How accurately do adult sons and daughters report and perceive parental deaths from coronary disease ?

OBJECTIVES: To describe how adult sons and daughters report and perceive parental deaths from heart disease DESIGN: Two generation family study. SETTING: West of Scotland. SUBJECTS: 1040 sons and 1298 daughters aged 30-59 from 1477 families, whose fathers and mothers were aged 45-64 in 1972-76 and have been followed up for mortality over 20 years. OUTCOME: Perception of a "family weakness" attributable to heart disease. RESULTS: 26% of sons and daughters had a parent who had died of coronary heart disease (CHD). The proportion was higher in older offspring (+18% per 10 year age difference) and in manual compared with non-manual groups (+37%). Eighty nine per cent of parental deaths from CHD were correctly reported by offspring. Only 23% of sons and 34% of daughters with at least one parent who had died of CHD considered that they had a family weakness attributable to heart disease. Perceptions of a family weakness were higher when one or both parents had died of CHD, when parental deaths occurred at a younger age, in daughters compared with sons and in offspring in non-manual compared with manual occupations. CONCLUSIONS: Only a minority of sons and daughters with experience of a parent having died from CHD perceive this in terms of a family weakness attributable to heart disease. Although men in manual occupations are most likely to develop CHD, they are least likely to interpret a parental death from CHD in terms of a family weakness. Health professionals giving advice to patients on their familial risks need to be aware of the difference between clinical definitions and lay perceptions of a family history of heart disease.     

The health of the Roma people: a review of the published literature

BACKGROUND: The Roma people originated in northern India and have been known in Europe for nearly a thousand years. For much of that time they have been the subjects of discrimination and oppression, culminating in the extermination of half a million Roma in the Nazi death camps. While it is widely believed that the health of Roma people is often poorer than the majority population, these inequalities remain largely unresearched. METHODS: Published literature on the health of the Roma people was identified using Medline. Opinion pieces were excluded, as were papers relating to anthropometry and to genetic markers. The resultant papers were analysed by country of study and by disease type or care group. RESULTS: Some 70% of papers identified related to just three countries; Spain and the Czech and Slovak Republics. Much literature concentrates upon communicable disease or reproductive health. The limited evidence suggests increased morbidity from non-communicable disease, but there is little published on this topic. Evidence on health care, though fragmentary, suggests poorer access to health services and uptake of preventative care. DISCUSSION: Published research on the health needs of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. There is a need for both further research into the health of Roma people; with particular emphasis on non-communicable disease; and also for interventions that improve Roma health. Such research must, however, be handled with sensitivity, recognising the social and political context of the society concerned.     

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall

STUDY OBJECTIVE: To compare the health status and factors influencing the health of populations that had previously lived under different political systems. DESIGN: Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted. SETTING: East and West Berlin shortly after reunification 1991. PARTICIPANTS: Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%). RESULTS: Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin. CONCLUSIONS: For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.     

Physical and developmental status of preschool small-for-gestational-age children: A comparative study

This study aimed to assess the current developmental and physical status of preschool children identified from hospital records as being small-for-gestational-age (SGA) at birth. Sixty-seven children were compared with a matched group of appropriately grown (AGA) children. Mothers of SGA children were more likely to have smoked during pregnancy, to have suffered pre-eclamptic toxaemia (PET), and to have had shorter labours than the AGA group. They were less likely to have breast-fed their babies, and reported higher incidences of eating problems and visits to the general practitioner. On physical and developmental parameters the AGA group was significantly ahead of the SGA group. For all subjects breast feeding was correlated with higher Stanford Binet scores, and environmental factors appeared more salient for the progress of the SGA children at this age than biological factors. The results are discussed with regard to possible amelioration of the effects of being born small for gestational age.     

INTERACTIONS OF LANGUAGE-DELAYED AND NORMAL PRESCHOOL BOYS WITH THEIR PEERS

This study examined the impact of specific language delay (LD) on peer interactions in preschool children. Three groups of dyads were studied: normal children interacting with normal children, normals interacting with LD children and LD children with each other. The normal children were more likely to initiate interaction when the partner was non-responsive and to attempt to dominate the interaction. The results of this study illustrate reciprocity in the social interactions of young children, the significant role of dominance and control in interaction and the sensitivity of preschool children to the characteristics of their peers.     

THE SALIENCE OF FACIAL EXPRESSION FOR AUTISTIC CHILDREN

Autistic and non-autistic retarded children who were matched for verbal ability were shown 'standard' pairs of photographs of people who differed in three, two or one of the following respects: sex, age, facial expression of emotion, and the type of hat they were wearing. When given similar photographs to sort, the majority of non-autistic children sorted according to people's facial expressions before they sorted according to type of hat, but most autistic children gave priority to sorting by type of hat, and many neglected the facial expressions altogether. It is suggested that these results reflect autistic children's insensitivity to other people's facial expressions of emotion.     

Supercyclone in Orissa: an assessment of psychological status of survivors

The study assessed the impact of the Orissa supercyclone on survivors' locus of control, anxiety, depression, and posttraumatic stress. The study was conducted in structured interview sessions 3 months after the supercyclone. The affected people (n = 65) who were close to the epicenter of supercyclone and lost their family members, relatives, and property, experienced more anxiety, depression, and posttraumatic stress than the unaffected (n = 65) who were away from the epicenter of supercyclone and had not experienced any loss. Effects of exposure remained significant with the effects of sex and neuroticism controlled. External support reduced anxiety and depression, and the amount of loss experienced by the survivors significantly increased external locus of control and anxiety.     

'Opportunity structures': urban landscape,social capital and health promotion in Australia

This paper presents data from 40 in-depth interviews that were conducted as part of a study of social capital and health in relation to people's perceptions of the influence of 'place' on their participation levels and health. These data were used to examine features of the western suburbs of Adelaide that were perceived as health damaging and health promoting. The paper demonstrates that our Australian suburban respondents expressed a considerable concern about these features and the impact they have on their perception of community and their ability to participate in it. Safety, connectedness to the area, the reputation of an area and the extent and nature of community facilities are all seen as important to a healthy community. The research found that in the more deprived socioeconomic areas within the study area, there was a significant degree of dissatisfaction with features of the urban environment, such as availability of amenities, provision of public transport, and proximity of industry to private dwellings. The paper concludes by considering certain features of urban environments that might make them more supportive of health through encouraging contact between people. We conclude that these environments could be improved using the following measures: a subsidy scheme to support the viability of local shops and cafés (thereby providing meeting places and employment); parks with facilitators (who could play a role in increasing safety in the park but also encouraging community development); attractive places to walk; and a general environmental improvement program.     

Health promotion behaviors in Chinese family caregivers of patients with stroke

The purpose of this study was to explore the relationship between and among the caregiver's personal factors, the care recipient's functional status, the caregiver's perceived self-efficacy, social support, reactions to caregiving, and health promotion behaviors in family caregivers of community-dwelling stroke patients in Taiwan. A structured home-interview survey methodology was used to collect data from 134 primary caregivers responsible for care of stroke patients in Taipei, Taiwan. The study results indicated that, in general, caregivers were female spousal caregivers (mean age 52 years, average caregiving period 24 months). Regression analyses revealed that the caregiver's health status was the strongest positive predictor of caregiver self-efficacy. Spousal caregivers with a better-perceived health status were more satisfied with their resources of social supports. Spousal caregivers with poor perceived health status had a higher level of caregiving strain. Results for the overall model indicated caregiver's social support and the care recipient's functional status made significant contributions in explaining the caregiver's health promotion behaviors. Implications for further practice suggest establishing community training programs and support groups for family caregivers.