Trends in coronary heart disease — has the socio‐economic differential changed?

OBJECTIVE: To compare both trends in rates of coronary heart disease and levels of coronary risk factors between different socio-economic groups. METHODS: Rates of coronary events for men and women aged 25 to 69 years were estimated from a population-based register in the Lower Hunter Region of New South Wales from 1985 to 1993. Risk factor levels were estimated for men and women aged 35 to 64 years from three surveys of risk factors conducted in 1983, 1988/89 and 1994 in the same study population. RESULTS: There was a decline in major coronary events from 1985 to 1993. The greatest decline was for fatal coronary events, which fell by between 4.3% and 9.1% per year. Trends in event rates were similar for all socio-economic groups, except for trends in non-fatal definite myocardial infarction among women. Women from the areas with high socio-economic status tended to have a greater reduction in non-fatal definite myocardial infarction compared with women from low socio-economic areas. Trends in risk-factor levels were similar except the prevalence of cigarette smoking among women from the lowest quintile of socio-economic status did not decline. CONCLUSION: Prevention strategies seem to have had a beneficial impact on this population, resulting in similar declines in rates of coronary events for all socio-economic groups. However, event rates are still high, suggesting a further reduction in mortality and morbidity is possible. This could be achieved by further reductions in smoking, cholesterol and blood pressure, especially among people from areas with low socio-economic status.     

The ‘demented other’ or simply ‘a person’? Extending the philosophical discourse of Naue and Kroll through the situated self

This article presents a critique of an article previously featured in Nursing Philosophy (10: 26-33) by Ursula Naue and Thilo Kroll, who suggested that people living with dementia are assigned a negative status upon receipt of a diagnosis, holding the identity of the 'demented other'. Specifically, in this critique, we suggest that unwitting use of the adjective 'demented' to define a person living with the condition is ill-informed and runs a risk of defining people through negative (self-)attributes, which has a deleterious impact upon that person's social and relational personae. Moreover, use of the locution 'demented' reinforces a divide between the 'demented' (them) and the 'healthy others' (us). Social constructionist theory, malignant positioning and viewing people with dementia as semiotic subjects are the philosophical pillars through which we construct the main arguments of the critique. The article concludes with the voice of one of the authors, a younger person with dementia, asking for language in dementia care to be carefully reconsidered and reframed and for the recognition of the diagnosed person's agency in the conduct of their day-to-day lives.     

School canteens – places for increasing social connectedness?

Research has shown that students who have a genuine engagement with others in the school community are more likely to complete their school education. There is evidence that a school's social atmosphere affects how happy students are at school and how well they learn. Creating opportunities for student participation in school life beyond the classroom has also been cited as helping to provide students with a sense of social inclusion.     

Medical consumerism in the UK,from ‘citizen’s challenge’ to the ‘managed consumer’—A symbol without meaning?

BackgroundIn Britain''s National Health Service (NHS), medical consumerism is disliked by many doctors but managed by NHS leaders. Managed consumers have choices about treatment options, but are expected to help contain costs, improve quality of care, take part in clinical research and advocacy, and increase productivity. There are so many meanings for medical consumerism that it can be categorized, in post‐structuralist terms, as a ‘symbol without meaning’, but meanings are plentiful in the NHS.Policy expectationsChoices made by discriminating consumers were expected to improve the quality of medical care for all. Extending choice to the many, and not restricting options to the few, would allow gains from choices to accumulate, so that choice would sustain social solidarity. Managed consumerism would in theory, therefore, instil reasonable choices and responsible behaviours in a moralized citizenry, across the nation. The advocates of New Labour''s espousal of medical consumerism expected the accumulative effects of customer choices to challenge professional and occupational power, erode the medical model of health and illness, constrain professional judgements, and open the NHS to new ways of working. Almost all their expectations have been thwarted, so far.ConclusionsManaged consumerism is far from being a meaningless symbol. This discussion paper explores the territory of managed consumerism and suggests realistic ways to make it more effective in shaping the NHS.Patient & Public ContributionWe developed the arguments in this discussion paper with insights provided by a lay expert (see Acknowledgements) with experience of consumerism in both public sector management and a disease‐related charity.     

‘M‐apping’ sleep? Trends and transformations in the digital age

This article critically explores recent trends and transformations in the monitoring and management of sleep in the digital age, taking as its focus the advent of new digital technologies to trace and track the ‘sleep of ourselves’ far away from the conventional sleep laboratory or clinic. Our argument is situated dually in the history of sleep science and medicine on the one hand, and the rise of new digital forms of so‐called self‐tracking and mobile health (m‐Health) on the other hand. While the recent history of sleep science and medicine may rightly we suggest, in Kroker's terms, be characterised as a concern with the ‘sleep of others’, a new chapter in this story may well be dawning through the advent of these smart new mobile tools and technologies for mapping, or ‘m‐apping’ as we term it, the ‘sleep of ourselves’ in the digital age. The problems and prospects this holds are then critically considered – through the interrelated themes of selfhood, sociality and governance – and some preliminary conclusions ventured in this new digital domain.     

Does the School Performance Variable Used in the International Health Behavior in School‐Aged Children (HBSC) Study Reflect Students' School Grades?

BACKGROUND: Given the pressure that educators and policy makers are under to achieve academic standards for students, understanding the relationship of academic success to various aspects of health is important. The international Health Behavior in School-Aged Children (HBSC) questionnaire, being used in 41 countries with different school and grading systems, has contained an item assessing perceived school performance (PSP) since 1986. Whereas the test-retest reliability of this item has been reported previously, we determined its convergent and discriminant validity. METHODS: This cross-sectional study used anonymous self-report data from Austrian (N = 266), Norwegian (N = 240), and Canadian (N = 9,717) samples. Students were between 10 and 17 years old. PSP responses were compared to the self-reported average school grades in 6 subjects (Austria) or 8 subjects (Norway), respectively, or to a general, 5-category-based appraisal of most recent school grades (Canada). RESULTS: Correlations between PSP and self-reported average school grade scores were between 0.51 and 0.65, representing large effect sizes. Differences between the median school grades in the 4 categories of the PSP item were statistically significant in all 3 samples. The PSP item showed predominantly small associations with some randomly selected HBSC items or scales designed to measure different concepts. CONCLUSIONS: The PSP item seems to be a valid and useful question that can distinguish groups of respondents that get good grades at school from those that do not. The meaning of PSP may be context-specific and may have different connotations across student populations from different countries with different school systems.     

Projecting the burden of diabetes in Australia – what is the size of the matter?

Objective: To analyse the implications of using different methods to predict diabetes prevalence for the future. Approach: Different methods used to predict diabetes were compared and recommendations are made. Conclusion: We recommend that all projections take a conservative approach to diabetes prevalence prediction and present a ‘base case’ using the most robust, contemporary data available. We also recommend that uncertainty analyses be included in all analyses. Implications: Despite variation in assumptions and methodology used, all the published predictions demonstrate that diabetes is an escalating problem for Australia. We can safely assume that unless trends in diabetes incidence are reversed there will be at least 2 million Australian adults with diabetes by 2025. If obesity and diabetes incidence trends, continue upwards, and mortality continues to decline, up to 3 million people will have diabetes by 2025, with the figure closer to 3.5 million by 2033. The impact of this for Australia has not been measured.     

Lead dust in Broken Hill homes — a potential hazard for young children?

OBJECTIVE: To determine the potential hazard posed by indoor lead dust to young children in Broken Hill, a silver-lead-zinc mining town in outback Australia, and the degree to which lead flux is influenced by factors such as geographical location, house construction type and condition. METHODS: 116 homes were selected and 93 (80%) studied from 10 localities in Broken Hill during the spring of 1995. Lead flux was measured using 85 mm diameter polystyrene petri dishes. Dishes were placed in four rooms of each house to collect dust over a six-to-eight-week period. Data on the location, condition and construction type of each house were recorded. Multiple linear regression was used to determine predictors of lead flux. Flux data were log transformed for the analysis. RESULTS: Average household lead flux varied nearly seven-fold across districts from a low of 166 (distant from the mines), to a high of 1,104 microg/m2/30-day period (adjacent to the mines). Houses that were 'adequately sealed' had 2.9 times the lead flux, and 'poorly sealed' houses 4.3 times the flux, of 'very well sealed' houses. Construction material did not significantly affect these flux levels, and no statistically significant interactions were found between house condition and location or house type. CONCLUSIONS: Many Broken Hill homes have high levels of lead flux that pose a potential risk to young children. Quantification of this hazard provides useful information for the community that can help focus efforts on actions required to minimise lead dust in the home. IMPLICATIONS: Household dust is a potential source of lead for young children in at-risk communities. Information on lead flux in homes can assist these communities and public health agencies to better understand and deal more effectively with the problem.