Which is the best deprivation predictor of foetal and infant mortality rates?

This study investigates which, if any, population-based indicator of deprivation best predicts foetal and infant mortality rates in England. For the year 1995, the deprivation levels of 364 English Local Authorities were compared; using the three commonly used indicators, Jarman score, Townsend score and percentage unemployed. The predictive value of these for stillbirth, neonatal and infant mortality rates was then calculated. The three deprivation indicators were highly inter-correlated (r=0.866-0.924). For each mortality rate, the correlation with deprivation did not differ significantly for the three indicators of deprivation. We conclude, when comparing these outcomes in different areas of England, that any of the three deprivation indicators may be used to adjust for deprivation.     

How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions

Purpose  

To assess and compare content, validity, and specificity of the QuickDASH (Disability of the arm, shoulder and hand questionnaire) as compared to the full-length DASH and other instruments to give a recommendation for its use depending on a specific clinical situation.     

How does the social environment 'get into the mind'? Epigenetics at the intersection of social and psychiatric epidemiology

The social environment plays a considerable role in determining major psychiatric disorders. Emerging evidence suggests that features of the social environment modify gene expression independently of the primary DNA sequence through epigenetic processes. Accordingly, dysfunction of epigenetic mechanisms offers a plausible mechanism by which an adverse social environment gets “into the mind” and results in poor mental health. The purpose of this review is to provide an overview of the studies suggesting that epigenetic changes introduced by the social environment then manifest as psychological consequences. Our goal is to build a platform to discuss the ways in which future epidemiologic studies may benefit from including epigenetic measures. We focus on schizophrenia, major depressive disorder, post-traumatic stress disorder, anorexia nervosa, and substance dependence as examples that highlight the ways in which social environmental exposures, mediated through epigenetic processes, affect mental health.     

Within prisons,is there an association between the quantity of prenatal care and infant birthweight?

There is still controversy surrounding the effectiveness of prenatal care in reducing low birthweight. In addition, very few studies have assessed the relationship between prenatal care and infant birthweight among pregnant women within the prison system. We sought to ascertain whether there is an association between the quantity of prenatal care and infant birthweight among pregnant women within such a setting. We examined the prison medical records of 147 infants born to women delivering at term (37-41 weeks of gestation) between 1 January 2002 and 31 December 2004 who were incarcerated during pregnancy in Texas state prisons. Linear regression was used to evaluate the association between the number of prison prenatal care visits and infant birthweight while adjusting for potential confounders (age, gravidity, maternal education, maternal race, history of substance use, history of alcohol use, history of tobacco use and the presence of any chronic disease). We also adjusted for the interaction between the gestational age at admission to prison and the number of prison prenatal care visits. There was a statistically significant 120.5 g increase in adjusted mean birthweight with each additional prison prenatal care visit (P = 0.001) among study infants whose mothers entered prison during the first trimester. This trend was not observed among women who came in after the first trimester. There appears to be a positive association between the amount of prison prenatal care and infant birthweight among incarcerated pregnant women delivering at term, but this association appears to be limited to women entering prison during the first trimester of pregnancy.     

Parents and nurses during the immunization of children--where is the power? A conversation analysis

Background. Best practice for health care practitioners is consideredpatient-centred approaches which empower patients. Immunizationof young children requires maintaining this approach while retainingprofessional management. Objective. The objectives were to assess situations within theimmunization event with discordance between health providerand caregiver and evaluate strategies used to empowering parentswhile obtaining the desired clinical outcome. Methods. This was a qualitative study nested within a largerstudy of immunization rates in 124 randomly selected primarycare practices. Interactions between immunizing practice nurses,caregivers and children were videotaped and transcribed andunderwent conversation analysis. Six purposively sampled primarycare practices in Auckland, New Zealand, served as the setting.The participants were eight practice nurses immunizing 10 childrenand their parents. Normative pattern of interactions and ‘deviantcases’ involving discordance between nurse and parent. Results. A total of 168 minutes of video-recorded conversationfrom 10 immunization sessions provided strong ‘typical’pattern and equally striking ‘deviant cases’. Parentsmostly treated nurses as ‘experts’ and acceptedasymmetry of knowledge over medical matters. Nurses demonstratedskilful strategies in delineating their area of medical expertisefrom areas in which patients are expert—their knowledgeof themselves and their children. Conclusion. While patient centredness and empowering patientsare contemporary goals of primary health care delivery, theseattributes are not precisely defined. Patients may wish to beinformed, but many trust their health professionals to directtheir decision making. Although health professionals may impartas much knowledge as they can, asymmetry of knowledge remains.However, patients hold expertise beyond their clinical situationin the social and economic world in which they live. Keywords. Caregivers, immunization, power, primary health care, qualitative research.     

Does socioeconomic status affect the association of social relationships and health? A moderator analysis

Background  

Social relations have repeatedly been found to be an important determinant of health. However, it is unclear whether the association between social relations and health is consistent throughout different status groups. It is likely that health effects of social relations vary in different status groups, as stated in the hypothesis of differential vulnerability. In this analysis we explore whether socioeconomic status (SES) moderates the association between social relations and health.     

How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence

This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them.     

How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence

This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them.     

A priori and a posteriori dietary patterns at the age of 1 year and body composition at the age of 6 years: the Generation R Study

Dietary patterns have been linked to obesity in adults, however, not much is known about this association in early childhood. We examined associations of different types of dietary patterns in 1-year-old children with body composition at school age in 2026 children participating in a population-based cohort study. Dietary intake at the age of 1 year was assessed with a food-frequency questionnaire. At the children’s age of 6 years we measured their body composition with dual-energy X-ray absorptiometry and we calculated body mass index, fat mass index (FMI), and fat-free mass index (FFMI). Three dietary pattern approaches were used: (1) An a priori-defined diet quality score; (2) dietary patterns based on variation in food intake, derived from principal-component-analysis (PCA); and (3) dietary patterns based on variations in FMI and FFMI, derived with reduced-rank-regression (RRR). Both the a priori-defined diet score and a ‘Health-conscious’ PCA-pattern were characterized by a high intake of fruit, vegetables, grains, and vegetable oils, and, after adjustment for confounders, children with higher adherence to these patterns had a higher FFMI at 6 years [0.19 SD (95 % CI 0.08;0.30) per SD increase in diet score], but had no different FMI. One of the two RRR-patterns was also positively associated with FFMI and was characterized by intake of whole grains, pasta and rice, and vegetable oils. Our results suggest that different a priori- and a posteriori-derived health-conscious dietary patterns in early childhood are associated with a higher fat-free mass, but not with fat mass, in later childhood.     

What is the risk of noise-induced hearing loss at 80, 85, 90 dB(A) and above?

Regulations regarding risk from exposure to noise at work entail action at levels of 85 dB(A) and above. At 80 dB(A) there is no material risk in the vast majority of individuals. At 85 dB(A) there is a marginal risk with susceptible individuals accruing a significant hearing impairment from a lifetime of exposure. At 90 dB(A) and above the risk becomes material, with the majority of individuals accruing a significant hearing impairment.     

Does the effect of PM10 on mortality depend on PM nickel and vanadium content? A reanalysis of the NMMAPS data

BACKGROUND: Lack of knowledge regarding particulate matter (PM) characteristics associated with toxicity is a crucial research gap. Short-term effects of PM can vary by location, possibly reflecting regional differences in mixtures. A report by Lippmann et al. [Lippmann et al., Environ Health Perspect 114:1662-1669 (2006)] analyzed mortality effect estimates from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) for 1987-1994. They found that average concentrations of nickel or vanadium in PM2.5 (PM with aerodynamic diameter < 2.5 microm) positively modified the lag-1 day association between PM10 and all-cause mortality. OBJECTIVE: We reestimated the relationship between county-specific lag-1 PM10 (PM with aerodynamic diameter < 10 microm) effects on mortality and county-specific nickel or vanadium PM2.5 average concentrations using 1987-2000 effect estimates. We explored whether such modification is sensitive to outliers. METHODS: We estimated long-term average county-level nickel and vanadium PM2.5 concentrations for 2000-2005 for 72 U.S. counties representing 69 communities. We fitted Bayesian hierarchical regression models to investigate whether county-specific short-term effects of PM10 on mortality are modified by long-term county-specific nickel or vanadium PM2.5 concentrations. We conducted sensitivity analyses by excluding individual communities and considering log-transformed data. RESULTS: Our results were consistent with those of Lippmann et al. However, we found that when counties included in the NMMAPS New York community were excluded from the sensitivity analysis, the evidence of effect modification of nickel or vanadium on the short-term effects of PM10 mortality was much weaker and no longer statistically significant. CONCLUSIONS: Our analysis does not contradict the hypothesis that nickel or vanadium may increase the risk of PM to human health, but it highlights the sensitivity of findings to particularly influential observations.     

A look at the educational preparation of the health-diagnosing and treating professions: do dietitians measure up?

Basic educational requirements for dietitians were developed almost 80 years ago and remain largely unchanged. In the interim, other health professions have increased their academic standards. A review of the educational preparation of 16 health-diagnosing and treating professions was undertaken to better understand the standards for dietetics education within a larger context. Educational standards for each profession were obtained and reviewed for types of degrees; duration of post-secondary, college-level education; division of didactic and clinical education; and presence of accredited post-professional education. Findings reveal that at least 11 of the professions studied offer first professional degrees. Differences were noted in duration and sequencing of undergraduate education, didactic or classroom education, and especially supervised practice. Models to facilitate comparison between educational standards were developed. The current educational model in dietetics is designed to prepare entry-level practitioners and academics who comprise less than 20% of the profession. This review supports the need to investigate educational opportunities for beyond-entry-level dietitians, and to develop educational programs that amplify the existing models for educating dietitians.     

Psychological workload and body weight: is there an association? A review of the literature

BACKGROUND: According to Karasek's Demand/Control Model, workload can be conceptualized as job strain, a combination of psychological job demands and control in the job. High job strain may result from high job demands combined with low job control. Aim To give an overview of the literature on the association between obesity and psychological workload. METHOD: We carried out a review of the associations between psychological workload and body weight in men and women. In total, 10 cross-sectional studies were identified. RESULTS: The review showed little evidence of a general association between psychological workload and body mass index. Only weak positive associations were found, and only between elements of psychological workload and overall body weight. For body fat distribution, two out of three studies showed a positive association in men, but the associations became insignificant after adjustment for education. For women, there was no evidence of a consistent association. CONCLUSION: The reviewed articles were not supportive of any associations between psychological workload and either general or abdominal obesity. Future epidemiological studies in this field should be prospective or experimental, and should examine how chronic work stress affects eating and to what extent initial body weight is a predictor for individual differences in perceived psychological workload.