The predictive ability of self-assessed health for mortality in different educational groups

BACKGROUND: The purpose of this study was to assess potential differences in the predictive ability of self-assessed health for mortality between educational groups, and to find explanations for any of these educational differences. METHODS: We used data from the longitudinal GLOBE study, with a 13-year mortality follow-up. Analyses were performed for people aged between 25-74 years at baseline (n = 16,722). The associations of self-assessed health with mortality were estimated with Cox regression analyses, and the resulting hazard ratios were used as indicators of the 'predictive ability' of self-assessed health for mortality. Differences between educational levels were estimated by including an interaction term of education with self-assessed health in regression models with mortality as the outcome. The analyses were subsequently adjusted for: life threatening chronic conditions, non-life threatening conditions, stressors and health behaviour, to test the contribution of these factors to the predictive ability of self-assessed health. RESULTS: Results indicated that the predictive ability of self-assessed health for mortality was greater in men with tertiary education as compared with the lowest educated men. No differences were observed in women. None of the four health aspects accounted for the educational difference in men. CONCLUSIONS: Because differences in the predictive ability for mortality were limited to the extreme educational groups in men, educational differences in self-assessed health that are reported in numerous studies should not be expected to seriously overestimate educational differences in 'objective' health status.     

Alcohol consumption, alcohol-related problems, problem drinking, and socioeconomic status

In general, a lower socioeconomic status (SES) is related to a lower health status, more health problems, and a shorter life expectancy. Although causal relations between SES and health are unclear, lifestyle factors play an intermediate role. The purpose of the present study was to obtain more insight into the relation between SES, alcohol consumption, alcohol-related problems, and problem drinking, through a general population survey among 8000 people in Rotterdam. Odds ratios were calculated using educational level as independent, and alcohol consumption, alcohol-related problems, and problem drinking as dependent variables. Abstinence decreased significantly by increasing educational level for both sexes. For men, excessive drinking, and notably very excessive drinking, was more prevalent in the lowest educational group. For women, no significant relation between educational level and prevalence of excessive drinking was found. After controlling for differences in drinking behaviour, among men the prevalence of 'psychological dependence' and 'social problems' was higher in intermediate educational groups, whereas prevalence of 'drunkenness' was lower in intermediate educational groups. For women, a negative relation was found between educational level and 'psychological dependence'; prevalence of 'symptomatic drinking' was higher in the lowest educational group. Prevalence of problem drinking was not related to educational level in either sex. It is concluded that differences exist between educational levels with respect to abstinence, but only limited differences were found with respect to excessive drinking. Furthermore, there is evidence for higher prevalences of alcohol-related problems in lower educational levels, after controlling for differences in drinking behaviour, in both sexes.     

Educational differences in starting excessive alcohol consumption: explanations from the longitudinal GLOBE study

This paper describes educational differences in starting excessive alcohol consumption during 6 1/2 years of follow-up among 1648 initially alcohol-consuming Dutch adults. The longitudinal GLOBE study provides the unique possibility to study explanations for educational differences due to the collection of extensive baseline information on educational level, alcohol consumption, stressors (tension reduction theory) and vulnerability indicators (differential vulnerability theory) in 1991. Alcohol consumption was again assessed in 1997. We report that lower educated people were almost three times more likely to start excessive alcohol consumption during follow-up compared to the highest educated persons. Both educational differences in exposure to stressors (financial problems) and vulnerability (low social support) contributed to the educational differences in starting excessive alcohol consumption and explained 23% of the educational variation in starting excessive alcohol consumption. Remaining educational differences were however still statistically significant. These results are discussed with regard to implications for interventions and possible additional explanatory mechanisms.     

Does formal approval of educational courses guarantee quality?

OBJECTIVES: To assess whether organizers of continuing medical education for general practitioners used principles of adult learning when designing their meetings. DESIGN: A questionnaire study of organizers of approved educational meetings for general medical practitioners (GPs). SETTING: South East Scotland. SUBJECTS: Organizers of educational meetings. RESULTS: Organizers often failed to use principles of adult learning in the construction of their meetings. Organizers with prior training in medical education were, however, significantly more likely to adopt these principles. CONCLUSIONS: Given concern about the quality of educational meetings as assessed by their educational impact, formal approval is not an indicator of quality. Postgraduate bodies should use explicit criteria both in the development and approval of continuing educational meetings.     

The prevalence and pattern of locomotor disorders in senior pupils

The study deals with the analysis of the prevalence of disorders of the locomotor apparatus (LMA) in senior schoolchildren from 9th-to-11th-forms of various general educational establishments, such as a secondary general educational school, a technical lyceum (general educational and specialized classes), and a physical engineering school. The academic load, educational conditions, and teaching methods in each establishment differed and conformed to the implemented school-based educational program. Sixty hundred and eighteen senior schoolchildren were examined. In the senior pupils of the physical engineering school the educational program of which is characterized by increased academic loads, the prevalence of scoliotic deformity of the spine was found to be 3-5 times greater than that in those of the secondary general educational school. The higher prevalence of LMA disorders in the pupils from the general educational classes of the technical lyceum (8.6- and 3-fold in boys and girls, respectively) is indicative of the leading influence of a social factor on the development of scoliotic deformity. The impact of increased academic loads on the MDA is also suggested by the difference in the incidence of MDA disorders among the pupils of general educational and specialized classes of the technical lyceum. Emphasis is laid on the need for taking into account the findings to substantiate comprehensive preventive programs and health-improving measures in the educational establishments.     

Education and obesity at age 40 among American adults

Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI ≥ 30) at age 40 in the USA's National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.     

Improving presentation skills of family medicine residents: a randomized controlled study

A randomized controlled time series design was used to evaluate the influence of an educational intervention designed to improve the presentation skills of family medicine residents. Each resident gave three presentations, with the educational intervention occurring between the first and second presentations in the experimental group, and between the second and third presentations in the control group. The presentations were evaluated using a standardized format. The experimental group, in contrast to the control group, showed significant improvement in scores for all major criteria after receiving the educational intervention between presentations 1 and 2. This improvement continued with repetition between presentations 2 and 3. After receiving the educational intervention between presentations 2 and 3, the control group also demonstrated significant improvement in several key areas. We conclude that an educational intervention can improve the presentation skills of family medicine residents. Education coupled with repeated opportunities for presentation will produce a greater improvement in resident performance than repeated presentations alone.     

Relationship between IHD risk factors and educational level in the Warsaw Pol-MONICA population

In the paper presented, the relationship was analysed between the educational level and the level of risk of ischaemic heart disease (IHD) in a random sample of the Warsaw population aged 35-64 years. Men with a lower educational level (elementary or basic vocational) were found to have a significantly higher means for systolic blood pressure level, for plasma high-density lipoprotein (HDL) cholesterol concentration, for the numbers of cigarettes smoked daily, and for the probability of IHD development according to the multivariate logistic function of Farchi and Menotti, and also significantly greater prevalences of cigarette smoking, hypertension and overweight. And for men, a negative relationship was noted between educational level and plasma low-density lipoprotein (LDL) cholesterol concentration. Women with a lower educational level had a higher mean plasma triglyceride concentration, higher values of systolic and systolic blood pressures, a greater probability of IHD development, and higher prevalences of hypertension, obesity and ischaemic heart disease symptoms. And for women, a negative relationship with educational level was noted for plasma LDL-cholesterol concentration and for the mean value of the overall risk score according to Rose.     

Birthweight, postnatal growth and cognitive function in a national UK birth cohort

BACKGROUND: Birthweight is associated with cognition and educational attainment across the full birthweight range in the normal population, independently of social background. However, the extent to which birthweight reflects fetal growth, or is a marker of subsequent size, with respect to this association, is not clear. We therefore investigated the independent effects of birthweight and postnatal height adjusted for postnatal weight on cognitive function and educational attainment while controlling for family background. METHODS: Using the British 1946 birth cohort we investigated the association between cognitive function at various ages and birthweight, height adjusted for weight in childhood and adulthood, and educational attainment, controlling for sex, father's social class, maternal education, birth order, and maternal age. RESULTS: Birthweight was positively associated with cognition up to age 26, and with the likelihood of obtaining advanced educational qualifications. Height was positively associated with cognition at all ages, and also with educational attainment. Weight was not associated with cognition at ages 8 and 15, but was negatively associated with verbal ability at age 26, with verbal memory at age 43, and with educational attainment. These effects were independent of each other, and of family background. Conditional analyses suggested the positive effect of height growth on cognition at two intervals, one in early childhood, and the other in late adolescence. In addition, weight gain after age 15 was negatively associated with cognition at 26. CONCLUSION: Birthweight and postnatal growth are independently associated with cognition.     

A participant perspective on collaborative reflection: video-stimulated interviews show what residents value and why

The potential of reflection for learning and development is broadly accepted across the medical curriculum. Our understanding of how exactly reflection yields its educational promise, however, is limited to broad hints at the relation between reflection and learning. Yet, such understanding is essential to the (re)design of reflection education for learning and development. In this qualitative study, we used participants’ video-stimulated comments on actual practice to identify features that do or do not make collaborative reflection valuable to participants. In doing so, we focus on aspects of the interactional process that constitute the educational activity of reflection. To identify valuable and less valuable features of collaborative reflection, we conducted one-on-one video-stimulated interviews with Dutch general practice residents about collaborative reflection sessions in their training program. Residents were invited to comment on any aspect of the session that they did or did not value. We synthesized all positively and negatively valued features and associated explanations put forward in residents’ narratives into shared normative orientations about collaborative reflection: what are the shared norms that residents display in telling about positive and negative experiences with collaborative reflection? These normative orientations display residents’ views on the aim of collaborative reflection (educational value for all) and the norms that allegedly contribute to realizing this aim (inclusivity and diversity, safety, and efficiency). These norms are also reflected in specific educational activities that ostensibly contribute to educational value. As such, the current synthesis of normative orientations displayed in residents’ narratives about valuable and less valuable elements of collaborative reflection deepen our understanding of reflection and its supposed connection with educational outcomes. Moreover, the current empirical endeavor illustrates the value of video-stimulated interviews as a tool to value features of educational processes for future educational enhancements.