Is pertussis being considered as a cause of persistent cough among adults?

A study was conducted to determine the 1124 French Sentinel network general practitioners ability to consider pertussis as a cause of persistent cough among adults. Pertussis was rarely considered in the differential diagnosis of cough (6%). Factors associated with pertussis being considered included younger age, shorter cough duration, world health organization clinical definition for pertussis, and muscular chest pain.     

Mental health among older adults in Japan: do sources of social support and negative interaction make a difference?

This study addresses the question of whether social support and interpersonal strain from different sources (i.e., spouse, children, and other relatives and friends) have differential impact on mental health. Data for this research came from a national probability sample of 2200 persons aged 60 and over in Japan. Structural equation models were evaluated within the context of two types of social networks: (a) persons who had a spouse and children (n=1299), and (b) those with children only (n=677). Between these two networks, the links among social support, negative relations, and mental health were contrasted. The effects of various sources of social support and negative interactions on mental health vary depending on the specific dimension of mental health as well as the nature of social networks. Among older Japanese who are married with children, social support from spouse has a greater association with positive well-being than social support from children and others. However, cognitive functioning is uncorrelated with all sources of positive and negative social exchanges. In contrast, among those without a spouse, only greater support from children is significantly correlated with higher positive well-being, less distress, and less cognitive impairment.     

Involvement in civil society groups: Is it good for your health?

STUDY OBJECTIVE: To determine the involvement in civil society groups (CSGs) and the impact of this on health. DESIGN: Case study, cross sectional, self completion questionnaire, and semi-structured interviews. SETTING: Residents in two suburbs in Adelaide, South Australia. PARTICIPANTS: Every household (1038) received a questionnaire asking the adult with the next birthday to complete it. A total of 530 questionnaires were returned. Sixteen questionnaire respondents were also interviewed. MAIN RESULTS: 279 (53%) questionnaire respondents had been involved in a CSG in the past 12 months, 190 (36%) in locally based CSGs, and 188 (35%) in CSGs outside the area. Eleven of the 16 interviewees had been involved in a CSG. A path analysis examined the relation between demographic variables, CSG involvement, and mental and physical health, as measured by the SF-12. Physical health was negatively associated with CSG involvement and older age, and positively associated with working full time or part time and higher education level. Mental health was positively associated with older age, working full time or part time, and higher income but negatively associated with having a child under 18, speaking a language other than English and higher education level. Very few interviewees made a direct link between CSGs and positive individual health outcomes, though some positive community level outcomes were noted. More consistent were reports of the detrimental effects of CSG involvement on mental and physical health. CONCLUSIONS: Involvement in CSGs was significant but not always positive for health. It is possible that CSG involvement is good for a community but not necessarily for the individual.     

Are albumin levels a good predictor of mortality in elderly patients with neck of femur fractures?

Background

Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (<35g/dl) has been highlighted as being a good biochemical predictor of short-term mortality (<12 months). Our aims were to assess whether there was an association between low albumin levels and mortality and whether the severity adversely affects outcomes.

Materials and Methods

Patients admitted to our large district hospital between January 2011 and December 2012 who had sustained a NOF fracture, were over 65 years old and had a pre-operative albumin level were included. This retrospective, longitudinal, observational study concluded in July 2014. Demographic and pre-operative function and albumin data was collated retrospectively. An association with mortality was made.

Results

471 patients had usable data. Mean pre-operative albumin level was 29.5g/dl (SD 6.22g/dl) in patients who died and 32.8g/dl (SD 6.43g/dl) in patients who survived during the study period. Pre-operative albumin level was significantly associated with survival (hazard ratio 0.957: 95% CI (0.937, 0.978); p<0.001). Thus, a reduction of 1g/dl in pre-operative albumin is associated with an increased hazard of death of 4.3%.

Conclusions

Early identification of patients with hypoalbuminaemia on admission with a venous blood sample and timely input from orthogeriatrians could optimise these patients pre- and post-operatively. This may enable rates of morbidity and mortality to fall. Hypoalbuminaemia may be a reasonable predictor of shorter-term mortality in this patient subgroup. However, this may reflect existing co-morbidities rather than an isolated cause. This study supports an association between hypoalbuminaemia and poorer outcome for patients with NOF fractures.

     

Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

Background

A number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality.

Methods

We used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births.

Results

Our results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied.

Conclusions

This study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth.

     

Determinants of self rated health and mortality in Russia – are they the same?

Background

Research into Russia's health crisis during the 1990s includes studies of both mortality and self-rated health, assuming that the determinants of the two are the same. In this paper, we tested this assumption, using data from a single study on both outcomes and socioeconomic, lifestyle and psychological predictor variables.

Methods

We analysed data from 7 rounds (1994–2001) of the Russia Longitudinal Monitoring Survey, a panel study of a general population sample (11,482 adults aged over 18 living in households of 2 or more people). Self-rated health was measured on a 5 point scale and dichotomised by combining responses "very poor" and "poor" into poor health. Deaths (n = 782) during a mean follow up of 4.1 years were reported by another household member. Associations between several predictor variables and poor or very poor self-rated health and mortality were measured using logistic regression and Cox proportional hazards analysis respectively.

Results

Poor self-rated health was significantly associated with mortality; hazard ratios, compared with very good, good or average health, were 1.69 (1.36-2.10) in men and 1.74 (1.38-2.20) in women. Low education predicted both mortality and poor self-rated health, but income predicted subjective health more strongly. Smoking doubled the risk of death but was unrelated to subjective wellbeing. Frequent drinkers experienced greater mortality than occasional drinkers, despite reporting better health. In contrast, dissatisfaction with life predicted poor self-rated health, but not mortality.

Conclusion

Differences between the predictors of subjective health and mortality, even though these outcomes were strongly associated, suggest that influences on subjective health are not restricted to serious disease. These findings also suggest the presence of risk factors for relatively sudden deaths in apparently well people, although further research is required. Meanwhile, caution is required when using studies of self-rated health in Russia to understand the determinants of mortality.     

Trends in social inequality in self-reported health in The Netherlands; does infant mortality in year of birth as a cohort indicator matter?

In this article, we study trends in self-reported health (general health and chronic conditions) and health inequality in the Netherlands between 1974 and 1998 using an age-period-cohort framework. We answer two questions: (1) to what extent can trends in self-reported health be explained by the current macro-context (period effect) and by infant mortality in year of birth (cohort effect)? And (2) do the effects of period and cohort differ for educational groups? Health indicators are self-reported poor health and chronic conditions. The use of 26 Dutch cross-sectional surveys makes it possible to estimate largely unbiased effects of period and cohort simultaneously (controlled for age effects) and thus to adequately describe trends in social inequality in health. Our results give rise to four conclusions. First, for men poor health has been more or less stable, for women there has been an increase. The prevalence of chronic conditions has increased for both sexes. Second, adding cohort specific experiences to a model including age and period effects is only relevant for women's poor health. Decreasing infant mortality in year of birth leads to better health and consequently the period effect initially found for women appears to be slightly underestimated. Third, we found no trends in social inequalities in self-reported health due to period effects. Fourth, our analyses do show socially unequal trends in health as a result of cohort specific experiences. Contrary to our hypothesis, we found that decreased infant mortality in year of birth makes for a stronger impact of educational differences on self-reported poor health. Concerning chronic conditions no trends for educational groups were found.     

Mainstream media and the social determinants of health in Canada: is it time to call it a day?

This article explores the dearth of coverage of the social determinants of health by the Canadian mainstream media. It is argued that this neglect is primarily a reflection of political and economic societal structures that has been associated with increasing corporate control of the mainstream media. Applying a critical political economy lens, it is argued that the barriers to having the Canadian mainstream media report on the social determinants of health are so numerous that it may indeed be 'time to call it a day' in regard to having them assist in the dissemination of social determinants of health findings. Recognizing this reality should spur the development of alternative means of communicating with the public in order to develop a citizens' movement to create health-promoting public policy. Recent dissemination efforts related to the Social Determinants of Health: The Canadian Facts provide an example of how this might be accomplished.     

Should we brush twice a day? Determinants of dental health among young adults in Finland

We explore the determinants of dental ill-health as measured by the occurrence of caries. A recursive bivariate probit model that was derived from health production and demand theory is employed to model caries, while taking account of dental care use. The data are from a follow-up questionnaire used in a longitudinal study of the Northern Finland 1966 Birth Cohort, with respondents aged 31 (n = 5020). The factors controlled for relate to family background and health behavior during their youth, current socioecononomic variables and dental health stock. The total effects on the occurrence of caries of the explanatory variables are computed.Among females, factors increasing caries are body mass index and intake of alcohol, sugar and soft drinks, and those reducing caries are birth weight and adolescent school achievement. Among males, caries is positively related to the metropolitan residence and negatively related to education and healthy diet. Smoking increases caries, whereas dental care use, regular dental attendance and brushing teeth at least twice a day decrease caries. To promote oral health, attention should focus on policies to improve dental health education and to reduce the impacts of common risk factors.     

The genetic conception of health: is it as radical as claimed?

The so-called new genetics is widely predicted to radically transform medicine and public health and deliver considerable benefits in the future. This article argues that, although it is doubtful that many of the promised benefits of genetic research will be delivered, an increasingly pervasive genetic worldview and expectations about future genetic innovations are profoundly shaping conceptions of health and illness and priorities in healthcare. Further, it suggests that debates about the normative and justice implications of new genetic technologies thus far have been constrained by bioethics discourse, which has tended to frame questions narrowly in terms of how best to ensure the protection and promotion of the rights and freedoms of the individual. Sociologists and other social scientists can help broaden debate in this field by exposing the assumptions underlying the genetic conception of health and exploring the implications of associated developments.     

Is the United States a good model for reducing social exclusion in Europe?

Advocates of U.S.-style labor market flexibility have long argued that Europe could generate jobs and lower unemployment if the continent's economies followed the example of the United States. More recently, proponents of the U.S. model have suggested that labor market deregulation also holds out the possibility of reducing the problem of "social exclusion" in Europe, primarily because unemployment is one of the worst forms of social exclusion and contributes to other forms of social marginalization. The authors review a broad range of social and economic indicators and conclude that the United States fares poorly compared with much of Europe on social measures. Meanwhile, U.S.-style flexibility has had only mixed success in improving employment outcomes, and the U.S. economy consistently provides lower levels of economic mobility than economies in Europe.     

Is grip strength a good marker of physical performance among community-dwelling older people?

Introduction

There is increasing interest in physical performance as it relates to both the current and future health of older people. It is often characterised using the Short Physical Performance Battery including assessment of gait speed, chair rises and standing balance. However this battery of tests may not be feasible in all clinical settings and simpler measures may be required. As muscle strength is central to physical performance, we explored whether grip strength could be used as a marker of the Short Physical Performance Battery.

Objective

To examine associations between grip strength and components of the Short Physical Performance Battery in older community dwelling men and women.

Methods

Grip strength measurement and the Short Physical Performance Battery were completed in 349 men and 280 women aged 63?C73 years taking part in the Hertfordshire Cohort Study (HCS). Relationships between grip strength and physical performance (6m timed-up-and-go [TUG], 3m walk, chair rises and standing balance times) were analysed using linear and logistic regression, without and with adjustment for age, anthropometry, lifestyle factors and co-morbidities.

Results

Among men, a kilo increase in grip strength was associated with a 0.07s (second) decrease in 6m TUG, a 0.02s decrease in 3m walk time, and a 1% decrease in chair rises time (p<0.001 for all). Among women, a kilo increase in grip strength was associated with a 0.13s decrease in 6m TUG, a 0.03s decrease in 3m walk time, and a 1% decrease in chair rises time (p<0.001). Higher grip strength was associated with better balance among men (p=0.01) but not women (p=0.57). Adjustment for age, anthropometry, lifestyle and co-morbidities did not alter these results.

Conclusions

Grip strength is a good marker of physical performance in this age group and may be more feasible than completing a short physical performance battery in some clinical settings.     

The socioeconomic status of older adults: How should we measure it in studies of health inequalities?

STUDY OBJECTIVE: To identify which of seven indicators of socioeconomic status used singly or combined with one other would be most useful in studies of health inequalities in the older population. DESIGN: Secondary analysis of socioeconomic and health data in a two wave survey. SETTING: Great Britain. Participants were interviewed at home by a trained interviewer. PARTICIPANTS: Nationally representative sample of 3543 adults aged 55-69 interviewed in 1988/9, 2243 of whom were interviewed again in 1994. METHODS: Desirable features of socioeconomic measurement systems for identifying health inequalities in older populations were identified with reference to the literature. Logistic regression was used to examine variations in self reported health by seven indicators of socioeconomic status. The pair of indicators with the greatest explanatory power was identified. MAIN RESULTS: All indicators were significantly associated with differences in self reported health. The best pair of variables, according to criteria used, was educational qualification or social class paired with a deprivation indicator. DISCUSSION: For a range of reasons the measurement of socioeconomic status is particularly challenging in older age groups. Extending our knowledge of which indicators work well in analyses and are relatively easy to collect should help both further study of health inequalities in the older population and appropriate planning.     

A higher prevalence of health problems in low income groups: does it reflect relative deprivation?

STUDY OBJECTIVE: Although it has frequently been suggested that income affects health, there is hardly any research in which this issue has been explored directly. The aim of this study was, firstly, to examine whether income is independently associated with health, secondly, to assess the extent to which this association reflects high levels of deprivation in low income groups, and thirdly, to examine which specific components of deprivation contribute most to the link between income and health. Health indicators used were the prevalence of chronic conditions, health complaints and less than "good" perceived general health. SETTING: Region in the south east of the Netherlands. PARTICIPANTS: A population of 2567 men and women who participated in an oral interview, aged 15-74. DESIGN: Data were obtained from the baseline of a prospective cohort study aimed at the explanation of socioeconomic inequalities in health. RESULTS: Large inequalities in health by (equivalent) income after differences in other socioeconomic indicators had been controlled for were observed. For example, among those in the lowest income group the risk of bad perceived health was three times as high as among people in the highest income group. The prevalence of deprivation (basic, housing, social) increased with decreasing income to approximately 50-60% in the lowest income group. A substantial part of the increased health risks of the lowest income groups could statistically be accounted for by the higher prevalence of deprivation in these groups. The components that are likely to influence health indirectly, through a psychological or behavioural mechanism, accounted for most of the effect. CONCLUSIONS: These analyses provide evidence to suggest that a low income has detrimental health effects through relative deprivation. Moreover, the results indicate an indirect link between deprivation and health problems involving psychological or behavioural factors.     

Does walkable mean sociable? Neighborhood determinants of social capital among older adults in Japan

Why are some communities more cohesive than others? The answer to the puzzle has two parts: (a) due to variations in the attributes of residents, and/or (b) due to variations in the attributes of places. However, few studies have sought to examine the community-level determinants of social capital. In the present study, we examined the associations between social capital and different area characteristics: (1) neighborhood walkability, (2) date of community settlement, and (3) degree of urbanization. We based our analysis on 9414 respondents from the Aichi Gerontological Evaluation Study (AGES), conducted in 2003. No significant positive association was found between the walkability score and any of the social capital indices. In contrast, community age and degree of urbanization were associated with many of the social capital indicators, even after controlling for characteristics of the residents. Community social capital thus appears to be more consistently linked to the broader historical and geographic contexts of neighborhoods, rather than to the proximal built environment (as measured by walkability).     

Is a general women's health promotion program as effective as an HIV-intensive prevention program in reducing HIV risk among Hispanic women?

OBJECTIVE: This study aimed to assess whether participants in an HIV-intensive prevention program and participants in a general women's health promotion program reported greater HIV risk-reduction than participants in a wait-list control group immediately following program participation and at three-month follow-up. METHODS: The authors studied 162 Hispanic women ages 18 to 35 years, most of them immigrants. Three-fourths of the sample (74%) reported earning less than $800 a month, 29% did not have a high school degree, and 90% had children. Data were gathered through surveys at baseline, at intervention completion, and at three-month follow-up. Information was collected on sociodemographics, HIV risk factors, and risk behaviors. Crude and adjusted (for demographics and dose) logistic regression analyses were used to assess program effects on participants' risk reduction. RESULTS: Crude logistic regression analyses reveal that both programs resulted in increased condom use at post-test and follow-up. Only participants in the HIV-intensive prevention program reported increased safer sex negotiation at post-test and follow-up, however, and only participants in the women's health promotion program reported increased HIV testing at post-test. CONCLUSION: Both interventions increased condom use. The HIV-intensive prevention program appeared to be more effective in promoting safer sex negotiation, and the women's health promotion program appeared more effective in promoting HIV testing. The findings suggest that both approaches may be viable ways to package HIV prevention for short-term behavior change in this population.     

The recognition of access to health care as a human right in South Africa: is it enough?

A right of access to health care services is among the economic and social rights guaranteed by the Constitution of South Africa. Given the jurisprudential novelty of such a right and its dependence on economic resources, however, its realization is likely to be difficult to secure. The article discusses the scope and limitations of the right of access to health care in South Africa. Though the country's courts have yet to develop clear principles for interpreting a right of access to health care services, the more significant obstacles to the full enjoyment of this right are the country's pervasive poverty, gross income disparities, and extremely high burden of disease.     

The resurgence of pertussis in developed countries: a problem for Brazil as well?

Pertussis is currently considered an important public health problem in developed countries. In most of these countries, mass immunization for pertussis was initiated in the 1950s and was followed by a marked decrease in disease incidence. In the 1970s, pertussis was apparently under control in countries were vaccine coverage was maintained high. However, in the last two decades of the 20th century, the number of reported cases increased in all age groups, including adolescents and adults, indicating resurgence of the disease. This brief note aims to present the possible reasons for resurgence of this disease and to discuss the prospects of its future dynamics in Brazil. There has been no evidence to date for the resurgence of pertussis in Brazil. However, since mass immunization in Brazil began only in the 1980s, one cannot rule out the possibility that pertussis will resurge in the near future. Therefore, it is important that public health services closely monitor the epidemiological situation of pertussis in order, if necessary, to rapidly update the current immunization strategy.