The determinants of health: structure, context and agency

Abstract The concept of social structure is one of the main building blocks of the social sciences, but it lacks any precise technical definition within general sociological theory. This paper reviews the way in which the concept has been deployed within medical sociology, arguing that in recent times it has been used primarily as a frame for the sociological interpretation of health inequalities and their social determinants. It goes on to examine the contribution that medical sociologists have made to the debate over health inequalities, giving particular attention to contributions to Sociology of Health and Illness. These have often provided a focus for discussions outside or critical of the mainstream debates that have been driven primarily by epidemiologists. The paper reviews some of the main points of criticism of epidemiological approaches, focusing in particular on the methodological constraints that limit the capacity of epidemiologists to develop more theoretically satisfactory accounts of the inter‐relationships of social structure, context and agency in their impact on health and well being. Some recent examples from the Journal of more theoretically innovative and analytically fine‐grained approaches to understanding the impact of social structure on health are then explored. The paper concludes with an argument for a more historically‐informed analysis of the relationships between social structure and health, using the knowledgeable narratives of people in places as a window onto those relationships.     

Drinking context and alcohol’s harm from others among men and women in the 2010 US National Alcohol Survey

Background: Little is known about how drinking in different contexts is associated with harms from someone else’s drinking, including marital problems, financial problems, and assault. We examined how drinking in four different contexts was associated with alcohol’s harm from others (AHFO). Methods: We utilized the landline sample of the 2010 US National Alcohol Survey (n = 5885) to examine associations between drinking context and AHFO using weighted binary logistic regression. Results: For women, drinking when friends dropped over was positively associated with assault and financial troubles due to someone else’s drinking. Drinking when friends dropped over was negatively associated with assault for men. For men, drinking at a bar, party, or during a quiet evening at home were each significantly associated with more assault by someone who had been drinking. Bar drinking among women was significantly associated with more marital problems, whereas drinking at a party at someone else’s home was associated with significantly less marital problems. Conclusions: Context-specific drinking has differential associations with specific types of harms from someone else’s drinking for men and women. Additional research on drinking context, relationship to the harmer, and violence experienced by men and women is needed.     

Prokineticin 2/Bv8 is expressed in Kupffer cells in liver and is down regulated in human hepatocellular carcinoma

AIM： TO study the implication of prokineticin 1 （PKI/EGVEGF） and prokineticin 2 （PK2/13v8） in hepatocellular carcinoma angiogenesis.
METHODS： The gene induction of PK1/EG-VEGF and PK2/Bv8 was investigated in 10 normal, 28 fibrotic and 28 tumoral livers by using real time PCR. Their expression was compared to the expression of VEGF （an angiogenesis marker）, vWF （an endothelial cell marker） and to CD68 （a monocyte/macrophage marker）. Furthermore, the rnRNA levels of PK1/EG-VEGF, PK2/Bv8, prokineticin receptor 1 and 2 were evaluated by real time PCR in isolated liver cell populations. Finally, PK2/Bv8 protein was detected in normal liver paraffin sections and in isolated liver cells by immunohistochernistry and immunocytochemistry.
RESULTS： PK2/Bv8 mRNA but not PK1/EG-VEGF was expressed in all types of normal liver samples examined. In the context of liver tumor development, we reported that PK2/13v8 correlates only with CD68 and showed a significant decrease in expression as the pathology evolves towards cancer. Whereas, VEGF and vWF mRNA were significantly upregulated in both fibrosis and HCC,as expected. In addition, out of all isolated liver cells examined, only Kupffer cells （liver resident macrophages） express significant levels of PK2/Bv8 and its receptors, prokineticin receptor 1 and 2.
CONCLUSION： In normal liver PK2/Bv8 and its receptors were specifically expressed by Kupffer cells. PK2/Bv8 expression decreased as the liver evolves towards cancer and did not correlate with HCC angiogenesis.     

Contribution of the retrosplenial cortex to temporal discrimination learning

The retrosplenial cortex (RSC) has an important role in contextual learning and memory. While the majority of experiments have focused on the physical context, the present study asked whether the RSC is involved in processing the temporal context. Rats were trained in a temporal discrimination procedure where the duration of the intertrial interval (ITI) signaled whether or not the next tone conditioned stimulus would be paired with food pellet reinforcement. When the tone was presented after a 16‐min ITI it was reinforced, but when it was presented after a 4‐min ITI it was not. Rats demonstrated successful discrimination in this procedure by responding more to the tone on reinforced trials than on non‐reinforced trials. Pre‐training electrolytic lesions of the RSC attenuated acquisition of the temporal discrimination. The results are the first to demonstrate a role for the RSC in processing temporal information and in turn extend the role of the RSC beyond the physical context to now include the temporal context. © 2014 Wiley Periodicals, Inc.     

体育情境中的风险决策行为:前景理论的初步系统验证

以90名在校大学生作为被试,使用自编体育情境风险决策问卷,并通过E-prime系统呈现,初步系统验证了前景理论对于解释、预测体育情境中的风险决策行为的适用性,并检验了认知风格、成就动机、风险偏好等因素对体育情境决策制定的影响。结果表明:(1)在体育情境下人们同样存在着与理性决策系统的偏差,与前景理论的理论模型基本一致;(2)上述因素对体育情境中的风险决策行为具有部分影响。场依存型对于三种启发法的依赖明显高于场独立型;在收益和损失情境下的风险追求者表现出较高的追求成功的动机水平,且与风险回避者在该动机上存在显著差异;局外人和局内人的参与角度对于被试的行为抉择没有显著影响。对上述结果的理论与实践意义,以及今后研究的可能方向进行了讨论。     

Psychological well-being of the institutionalized and community-residing oldest old in China: The role of children

Studies have shown that institutionalized older adults have worse psychological health than their community-residing counterparts. However, much less is known about this association in developing countries such as China with a rapidly aging population and a short history of institutional care. This article investigates the role of children in differences in psychological well-being between institutionalized and community-residing oldest-old adults in China. Using national data from the 1998, 2000, and 2002 waves of the Chinese Longitudinal Healthy Longevity Survey, results show that the institutionalized have significantly better psychological health-measured by positive affect, loneliness, and quality of life-than those living in the community. Furthermore, we find that the associations are moderated by child-related factors (number of children, proximity, and visits) and strengthened for the three measures of psychological well-being after adjustments for socioeconomic factors, social support, health behaviors, and health status. The results underscore the importance of family dynamics for the psychological health of the institutionalized population in a historically family-care oriented society.     

Dorsolateral caudate nucleus differentiates cocaine from natural reward-associated contextual cues

Chronic drug administration induces neuroplastic changes within brain circuits regulating cognitive control and/or emotions. Following repeated pairings between drug intake and environmental cues, increased sensitivity to or salience of these contextual cues provoke conscious or unconscious craving and enhance susceptibility to relapse. To explore brain circuits participating in such experience-induced plasticity, we combined functional MRI with a preclinical drug vs. food self-administration (SA) withdrawal model. Specifically, two groups of rats were trained to associate odor cues with the availability of i.v. cocaine or oral sucrose, respectively. After 20 d of cocaine or sucrose SA followed by prolonged (30 d) forced abstinence, animals were presented with odor cues previously associated with or without (S+/S−) reinforcer (cocaine/sucrose) availability while undergoing functional MRI scans. ANOVA results demonstrate that a learning effect distinguishing S+ from S− was seen in the insula and nucleus accumbens, with the insula response reflecting the individual history of cocaine SA intake. A main effect of group, distinguishing cocaine from sucrose, was seen in the medial prefrontal cortex (infralimbic, prelimbic, and cingulate cortex) and dorsolateral striatum. Critically, only the dorsomedial striatum demonstrated a double dissociation between the two SA groups and learning (S+ vs. S−). These findings demonstrate altered cortico-limbic-striatal reward-related processing to learned, environment reward-associated contextual odor cues, which may serve as potential biomarkers for therapeutic interventions.     

Effect of hospital noise on patients' ability to hear,understand, and recall speech

Speech intelligibility and recall were examined in normally hearing and hearing‐impaired hospitalized patients. Fifty‐two participants completed testing in a sound‐attenuated booth. While listening to a recorded male speaker talking at conversational level, participants were asked to identify and remember the last (key) word in each of a series of five sentences presented in hospital noise with or without voices at three decibel levels (59, 64, and 69 dBA). Noise level and sentence context had the largest impact on key word identification (p < .001). Noise level had the largest impact on key word recall (p < .001). Type of hospital noise and hearing loss also significantly influenced performance on both measures. These findings have implications for healthcare providers communicating with hospitalized patients. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36:228–241, 2013