Dimensions of social inequality in the health of women in England: occupational, material and behavioural pathways

This paper examines the role of behavioural and psychosocial risk and protective factors in explaining social inequalities in the general self-assessed health of women. Using path analysis, data from the Health Survey for England (1993) are used to demonstrate how different dimensions of social position (working conditions, general social advantage and material deprivation) have distinct pathways to ill-health. Smoking, diet, alcohol consumption, exercise, social support and job strain were all related to poorer health, but not always in the predicted direction. The effects of social position on health were not fully mediated through these risk and protective factors. Each dimension of social position had unique pathways to ill-health via other unidentified mechanisms. Furthermore, the salience of the three dimensions of social position differed according to the level of labour market attachment. Different path models are required to fit the data for women at home or in full-time or part-time work.     

Unanswered questions prompted during pediatric primary care visits.

OBJECTIVES: To identify the frequency, types, and perceived importance of questions prompted during primary care visits for which pediatricians have no ready answer; to characterize pediatricians' responses to them; and to determine how questions prompted while caring for children with special health care needs (CSHCN) and children without special needs (Cw/oSN) differ. METHODS: Patient visits with 35 general pediatricians were observed. Parents completed a CSHCN screener. Physicians provided details about their unanswered questions and their pursuit of answers. RESULTS: Of 890 observed visits, 170 (19.1%) prompted unanswered questions, of which 60.1% were deemed important or very important. Physicians intended to pursue answers to 49.7% of the questions but actually pursued answers for only 27.5%, citing lack of time and inadequate information resources as barriers. One hundred sixty-seven (18.8%) visits were with CSHCN. Unanswered questions arose more often with CSHCN than with Cw/oSN (28.7% vs 16.9%; odds ratio 1.98; 95% confidence interval, 1.32-2.97), particularly during well visits (34.6% vs 14.9%; odds ratio 3.24; 95% confidence interval, 1.59-6.39). CSHCN prompted more diagnosis and treatment questions than Cw/oSN. Questions prompted by CSHCN were ranked as more important but were no more likely to be pursued than those prompted by Cw/oSN. CONCLUSIONS: Unanswered questions arise during nearly 20% of pediatric primary care visits. Visits with CSHCN, particularly well visits, generate more questions than those with Cw/oSN. Answers are pursued for few unanswered questions, both overall and for CSHCN. Potential strategies to overcome barriers to answering questions include scheduling more time or more visits for CSHCN.     

Health of farmers in southland: an overview.

AIM: To describe the health of farmers in Southland. METHODS: Coss-sectional study of a random sample of farmers in Southland. RESULTS: 586 individuals were interviewed from 286 farms with a response rate of 65.4%. The prevalence of at least one injury in the last twelve months which prevented normal farm work was 17.1%. Low back pain was common with 54.6% reporting such an episode in the last twelve months. Noise-induced hearing loss was prevalent among men with 28.7% of those 45 years and over being affected. Levels of asthma appeared low with a point prevalence of 6.8%, with 4.6% on medication.There were 19.3% of male farmers who were obese. The prevalence of alcohol use disorder among men aged 15-24 years was 57.4%, and 39.0% among farm workers. Similarly, 32.0% of men in this age-group smoked, with 35.6% of farm workers being smokers. CONCLUSIONS: Farmers experienced high levels of injury, low back pain and noise-induced hearing loss. Community intervention programmes to prevent injury remain a priority for farmers, although lifestyle factors should also be addressed, particularly among farm workers.     

Developing a social perspective in mental health services in primary care

The influence of Primary Care Trusts (PCTs) on the reorganisation of UK health and social care provision is already considerable. As well as challenging institutionalised processes of care, PCTs are encouraging innovation. This article reflects on a service pioneered by a small group of mental health social workers, which has been reconfigured within a new PCT, illuminated by examples of direct therapeutic work and service user feedback. In the new service, the practical application of a social perspective in mental health provision is demonstrated by eligibility criteria based on social context as well as psychological adversity. Possible developments arising from the prospective, multidisciplinary team membership and interface with secondary care are anticipated.     

Whole abdominal radiotherapy following second-look laparotomy for ovarian carcinoma.

AIM: The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated with primary surgery and chemotherapy, followed by second-look laparotomy (SLL). Overall survival and acute and late toxicity of treated patients were assessed. METHODS: Patients were recruited between April 1981 and June 1994. All patients had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosis, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, field size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute and late toxicity were recorded. RESULTS: Fifty-one patients were evaluated; the median age was 51 years. Median follow-up for patients still alive was 62 months. Prior to 1988, chemotherapy comprised oral chlorambucil, with or without cisplatin (n = 25), while after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22. 5 Gy over 22 fractions was planned to the whole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiotherapy was completed in 37 (73%) patients. Treatment interruptions were necessary in 12 (24%) patients. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment. Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparotomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean follow-up time for surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after primary surgery, smaller preirradiation tumor residuum, and completion of radiotherapy were independently associated with improved overall survival. CONCLUSION: In this poor-prognosis group of patients, a combined approach of surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival.     

Scales for the measurement of attitudes toward blood donation

Attitudes toward blood donation are frequently assumed to vary along a single dimension from unfavorable to favorable. In contrast, theories of attitude structure specify three distinct attitude components: affect, cognition, and behavior. This article describes the development of three new scales for the measurement of affective, cognitive, and behavioral components of attitudes toward blood donation. The scales were developed using the method of equal-appearing intervals and were administered to both donors of blood and nondonors. Correlations among the scales were relatively small and supported the three-component distinction. Affect was more strongly correlated with the number of prior donations than was cognition, which suggested an important role for emotional factors in blood donation. Scores on all three scales showed the attitudes of blood donors to be more favorable than those of nondonors.     

Familial hypercholesterolaemia: the Cape Town experience.

Familial hypercholesterolaemia (FH), an autosomal dominantly inherited disorder characterised by elevated plasma low-density lipoprotein (LDL) cholesterol levels, tendon xanthomata and premature ischaemic heart disease, is amenable to treatment with modern medication. The clinical and biochemical details of 1 031 patients with FH were analysed. FH is the most common monogenic disorder of lipoprotein metabolism presenting to the Lipid Clinic at Groote Schuur Hospital, accounting for about 20% of consultations. The hospital classified 55% of the FH patients as white, 43% as coloured, 1.5% as Asian and 0.5% as black. In the FH cohort (whose mean age at presentation was 44 years), 80% had tendon xanthomata, 36% had arcus cornealis, and 14% had xanthelasma. Tendon xanthomata was present in almost 90% of patients by the age of 50 years. Arcus cornealis was present in about 45% by the age of 40 years, further increasing in frequency with age. Cardiovascular complications included ischaemic heart disease (43%), stroke (1.5%), transient ischaemic attacks (1.3%), and peripheral vascular disease (3.7%). The mean age of death was 55 (+/-13) years; 51 ( +/-10) years in men and 61 ( +/-12) years in women. In 46% of the cohort, a defective gene was identified by testing for locally prevalent mutations.