Are feelings of peace or depression the drivers of the relationship between neighbourhood social fragmentation and mental health in Aotearoa/New Zealand?

Exploration of the influence of neighbourhood social context on supportive relationships and social cohesion is on the rise. Positive social contexts may be less stressful for residents, resulting in mental wellbeing and calmness; whereas negative contexts may increase stress and deleterious mental health. To examine this, we measured the relationship between an Index of Neighbourhood Social Fragmentation and overall mental well-being in New Zealand. Then we examined the influence of fragmentation on two components of mental health: depression and calmness. Increased fragmentation was significantly associated with lower mental health scores for the entire population and for females, with similar but insignificant trends for males. Increased fragmentation was associated with increased depression in both sexes, but not calmness. Depression rather than calmness may contribute to the observed association between fragmentation and overall mental health. Groups vulnerable to stressful social contexts may be prone to depression in fragmented neighbourhoods. Further examination of the specific aspects of living in fragmented neighbourhoods which increase depressive feelings is warranted.     

Partners in health? Exploring resemblance in health between partners in married and cohabiting couples

Sociological theories on family formation and families and health suggest that married and cohabiting partners will resemble each other in health status, positively or negatively. The family is often seen as a health-enhancing agent for individuals. However, there are large health differences among families. This study aims to answer the question whether it is the case that the healthy live with the healthy and individuals with poor health have partners who are also in poor health. Moreover, it examines whether resemblance in health is a consequence of partner choice--educational homogamy in particular--behaviour or shared circumstances. Younger and older couples are compared to investigate whether health resemblance increases over the lifecourse. Analyses of a nationally representative sample of almost 12,000 Dutch couples show that partners are indeed significantly alike with regard to several health indicators. Respondents whose partner reports poor health are almost three times more likely to report poor health than respondents whose partner is in good health. There is a strong accumulation of health problems within households. Partner selection with regard to education causes part of the partner resemblance in health. Less support is found for the hypotheses that risk behaviour, mutual influence or the effects of shared circumstances cause similarity between partners' health status. Surprisingly, partners in older couples, who have been together for a longer time, do not resemble each other significantly more than partners in younger couples. The implications of these findings for sociological theory and social inequalities in health are discussed.     

Sympathetic listening or steamrolling? Quality in the health professional-patient relationship in light of new information technology

In the services sector, the product of labor is not a commodity that can be traded easily. What is sold is a specialized service, basically through an exchange of information to meet the client's needs and expectations. What emerge are thus the social relations between individuals: professionals and clients/consumers. This article presents evidence that the introduction of information technology undermines the quality of the relationship between the health professional and the patient. The article begins by discussing concepts pertaining to quality in the health sector. The health professional-patient relationship is then discussed through a brief review of the health/disease concept and specifically the physician-patient relationship. Analysis of primary data shows some indication that technological, physical, and management changes in health care units are undermining the quality of health care: many technological changes, but few operational changes, and many machines, but few professionals to treat patients.     

Is there any relationship between obesity and mental flexibility in children?

Cognitive profiles of 12 schoolboys with obesity were compared with their peers with normal weight. For the cognitive assessment five clinical tasks were selected: digit span memory, Raven's progressive matrices (intelligence), semantic verbal fluency, D2 attention endurance and Wisconsin card sorting test. We found no differences in memory, intelligence and verbal fluency between the two groups. Children with obesity performed worse on D2 and Wisconsin tests. Correlations confirmed relationships between body weight, body mass index, attention and Wisconsin measured perseveration in set-shifting. This suggests that childhood obesity involves cognitive deficits in shifting and attention abilities.     

What is the relationship between income inequality and health? Evidence from the BHPS

Income inequality hypotheses propose that income differentials and/or income distributions have a detrimental effect on health. This previously well accepted relationship between inequality and health has recently come under scrutiny; some claim that it is a statistical artefact, arguing that aggregate level data are not sophisticated enough to adequately test for (and discriminate between) their existence. Supporters argue that it is a question of estimating the relationship using, amongst other things, an appropriate geographical scale. This paper adds to the debate by estimating the relationship between income inequality and health using individual panel data, exploring the relationship at the regional as well as the national level, while attempting to discriminate between the competing hypotheses. Pooled, random and fixed effects ordered probit models are exploited to estimate the relationship between self-reported health and household income, income inequality and relative income. While the estimating regressions find support for the absolute income hypothesis, there is no support for the income inequality hypothesis or relative income hypothesis, and as such we argue that there is limited evidence of an effect of income inequality on health within Britain.     

Right or wrong? On the difficult relationship between epidemiologists and handedness

The declining prevalence of left-handers with age has resulted in the hypothesis that sinistrality, being the result of a developmental insult, may be associated with a reduced life span. While it is plausible that some individuals become left-handed as a consequence of neurologic impairment, the literature on handedness itself appears to suffer from a number of problems. These include the ease with which information on handedness can be collected in the absence of prior hypotheses, the failure to address heterogeneity among left-handers, and the selective publication of positive results. Even if individual contributions, including one published in this issue of Epidemiology, are of reasonable quality, all the above problems conspire to lower the credibility of this area of research.     

Profit or patients’ health benefit? Exploring the heterogeneity in physician altruism

This paper investigates physician altruism toward patients’ health benefit using behavioral data from Hennig-Schmidt et al.'s (2011) laboratory experiment. In the experiment, medical students in the role of physicians decide on the provision of medical services. The experimental setup allows us to identify the influence of profits and patients’ health benefit on the choice of medical treatment. We estimate physician altruism, the weight individuals attach to patients’ health benefit, by fitting mixed logit and multinomial logit regression models to the experimental data. Estimation results provide evidence for physician altruism. We find, however, substantial variation in the degree of physician altruism. We also discuss some implications of our results for the design of physician payment schemes in the light of the theoretical literature.     

Exploring relative deprivation: is social comparison a mechanism in the relation between income and health?

During the last decade there has been a growing interest in the relation between income and health. The discussion has mostly focused on the individual's relative standing in the income distribution with the implicit understanding that the absolute level of income is not as relevant when the individual's basic needs are fulfilled. This study hypothesises relative deprivation to be a mechanism in the relation between income and health in Sweden: being relatively deprived in comparison to a reference group causes a stressful situation, which might affect self-rated health. Reference groups were formed by combining indicators of social class, age and living region, resulting in 40 reference groups. Within each of these groups a mean income level was calculated and individuals with an income below 70% of the mean income level in the reference group were considered as being relatively deprived. The results showed that more women than men were relatively deprived, but the effect of relative deprivation on self-rated health was more pronounced among men than among women. In order to estimate the importance of the effect of relative income versus the effect of absolute income, some analyses on the effect of relative deprivation on self-rated health were also carried out within different absolute income levels. When restricting the analysis to the lowest 40% of the income span the effect of relative deprivation almost disappeared. Relative deprivation may have a significant relation to health among men. However, for the 40% with the lowest income in the population the effect of relative deprivation on health is considerably reduced, possibly due to the more prominent relation between low absolute income and poor health.     

Does transportation vulnerability explain the relationship between changes in exposure to segregation and youth cardiovascular health?

Transportation vulnerability (lack of community/personal access to transportation that in turn increases the risk for health or financial consequences in the event of hardship/disease/disasters) may be an important mechanistic factor linking residential segregation to youth cardiovascular health inequities. This natural experiment examined the impact of transportation vulnerability on the association between changes in exposure to residential segregation and cardiovascular health among minority youth (n = 2,129, mean age 9.1 years, 54% male; 52% Hispanic, 48% non-Hispanic black [NHB]; 49% high area poverty) over two years. Two-level generalized linear mixed models with random intercepts were fit to test the effects of transportation vulnerability on the association between changes in segregation and cardiovascular health (body mass index percentile (BMIP), sum of skinfold thicknesses, 400 m run time, systolic and diastolic blood pressure percentiles (SBPP and DBPP, respectively) over two school years and across gender. After adjusting for potential confounders (individual-level race/ethnicity, age, time, and park-area poverty), improvements in cardiovascular health were greatest for girls exposed to reduced segregation with high compared with low transportation vulnerability for all outcomes. Specifically, BMIP and SBPP decreased 29% (IRR 95% CI: 0.69, 0.73) and 13% (IRR 95% CI: 0.85, 0.90) vs. 10% (IRR 95% CI: 0.84, 0.96) and no significant change (IRR 95% CI: 0.88, 1.00), for high and low transportation vulnerability, respectively. Adjusted models showed the greatest improvements in cardiovascular health for boys exposed to reduced segregation and low compared with high transportation vulnerability for BMIP and skinfold thicknesses. Specifically, BMIP and skinfold thicknesses decreased 33% (IRR 95% CI: 0.73, 0.81) and 21% (IRR 95% CI: 0.74, 0.84) vs. increased 8% (IRR 95% CI: 1.05, 1.11) and no significant change (IRR 95% CI: 0.96, 1.03), for low and high transportation vulnerability, respectively. Policy interventions that promote transportation equity should be further studied as a means to reduce youth cardiovascular health disparities, particularly for girls living in areas with high racial/ethnic segregation.     

Knowledge in process? Exploring barriers between epidemiological research and local health policy development

Background  

In the Netherlands municipalities are legally required to draw up a Local Health Policy Memorandum every four years. This policy memorandum should be based on (local) epidemiological research as performed by the Regional Health Services. However, it is largely unknown if and in what way epidemiological research is used during local policy development. As part of a larger study on knowledge utilization at the local level in The Netherlands, an analytical framework on the use of epidemiological research in local health policy development in the Netherlands is presented here.     

Does age modify the relationship between morbidity severity and physical health in English and Dutch family practice populations?

Purpose  To investigate the co-influences of age and morbidity severity on physical health in adult family practice populations. Methods  Morbidity data in a 12-month period for 7,833 older English consulters aged 50 years and over and 6,846 Dutch consulters aged 18 years and over was linked to their physical health status obtained from cross-sectional health surveys. Individual patients were categorised using 78 consulting morbidities classified by a chronicity measure (acute, acute-on-chronic and chronic) into an ordinal scale of morbidity severity ranging from single to multiple chronicity groups. Associations between morbidity severity, age and SF-12 Physical Component Summary (PCS) score were assessed using linear regression methods. Results  Increased age and higher morbidity severity were significantly associated with poorer physical health. Of the explained total variance in adjusted PCS scores, an estimated 43% was attributed to increasing age, 40% to morbidity severity and 17% to deprivation for English consulters; the figures were 21, 42 and 31%, respectively for Dutch consulters. The largest differences in PCS scores between severity categories were observed in the younger age groups. Conclusions  Morbidity severity and age mainly act separately in adversely influencing physical health. In ageing populations who will experience higher multimorbidity, this study underlines the importance that health care and public health will need to address morbidity severity and ageing as related but distinct issues.     

Men's health promotion: a new frontier in Australia and the UK?

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier.