Social capital and self‐rated health: A cross‐sectional study of the general social survey data comparing rural and urban adults in Ontario

The concept of social capital shows great promise for its potential to influence individual and population health. Yet challenges persist in defining and measuring social capital, and little is known about the mechanisms that link social capital and health. This paper reports on the quantitative phase of a sequential explanatory mixed methods study using data from Canada's 2013 General Social Survey (data collected 2013–14). An exploratory factor analysis revealed six underlying dimensions of social capital for 7,187 adults living in Ontario, Canada. These factors included trust in people, neighbourhood social capital, trust in institutions, sense of belonging, civic engagement, and social network size. A logistic regression indicated that having high Trust in People and Trust in Institutions were associated with better mental health while high Trust in Institutions, Sense of Belonging, and Civic Engagement were associated with better physical health. When comparing rural and urban residents, there were no differences in their self‐reported health, nor did social capital influence their health any differently, despite rural residents having higher social capital scores. The study findings are important for understanding the nature of social capital and how it influences health, and provide direction for targeted health promotion strategies.     

Hip impingement in slipped capital femoral epiphysis: a changing perspective

Background

Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement.

Methods

The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered.

Results

Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations.

Conclusions

Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head–neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis.

Level of evidence

V.     

提高社区诊所为集贸市场商贩性病卫生服务满意度研究

目的鼓励有可疑性病症状的集贸市场商贩及时就诊,避免性病的传播。方法采用描述性分析、χ2检验、Logistic回归等分析方法,对集贸市场商贩具有的高危性态度和性行为,开展以提高疑似性病患者满意度为主要内容的卫生服务研究。结果具有疑似性病症状的集贸市场商贩的就诊意识得到加强,出现症状后的就诊率干预前为43.7%,干预后提高到57.9%(P<0.05);在诊所中开展的性病卫生服务营销方式,使患者的满意度由干预前的84.8%提高到干预后的93.0%(P<0.05)。结论提高社区诊所性病卫生服务满意度是集贸市场内进行性病防治的可行方法,对在相似人群中的性病预防控制工作有重要的参考价值。     

Evaluation of a structured educational programme for type 2 diabetes patients seen in private practice

AIM: Structured education is necessary in the management of a chronic disease such as diabetes and should be readily offered to patients in different settings. Our aim was to demonstrate the feasibility and advantages of a group education programme for type 2 diabetic patients in a private setting in France. METHODS: A programme of group education for patients with type 2 diabetes was initiated by a multidisciplinary group of volunteer healthcare providers, including general practitioners, specialists in diabetology and non-medical members. All volunteers received one day of training, and physicians were instructed to organize several sessions of group education for the type 2 diabetic patients who regularly attended their practice. The first 427 patients entering the programme were included in the study, and asked to fill in a questionnaire to assess their knowledge, beliefs and behaviours with regard to diabetes. Their physician filled in a medical form. Six months later, the same questionnaire and form were sent for follow-up information. RESULTS: At six months versus baseline, patients exhibited small, but consistent, improvements: (i) fasting glucose 142+/-42 mg/dL (P<0.04) vs 146+/-44 mg/dL (P<0.04); (ii) HbA(1c) 7.41+/-1.26% vs 7.57+/-1.33% (P<0.01); and (iii) all of the main parameters of diabetes self-management recorded in the study. The percentage of patients who inspected their feet at least once a week increased from 67 to 77% (P<0.001). Patients improved their knowledge of the disease and developed a more positive attitude towards their diabetes. CONCLUSION: Our study demonstrates that it is possible to organize educational sessions for diabetic patients in a private-practice setting. At six months, patients receiving these sessions showed benefits in terms of blood glucose control and other important markers of self-management of their disease.     

Social capital and depression: evidence from urban elderly in China

Objectives: To study the relationship between social capital and depression among older adults from urban China and the mediating effect of social support on the influence of social capital on depression.

Methods: Data were collected from face-to-face interviews targeting older adults (N = 928, response rate = 68.1%) aged over 60 years residing in Hangzhou, China, in 2013. Indicators of social capital included both cognitive (trust and reciprocity) and structural (social network and social participation) aspects. The dependent variable depression was measured by the Geriatric Depression Scale, social support was measured by the Multidimensional Scale of Perceived Social Support, and sociodemographic variables (age, education, and household income) and physical function were controlled for analysis. The data were analyzed by factor analysis and a hierarchical regression model.

Results: Trust, reciprocity, and social network were significantly associated with geriatric depression after controlling. Social participation was not correlated with geriatric depression. Social support partially mediated the relationships between social capital and geriatric depression.

Conclusion: This study provides new evidence that social capital effectively mediates geriatric depression directly and indirectly. The intervention of social capital on depression should therefore consider the two pathways. Future longitudinal studies should help further understand the mechanisms linking social capital and depression.     

Flourishing,languishing and moderate mental health: Prevalence and change in mental health during recovery from drug and alcohol problems

The aim was to explore the utility of Keyes’ concept of mental health in a substance addiction context. Mental health is considered the presence of emotional wellbeing in conjunction with high levels of social and psychological functioning. Using Keyes' measure, the frequency of languishing and flourishing is compared between clients who became abstinent and those continuing to use substances following treatment. It was hypothesised that there would be a significant interaction between substance use and levels of mental health over time. Participants were 794 individuals (79.5% male) attending residential substance abuse treatment provided by The Australian Salvation Army. The current sample was drawn from a larger longitudinal study evaluating routine client outcomes. At entry to treatment there were higher rates of languishing compared to population estimates, yet greater rates of flourishing at all time points compared to community normative data. There was a significant interaction between continuous mental health and substance use status. Mental health was rated significantly higher by individuals who were abstinent than those who had used substances at 3-month post-discharge follow-up. The comorbidity of mental illness and substance misuse has previously been investigated, but this is the first study to investigate the prevalence of mental health. While participants who remained abstinent achieved the highest levels of flourishing, at follow-up there were lower rates of languishing than found in a general community sample. Additionally, results suggested that improved mental health was a consequence of reduced severity of alcohol and other drug abuse, and followed reductions in cravings.     

Types of natural recovery from alcohol dependence: a cluster analytic approach

Background Social capital and a low severity of alcohol‐related problems have been focused upon to explain the processes of natural recovery from alcohol dependence. However, studies using control groups have not found significant differences in these variables. Subtypes of natural remission which might account for this inconsistency have only been described on grounds of qualitative data. Aims To identify subtypes of natural remitters using cluster analysis. Participants One hundred and seventy‐eight media‐recruited natural remitters were interviewed personally. Several triggering mechanisms and maintenance factors of remission were assessed using standardized questionnaires. Based on age of onset and severity of dependence, adverse consequences from drinking, social pressure and social support, cluster analyses were performed. Results Cluster analyses yielded three groups of natural remitters: one cluster with a high severity of dependence, low alcohol‐related problems and low social support (‘low problems—low support’; n = 65), one group characterized by high severity of dependence, high alcohol‐related problems and medium social support (‘high problems—medium support’; n = 37), and a third group which consisted of subjects with high social support, late age of onset, low severity of dependence, and low alcohol‐related problems (‘low problems—high support’; n = 76). Cluster solutions were confirmed using discriminant analyses. Analyses of variance (ANOVAs) revealed further group differences on other triggering and maintaining factors of remission. Conclusions Failure to identify specific pointers to natural recovery in previous research might be due to heterogeneous subgroups of natural remitters. In order to build a conceptual framework for understanding the processes of natural recovery, interactions of different independent variables should be considered.     

Substance use in rural adolescents: The impact of social capital,anti-social capital,and social capital deprivation

Middle- and high-school substance use is a pressing public health problem in the United States. Despite similar or, in some cases, elevated rates of substance use among rural youth, much of the extant research on adolescent substance use has focused on urban areas. The current study aims to uncover forms of social capital (e.g., ethnic identity), social capital deprivation (e.g., parent-child conflict), and anti-social capital (e.g., delinquent friends) that impact the use of alcohol, cigarettes, and marijuana in a sample of middle- and high-school students from the rural south. It was hypothesized that social capital factors would be associated with decreased substance use while social capital deprivation and anti-social capital factors would be associated with increased substance use. The hypotheses were tested using logistic regression models with generalized estimating equations. The findings indicated that for middle school youth, anti-social capital in the form of aggression and delinquent friends was significantly associated with an increased likelihood of using alcohol, cigarettes, and marijuana. For high school students, anti-social capital in the form of aggression and delinquent friends and social capital deprivation in the form of neighborhood crime were significantly associated with an increased likelihood of using alcohol, cigarettes, and marijuana. Violent behavior was also significantly associated with an increased likelihood of using marijuana. Females reported less substance use in both middle and high school; reports of use increased with age. Implications are discussed. Given the salience of social capital deprivation, substance use programs should emphasize the skills necessary to avoid or disengage from antisocial relationships.