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Jönköping International Business School, Gjuterigatan 5, Box 1026, 551 11 Jönköping, Sweden
| | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Lidingövägen 1, 114 33 Stockholm, Sweden
| | - Liselotte Schäfer Elinder
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden
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193
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McCartney G, Bartley M, Dundas R, Katikireddi SV, Mitchell R, Popham F, Walsh D, Wami W. Theorising social class and its application to the study of health inequalities. SSM Popul Health 2019; 7:015-15. [PMID: 31297431 PMCID: PMC6598164 DOI: 10.1016/j.ssmph.2018.10.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/24/2023] Open
Abstract
The literature on health inequalities often uses measures of socio-economic position pragmatically to rank the population to describe inequalities in health rather than to understand social and economic relationships between groups. Theoretical considerations about the meaning of different measures, the social processes they describe, and how these might link to health are often limited. This paper builds upon Wright's synthesis of social class theories to propose a new integrated model for understanding social class as applied to health. This model incorporates several social class mechanisms: social background and early years' circumstances; Bourdieu's habitus and distinction; social closure and opportunity hoarding; Marxist conflict over production (domination and exploitation); and Weberian conflict over distribution. The importance of discrimination and prejudice in determining the opportunities for groups is also explicitly recognised, as is the relationship with health behaviours. In linking the different social class processes we have created an integrated theory of how and why social class causes inequalities in health. Further work is required to test this approach, to promote greater understanding of researchers of the social processes underlying different measures, and to understand how better and more comprehensive data on the range of social class processes these might be collected in the future.
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Affiliation(s)
- Gerry McCartney
- NHS Health Scotland, 5th Floor, Meridian Court, 5 Cadogan Street, Glasgow, Scotland, UK
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194
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Dreger S, Schüle SA, Hilz LK, Bolte G. Social Inequalities in Environmental Noise Exposure: A Review of Evidence in the WHO European Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061011. [PMID: 30897765 PMCID: PMC6466273 DOI: 10.3390/ijerph16061011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 01/19/2023]
Abstract
Environmental noise is an important public health problem, being among the top environmental risks to health. The burden of noise exposure seems to be unequally distributed in societies. Up to now there is fragmentary evidence regarding which social groups are most affected. The aim of this review was to systematically assess published evidence on social inequalities in environmental noise exposure in the WHO European Region, taking different sociodemographic and socioeconomic dimensions as well as subjective and objective measures of environmental noise exposure into account. Articles published in English in a peer reviewed journal between 2010 and 2017 were included in the review. Eight studies were finally included in the review, four of them analysed aggregated data and four analysed individual data. Though results of social inequalities in noise exposures were mixed between and within studies, there was a trend that studies using indicators of material deprivation and deprivation indices showed higher environmental noise exposures in groups with lower socioeconomic position. More research on the social distribution of environmental noise exposure on a small spatial scale is needed, taking into account aspects of vulnerability and procedural justice.
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Affiliation(s)
- Stefanie Dreger
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Steffen Andreas Schüle
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Lisa Karla Hilz
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
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195
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Sen A, Bisquera A, Wang Y, McKevitt CJ, Rudd AG, Wolfe CD, Bhalla A. Factors, trends, and long-term outcomes for stroke patients returning to work: The South London Stroke Register. Int J Stroke 2019; 14:696-705. [DOI: 10.1177/1747493019832997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and purpose There is limited information on factors, trends, and outcomes in return to work at different time-points post-stroke; this study aims to identify these in a multi-ethnic urban population. Methods Patterns of return to work were identified in individuals in paid work prior to first-ever stroke in the population-based South London Stroke Register (SLSR) between 1995 and 2014. Multivariable logistic regression examined associations between patient characteristics and return to work at 1 year (1 y), 5 years (5 y) and 10 years (10 y) post-stroke. Results Among 5609 patients, 940 (17%) were working prior to their stroke, of whom 177 (19%) were working 3 months post-stroke, declining to 172 (18%) at 1 y, 113 (12%) at 5 y, and 27 (3%) at 10 y. Factors associated with return to work within 1 y, after logistic regression, included functional independence (BI ≥ 19; p < 0.01) and shorter length of stay ( p < 0.05). Younger age ( p < 0.01) was associated with return to work at 5 y and 10 y post-stroke. Non-manual occupation ( p < 0.05) was associated with return to work at 10 y post-stroke. Return to work within 1 y increased the likelihood of working at 5 y (OR: 13.68; 95% CI 5.03–37.24) and 10 y (9.07; 2.07–39.8). Of those who were independent at follow-up (BI ≥ 19), 48% were working at 1 y, 42% at 5 y, and 28% at 10 y. Lower rates of anxiety and depression and higher self-rated health were associated with return to work at 1 y ( p < 0.01). Conclusion Although functionally independent stroke survivors are more likely to return to work long-term, a large proportion do not return to work despite functional independence. Return to work post-stroke is associated with improved long-term psychological outcomes and quality of life.
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Affiliation(s)
- Arup Sen
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Alessandra Bisquera
- School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Yanzhong Wang
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Christopher J McKevitt
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Anthony G Rudd
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Charles D Wolfe
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Ajay Bhalla
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Population Health & Environmental Sciences, King’s College London, London, UK
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196
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Jay MA, Bendayan R, Cooper R, Muthuri SG. Lifetime socioeconomic circumstances and chronic pain in later adulthood: findings from a British birth cohort study. BMJ Open 2019; 9:e024250. [PMID: 30850405 PMCID: PMC6429846 DOI: 10.1136/bmjopen-2018-024250] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate associations between a range of different indicators of socioeconomic position (SEP: occupational class, education, household overcrowding and tenure, and experience of financial hardship) across life and chronic widespread and regional pain (CWP and CRP) at age 68. DESIGN Prospective birth cohort; the Medical Research Council National Survey of Health and Development. SETTING England, Scotland and Wales. PARTICIPANTS Up to 2378 men and women who have been followed-up since birth in 1946 to age 68. PRIMARY OUTCOME MEASURES On the basis of their self-report of pain at age 68, participants were classified as: CWP (American College of Rheumatology criteria), CRP (pain of at least 3 months' duration but that does not meet the definition of CWP), other pain (<3 months in duration) or no pain. RESULTS At age 68, the prevalence of CWP was 13.3% and 7.8% in women and men, respectively, and that of CRP was 32.3% and 28.7% in women and men, respectively. There was no clear evidence that indicators of SEP in childhood or later adulthood were associated with pain. Having experienced (vs not) financial hardship and being a tenant (vs owner-occupier) in earlier adulthood were both associated with an increased risk of CWP; for example, moderate hardship adjusted relative risk ratio (RRRadj) 2.32 (95% CI: 1.19 to 4.52) and most hardship RRRadj 4.44 (95% CI: 2.02 to 9.77). Accumulation of financial hardship across earlier and later adulthood was also associated with an increased risk of CWP. CONCLUSIONS Consideration of socioeconomic factors in earlier adulthood may be important when identifying targets for intervention to prevent CWP in later life.
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Affiliation(s)
- Matthew A Jay
- GOS Institute of Child Health, University College London, London, UK
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Stella G Muthuri
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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197
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Ireland A, Saunders FR, Muthuri SG, Pavlova AV, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Gregory JS, Cooper R. Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age. J Bone Miner Res 2019; 34:455-463. [PMID: 30496618 PMCID: PMC6446733 DOI: 10.1002/jbmr.3627] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements; accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60 to 64 years in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally representative British birth cohort. Walking age in months was obtained from maternal interview at age 2 years. Ten modes of variation in hip shape (HM1 to HM10), described by statistical shape models, were ascertained from DXA images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition, and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1, HM4) femoral heads, wider (HM1, HM4, HM7) and flatter (HM1, HM7) femoral necks, a smaller neck-shaft angle (HM1, HM4), anteversion (HM2, HM7), and early development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass, suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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198
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Multi-cohort study identifies social determinants of systemic inflammation over the life course. Nat Commun 2019; 10:773. [PMID: 30770820 PMCID: PMC6377676 DOI: 10.1038/s41467-019-08732-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Chronic inflammation has been proposed as having a prominent role in the construction of social inequalities in health. Disentangling the effects of early life and adulthood social disadvantage on inflammation is key in elucidating biological mechanisms underlying socioeconomic disparities. Here we explore the relationship between socioeconomic position (SEP) across the life course and inflammation (as measured by CRP levels) in up to 23,008 participants from six European cohort studies from three countries conducted between 1958 and 2013. We find a consistent inverse association between SEP and CRP across cohorts, where participants with a less advantaged SEP have higher levels of inflammation. Educational attainment is most strongly related to inflammation, after adjusting for health behaviours, body mass index and later-in-life SEP. These findings suggest socioeconomic disadvantage in young adulthood is independently associated with later life inflammation calling for further studies of the pathways operating through educational processes. Here, the authors explore the relationship between socioeconomic position (SEP) across the life course and inflammation in a multi-cohort study and show that educational attainment is most strongly related to inflammation, suggesting that socioeconomic disadvantage in young adulthood is independently associated with later life inflammation.
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199
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Lunden SE, Pittman JC, Prashad N, Malhotra R, Sheffer CE. Cognitive, Behavioral, and Situational Influences on Relapse to Smoking After Group Treatment for Tobacco Dependence. Front Psychol 2019; 9:2756. [PMID: 30761059 PMCID: PMC6363657 DOI: 10.3389/fpsyg.2018.02756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
Socioeconomic disparities in treatment failure rates for evidence-based tobacco dependence treatment are well-established. Adapted cognitive behavioral treatments are extensively tailored to meet the needs of lower socioeconomic status (SES) smokers and dramatically improve early treatment success, but there is little understanding of why treatment failure occurs after a longer period of abstinence than with standard treatment, why early treatment success is not sustained, and why long-term treatment failure rates are no different from standard treatments. We sought to understand the causes of treatment failure from the perspective of diverse participants who relapsed after receiving standard or adapted treatment in a randomized control trial. We used a qualitative approach and a cognitive-behavioral framework to examine themes in responses to a semi-structured post-relapse telephone interview. The primary causes of relapse were familiar (i.e., habit, stress, unanticipated precipitating events). The adapted treatment appeared to improve the management of habits and stress short-term, but did not adequately prepare respondents for unanticipated events. Respondents reported that they would have benefited from continued support. New therapeutic targets might include innovative methods to reduce long-term treatment failure by delivering extended relapse prevention interventions to support early treatment success. Trial Registration: Clinicaltrials.gov NCT02785536.
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Affiliation(s)
- Sara E. Lunden
- Department of Community Health and Social Medicine, City University of New York School of Medicine, City College of New York, New York, NY, United States
| | - Jami C. Pittman
- Department of Community Health and Social Medicine, City University of New York School of Medicine, City College of New York, New York, NY, United States
| | - Neelam Prashad
- Department of Community Health and Social Medicine, City University of New York School of Medicine, City College of New York, New York, NY, United States
| | - Ria Malhotra
- Department of Community Health and Social Medicine, City University of New York School of Medicine, City College of New York, New York, NY, United States
| | - Christine E. Sheffer
- Department of Community Health and Social Medicine, City University of New York School of Medicine, City College of New York, New York, NY, United States
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, United States
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200
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Dean LT, Knapp EA, Snguon S, Ransome Y, Qato DM, Visvanathan K. Consumer credit, chronic disease and risk behaviours. J Epidemiol Community Health 2019; 73:73-78. [PMID: 30322882 PMCID: PMC6512797 DOI: 10.1136/jech-2018-211160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/15/2018] [Accepted: 09/22/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Credit scores have been identified as a marker of disease burden. This study investigated credit scores' association with chronic diseases and health behaviours that are associated with chronic diseases. METHODS This cross-sectional analysis included data on 2083 residents of Philadelphia, Pennsylvania, USA in 2015. Nine-digit ZIP code level FICO credit scores were appended to individual self-reported chronic diseases (obesity, diabetes, hypertension) and related health behaviours (smoking, exercise, and salt intake and medication adherence among those with hypertension). Models adjusted for individual-level and area-level demographics and retail pharmacy accessibility. RESULTS Median ZIP code credit score was 665 (SD=58). In adjusted models, each 50-point increase in ZIP code credit score was significantly associated with: 8% lower chronic disease risk; 6% lower overweight/obesity risk, 19% lower diabetes risk; 9% lower hypertension risk and 14% lower smoking risk. Other health behaviours were not significantly associated. Compared with high prime credit, subprime credit score was significantly associated with a 15%-70% increased risk of chronic disease, following a dose-response pattern with a prime rating. CONCLUSION Lower area level credit scores may be associated with greater chronic disease prevalence but not necessarily with related health behaviours. Area-level consumer credit may make a novel contribution to identifying chronic disease patterns.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sevly Snguon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Dima M Qato
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois College of Pharmacy, Chicago, Illinois, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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