Late life disability and experienced wellbeing: Are economic resources a buffer?

BackgroundDisablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.ObjectiveDrawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.MethodsWe use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.ResultsWe find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.ConclusionsFuture research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.     

药房托管的试行与发展

近年来我国居民＂看病难、看病贵＂的矛盾不断突出,党和政府以及广大人民群众十分关心,社会各界对此反映十分强烈。医药分开一直是我国医疗卫生体制改革的重点,医院门诊药房托管作为我国医药分开改革中的一种试点模式,在我国已有6年的试行历史,并取得了不俗的成绩。实行药房托管是现行医药体制下的必然选择。本文归纳介绍了药房托管的起源,一般形式及优点,以及完善药房托管的管理措施等,对医院药房的改革有参考作用。医院在进行药房托管试验模式的同时应该抓住机遇,不断提高医院药学专业人员的综合素质,加快医院业务的开展,进一步不断深化医药卫生体制改革。     

Socioeconomic inequalities in quality of life and psychological outcomes among cardiac patients

Objectives:  The aim of this article is to explore socioeconomic inequalities in the psychological characteristics (psychological well-being, perceived mental health status) and perceived quality of life among cardiac patients. Methods:  A structured interview was conducted with 362 patients (32% women, mean age 56 ± 7.3 years) referred for coronary angiography. The GHQ-28 was used to measure psychological well-being, the SF-36 for perceived mental health status. Income and education indicated socioeconomic position. Logistic regressions were employed, adjusted for age, gender, functional status and severity of disease. Results:  Patients with low income or education had a higher probability of having poor psychological well-being compared to participants with high income or education (OR 5.5,CI 2.32-12.80; OR 3.1,CI 1.52-6.37 resp.), and were also more likely to have worse mental health status (OR2.9,CI 1.02-8.51;OR 4.8,CI 1.36-16.99 resp.), and low quality of life (OR 2.9,CI 1.02-8.51; OR 4.8,CI 1.36-16.99 resp.). Conclusions:  Socioeconomic status was found to be negatively associated with the psychological outcomes and quality of life among cardiac patients. Socioeconomic inequalities should be taken into account when designing suitably-adapted interventions focusing on psychosocial factors among cardiac patients. Submitted: 27 September 2007; revised: 08 January 2009, 16 March 2009; accepted: 18 March 2009     

乡（镇）村卫生一体化管理下乡村医生报酬的优化设计

在分析乡村医生报酬对乡村医生队伍稳定与发展的影响以及乡（镇）村卫生一体化管理下乡村医生报酬水平和结构问题的基础上,阐述乡村医生报酬的优化设计,为完善乡（镇）村卫生一体化管理体制和运行机制提供决策支持。     

Social comparisons and health: Can having richer friends and neighbors make you sick?

Do richer friends and neighbors improve your health through positive material effects, or do they make you feel worse through the negative effect of social comparison and relative deprivation? Using the newly available National Social Life, Health, and Aging Project (NSHAP) data set that reports individuals' income positions within their self-defined social networks, this paper examines whether there is an association between relative position and health in the US. Because this study uses measures of individuals' positions within their self-defined social groups rather than researcher-imputed measures of relative position, I am able to more precisely examine linkages between individual relative position and health. I find a relationship between relative position and health status, and find indirect support for the biological mechanism underlying the relative deprivation model: lower relative position tends to be associated with those health conditions thought to be linked to physiological stress. I also find, however, that only extremes of relative position matter: very low relative position is associated with worse self-rated physical health and mobility, increased overall disease burden, and increased reporting of cardiovascular morbidity; very high relative position is associated with lower probabilities of reporting diabetes, ulcers, and hypertension. I observe few associations between health and either moderately high or moderately low positions. This analysis suggests that the mechanism underlying the relative deprivation model may only have significant effects for those at the very bottom or the very top.     

Social capital,income inequality and self-rated health in Chita peninsula,Japan: a multilevel analysis of older people in 25 communities

The effect of social capital on one's health has drawn researchers' attention. In East-Asian countries, however, such an effect has been less studied than in Western countries. Mindful of this background, this study aimed to investigate the linkage between social capital and health at the level of a small area in Japan, and also to examine whether social capital mediates the relation between income inequality and health.     

Global variations in health: Evaluating Wilkinson's income inequality hypothesis using the World Values Survey

This international comparative study analyses individual-level data derived from the World Values Survey to evaluate Wilkinson's [(1996). Unhealthy societies: The afflictions of inequality. London: Routledge; (1998). Mortality and distribution of income. Low relative income affects mortality [letter; comment]. British Medical Journal, 316, 1611–1612] income inequality hypothesis regarding variations in health status. Random-coefficient, multilevel modelling provides a direct test of Wilkinson's hypothesis using micro-data on individuals and macro-data on income inequalities analysed simultaneously. This overcomes the ecological fallacy that has troubled previous research into links between individual self-rated health, individual income, country income and income inequality data. Logic regression analysis reveals that there are substantial differences between countries in self-rated health after taking account of age and gender, and individual income has a clear effect in that poorer people report experiencing worse health. The Wilkinson hypothesis is not supported, however, since there is no significant relationship between health and income inequality when individual factors are taken into account. Substantial differences between countries remain even after taking account of micro- and macro-variables; in particular the former communist countries report high levels of poor health.     

Relative deprivation in income and self-rated health in the United States

Absolute income is robustly associated with health status. Few studies have, however, examined if relative income is independently associated with health. We examined if, over and above the effects of absolute income, individual relative deprivation in income as well as position in the income hierarchy is associated with individual poor health in the U.S. Using three rounds of the Current Population Surveys (CPS), we analyzed the association between self-rated health (1 = fair/poor, 0 = otherwise) and the Yitzhaki index of relative deprivation in income and percentile position in the income hierarchy across 17 reference groups. Over and above the effects of absolute income, the odds ratio for reporting poor health among individuals in the highest quintile of relative deprivation compared to the lowest quintile ranged between 2.18 and 3.30, depending on the reference groups used. A 10 percentile increase in income position within reference groups was associated with an odds ratio of poor health of 0.89. Relative deprivation appeared to explain between 33 and 94% of the association between individual income and self-rated health. Relative deprivation in income is independently associated with poor health over and above the well established effects of absolute income on health. Relative deprivation may partly explain the association between income inequality and worse population health status.     

Policy-related determinants of child nutritional status in China: The effect of only-child status and access to healthcare

This paper examines the determinants of child nutritional status in China, focusing specifically on those determinants related to health system reform and only-child status. Data are drawn from four waves of the China Health and Nutrition Survey (1991–2000). The empirical relationship between nutritional status, on the one hand, and income, access to quality healthcare and being an only-child, on the other hand, is investigated using ordinary least squares (OLS), random effects (RE), fixed effects (FE) and instrumental variables (IV) models. In the preferred model – a fixed effects model where income is instrumented – we find that being an only-child increases height-for-age z-scores by 0.12 of a standard deviation. By contrast, measures of access to quality healthcare are not found to be significantly associated with improved nutritional status.