No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Health as a Social Construct and a Lived Reality: Entangling Bodies in Health and Human Services
ResearchGate has not been able to resolve any citations for this publication.
Background
To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community.
Methods
Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman.
Results
Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016.
Conclusion
Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.
Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.
An increasing body of research suggests that young people living in Western societies are becoming increasingly individualistic in the way they orientate themselves socially, with further findings suggestive that such orientations may be associated with reduced wellbeing outcomes. Through a systematic review of past research, this paper examines the findings on individualism and the wellbeing of young people living within Western contexts. Findings from our review indicate that whilst individualistic cultures may be associated with higher wellbeing outcomes when compared with collectivistic cultures, such associations tend to disappear when explored at the personal level. Additionally, we find that distinguishing how individualism is measured provides important insight into specific traits associated with individualism that can lead to poorer wellbeing outcomes. Based on the studies reviewed, we propose that whilst the freedom and autonomy embedded within individualistic social orientations can have positive associations, there is an emerging understanding of some of the darker traits that can be associated with these values. These synthesized findings increase our understanding of the connection between individualism, its associated behaviours, and the mental health of young people.
Veteran homelessness is a public health crisis, especially among the disproportionate number of minority veterans in the homeless veteran population. African American homeless veterans in particular face unique challenges accessing appropriate health care services to meet their medical needs. Their needs are often underrepresented in the literature on veteran homelessness. Drawing together over 80 studies and government reports from the last two decades, this review provides a timely synopsis of homeless veterans’ health care access, with a particular focus on the barriers faced by African American veterans. This review employs Penchansky and Thomas’ Access Model to frame health access barriers faced by homeless veterans, dialing in on what is known about the experience of African American veterans, within the five dimensions of access: Availability, Accessibility, Accommodation, Affordability, and Acceptability. Actionable guidance and targeted interventions to address health access barriers for all veterans are delineated with a focus on the need to gather further data for African American homeless veterans and to consider tailoring interventions for this important and underserved group.
Objectives:
Socioeconomic disparities in life expectancy in the United States (US) are marked and have widened over time. However, there is limited research using individual-level socioeconomic variables as such information is generally lacking or unreliable in vital records used for life table construction. Using longitudinal cohort data, we computed life expectancy for US adults by social determinants such as education, income/poverty level, occupation, and housing tenure.
Methods:
We analyzed the 1997-2014 National Health Interview Survey prospectively linked to mortality records in the National Death Index (N=1,146,271). Standard life table methodologies were used to compute life expectancy and other life table functions at various ages according to socioeconomic variables stratified by sex and race/ethnicity.
Results:
Adults with at least a Master's degree had 14.7 years higher life expectancy at age 18 than those with less than a high school education and 8.3 years higher life expectancy than those with a high school education. Poverty was inversely related to life expectancy. Individuals living in poverty had 10.5 years lower life expectancy at age 18 than those with incomes ≥400% of the poverty threshold. Laborers and those employed in craft and repair occupations had, respectively, 10.9 years and 8.6 years lower life expectancy at age 18 than those with professional and managerial occupations. Male and female renters had, respectively, 4.0 years and 4.6 years lower life expectancy at age 18 than homeowners. Women in the most advantaged socioeconomic group outlived men in the most disadvantaged group by 23.5 years at age 18.
Conclusions and global health implications:
Marked socioeconomic gradients in US life expectancy were found across all sex and racial/ethnic groups. Adults with lower education, higher poverty levels, in manual occupations, and with rental housing had substantially lower life expectancy compared to their counterparts with higher socioeconomic position.
To conduct a systematic review and develop a conceptual framework on the mechanisms linking loneliness, social isolation, health outcomes and mortality. Electronic databases were systematically searched (PubMed, MEDLINE, Scopus and EMBASE) from inception to October 2018 followed by manual searching to identify research on loneliness, social isolation and mortality in adults published in the English language. Articles were assessed for quality and synthesised into a conceptual framework using meta-ethnographical approaches. A total of 122 articles were included. These collated observational designs examining mediators and moderations of the association in addition to qualitative studies exploring potential mechanisms were included. A framework incorporating 18 discrete factors implicated in the association between loneliness, social isolation and mortality was developed. Factors were categorised into societal or individual, and sub-categorised into biological, behavioural and psychological. These findings emphasise the complex multidirectional relationship between loneliness, social isolation and mortality. Our conceptual framework may allow development of more holistic interventions, targeting many of the interdependent factors that contribute to poor outcomes for lonely and socially isolated people.
Background:
During the past decades, life expectancy has continued to increase in most high-income countries. Previous research suggests that improvements in life expectancy have primarily been driven by advances at the upper end of the health distribution, while parts of the population have lagged behind. Using data from the entire Swedish population, this study aims to examine the life expectancy development among subgroups of individuals with a history of common diseases relative to that of the general population.
Methods:
The remaining life expectancy at age 65 was estimated for each year in 1998-2017 among individuals with a history of disease, and for the total Swedish population. We defined population subgroups as individuals with a history of myocardial infarction, ischemic or hemorrhagic stroke, hip fracture, or colon, breast, or lung cancer. We further distinguished between different educational levels and Charlson comorbidity index scores.
Results:
Life expectancy gains have been larger for men and women with a history of myocardial infarction, ischemic or hemorrhagic stroke, and colon or breast cancer than for the general population. The life expectancy gap between individuals with a history of hip fracture or lung cancer and the general population has, however, been growing. Education and comorbidity have affected mortality levels, but have not altered the rate of increase in life expectancy among individuals with disease history. The female advantage in life expectancy was less pronounced among individuals with disease history than among the general population.
Conclusions:
Life expectancy has increased faster in many subpopulations with a history of disease than in the general population, while still remaining at lower levels. Improvements in life expectancy have been observed regardless of comorbidity or educational level. These findings suggest that the rise in overall life expectancy reflects more than just improved survival among the healthy or the delayed onset of disease.
The purpose of this study is to understand the linkages between disaster and its impact on mental health. To fulfil this objective, an attempt has been made to examine the existing qualitative literature on disaster and mental health. In this paper, disaster and mental health as a concept has been used in a holistic sense. Based on the review of literature, the following broad themes have been identified: natural disaster and its impact on mental health, man-made disaster and its effect on mental health, effects of industrial disaster on mental health. It examines the post-disaster behavioural and psychological symptoms associated with an impairment in functioning. By this review, various protective factors, including resilience and other coping strategies which amplified the individual's capacity while encountering negative situations, have been identified. The effectiveness of post-disaster intervention techniques is also highlighted. Better preparedness and community empowerment can improve the condition of the vulnerable population affected by the disaster. Thus, efforts should be given for holistic rehabilitation of the affected population.
Objective:
To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes.
Data source and study design:
Data came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017.
Methods:
We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents.
Principal findings:
Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system CONCLUSIONS: Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.
Over the past decade, rising authoritarian regimes have begun to challenge the liberal international order. This challenge is particularly pronounced in the field of multilateral development finance, where China and its coalition partners from Brazil, Russia, India, and South Africa have created two new multilateral development banks. This article argues that China and its partners have used the New Development Bank and the Asian Infrastructure Investment Bank to increase their power and to restrict democratic control mechanisms. By comparing formal mechanisms of democratic control in both organizations to the World Bank, this article shows that civil society access, transparency, and accountability are lower at the AIIB and NDB than they are at the World Bank.
This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities.
In recent decades, there has been remarkable growth in scientific research examining the multiple ways in which racism can adversely affect health. This interest has been driven in part by the striking persistence of racial/ethnic inequities in health and the empirical evidence that indicates that socioeconomic factors alone do not account for racial/ethnic inequities in health. Racism is considered a fundamental cause of adverse health outcomes for racial/ethnic minorities and racial/ethnic inequities in health. This article provides an overview of the evidence linking the primary domains of racism - structural racism, cultural racism, and individual-level discrimination - to mental and physical health outcomes. For each mechanism, we describe key findings and identify priorities for future research. We also discuss evidence for interventions to reduce racism and describe research needed to advance knowledge in this area.
Harold Ellis, Sala Abdalla
Taylor & Francis, 10 Dec 2018 - 266 pages
Written in a personal and engaging style, this book provides a fascinating and informative introduction to the development of surgery through the ages. It describes the key advances in surgery through the ages, from primitive techniques such as trepanning, some of the gruesome but occasionally successful methods employed by the ancient civilisations, the increasingly sophisticated techniques of the Greeks and Romans, the advances of the Dark Ages and the Renaissance and on to the early pioneers of anaesthesia and antisepsis such as Morton, Lister and Pasteur. Fully illustrated in colour, this third edition of A History of Surgery is the only serious choice for a reader wanting a lively and informative single-volume introduction to surgical history.
The dependence on history of both present and future dynamics of life is a common intuition in biology and in humanities. Historicity will be understood in terms of changes of the space of possibilities (or of “phase space”) as well as by the role of diversity in life’s structural stability and of rare events in history formation. We hint to a rigorous analysis of “path dependence” in terms of invariants and invariance preserving transformations, as it may be found also in physics, while departing from the physico-mathematical analyses. The idea is that the (relative or historicized) invariant traces of the past under organismal or ecosystemic transformations contribute to the understanding (or the “theoretical determination”) of present and future states of affairs. This yields a peculiar form of unpredictability (or randomness) in biology, at the core of novelty formation: the changes of observables and pertinent parameters may depend also on past events. In particular, in relation to the properties of synchronic measurement in physics, the relevance of diachronic measurement in biology is highlighted. This analysis may a fortiori apply to cognitive and historical human dynamics, while allowing to investigate some general properties of historicity in biology.
Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people have achieved victories in obtaining equal rights in some countries, but most states deny these rights and actively discriminate against LGBTQ people. This research presents one of the first attempts to assess cross-nationally discrimination against LGBTQ people through a discrimination index comprised of three components: criminalization and punishment of homosexuality, rights denied to LGBTQ people, and the level of intolerance that LGBTQ people face. Spanning 175 countries, the index shows that most states have high levels of discrimination, which not only prevent LGBTQ people from attaining equal rights, but also threatens their well-being.
Objective: To investigate the impact of objective and subjective social isolation from extended family members and friends on depressive symptoms and psychological distress among a national sample of older adults. Method: Data for older adults (55 years and above) from the National Survey of American Life (N = 1,439) were used to assess level of objective social isolation and subjective social isolation and to test regression models examining their impact on depressive symptoms (Center for Epidemiologic Studies Depression [CES-D] Scale) and psychological distress (Kessler 6 [K6] Scale). Results: The majority of respondents were not socially isolated from family or friends; 5% were objectively isolated from family and friends, and less than 1% were subjectively isolated from family and friends. Regression analyses using both social isolation measures indicated that objective social isolation was unrelated to depressive symptoms and psychological distress. However, subjective social isolation from both family and friends and from friends only was associated with more depressive symptoms, and subjective social isolation from friends only was associated with higher levels of psychological distress. Discussion: Assessments of social isolation among older populations should account for both subjective and objective dimensions, as well as both family and friend social networks. Social isolation from friends is an important, but understudied, issue that has significant consequences for older adult mental health.
Purpose:
To investigate the association between social isolation and loneliness, how they relate to depression, and whether these associations are explained by genetic influences.
Methods:
We used data from the age-18 wave of the Environmental Risk Longitudinal Twin Study, a birth cohort of 1116 same-sex twin pairs born in England and Wales in 1994 and 1995. Participants reported on their levels of social isolation, loneliness and depressive symptoms. We conducted regression analyses to test the differential associations of isolation and loneliness with depression. Using the twin study design, we estimated the proportion of variance in each construct and their covariance that was accounted for by genetic and environmental factors.
Results:
Social isolation and loneliness were moderately correlated (r = 0.39), reflecting the separateness of these constructs, and both were associated with depression. When entered simultaneously in a regression analysis, loneliness was more robustly associated with depression. We observed similar degrees of genetic influence on social isolation (40 %) and loneliness (38 %), and a smaller genetic influence on depressive symptoms (29 %), with the remaining variance accounted for by the non-shared environment. Genetic correlations of 0.65 between isolation and loneliness and 0.63 between loneliness and depression indicated a strong role of genetic influences in the co-occurrence of these phenotypes.
Conclusions:
Socially isolated young adults do not necessarily experience loneliness. However, those who are lonely are often depressed, partly because the same genes influence loneliness and depression. Interventions should not only aim at increasing social connections but also focus on subjective feelings of loneliness.
Social context matters for health, healthcare processes/quality and patient outcomes. The social status and circumstances we are born into, grow up in and live under, are called social determinants of health; they drive our health, and how we access and experience care; they are the fundamental causes of disease outcomes. Such circumstances are influenced heavily by our location through neighborhood context, which relates to support networks. Geography can influence proximity to resources and is an important dimension of social determinants of health, which also encompass race/ethnicity, language, health literacy, gender identity, social capital, wealth and income. Beginning with an explanation of social determinants, we explore the use of Geospatial Analysis methods and geocoding, including the importance of collaborating with geography experts, the pitfalls of geocoding, and how geographic analysis can help us to understand patient populations within the context of Social Determinants of Health. We then explain mechanisms and methods of geospatial analysis with two examples: (1) Bayesian hierarchical regression with crossed random effects and (2) discontinuity regression i.e., change point analysis. We leveraged the local University of Utah and Yale cohorts of the Multicenter Perioperative Outcomes Group (MPOG.org), a perioperative electronic health registry; we enriched the Utah cohort with US-census tract level social determinants of health after geocoding patient addresses and extracting social determinants of health from the National Neighborhood Database (NaNDA). We explain how to investigate the impact of US-census tract level community deprivation indices and racial/ethnic composition on (1) individual clinicians’ administration of risk-adjusted perioperative antiemetic prophylaxis, (2) patients’ decisions to defer cataract surgery at the cusp of Medicare eligibility and finally (3) methods to further characterize patient populations at risk through publicly available datasets in the context of public transit access. Our examples are not rigorous analyses, and our preliminary inferences should not be taken at face value, but rather seen as illustration of geospatial analysis processes and methods. Our worked examples show the potential utility of geospatial analysis, and in particular the power of geocoding patient addresses to extract US-census level social determinants of health from publicly available databases to enrich electronic health registries for healthcare disparity research and targeted health system level countermeasures.
This resource shows that the social circumstances that spread addiction in a conquered tribe or a falling civilisation are also built into today's globalizing free-market society, and argues that the most effective response to a growing addiction problem is a social and political one, rather than an individual one.
Multiscale competency is a central phenomenon in biology: molecular networks, cells, tissues, and organisms all solve problems via behavior in various spaces (metabolic, physiological, anatomical, and the familiar 3D space of movement). These capabilities require being able to reach specific goal states despite perturbations and changes in their own parts and in the environment: effective teleonomy. Strong examples of the remarkable scaling of such goal states during teleonomic processes are seenacross development, regeneration, and cancer suppression. I illustrate examples of regulative morphogenesis of multicellular bodies as the teleonomic behavior of a collective intelligence composed of cells. This perspective helps to unify many phenomena across multiscale biology, and suggests a framework for understanding how teleonomic capacity increased and diversified during evolution. Thus, teleonomy is a lynchpin concept that helps address key open questions around evolvability, biologicalplasticity, and basal cognition, and is a powerful invariant that drives novel empirical research programs.
This paper aims to answer two important questions: first, does child mortality reduce with better access to sanitation and safe drinking water? second, does life expectancy improve by adopting safer sanitation and drinking water facilities? The study also accounts for other important variables in the models, such as household final consumption expenditure, per capita income, and urbanisation. The study employs robust panel econometric techniques to achieve the study objectives using annual data of 100 countries from 1990 to 2015. Our findings establish that sanitation and safe drinking water facilities have a significant negative and positive impacts on child mortality and life expectancy, respectively. Our results also suggest that the effect is more from safe drinking water facilities than the sanitation across both models. The robustness check results confirm that access to sanitation and water facilities in rural and urban areas also plays a vital role in reducing child mortality and improving quality of life by increasing life expectancy. Our study provides some policy suggestions and adds value to the body of knowledge.
Since the 1980s, globalization has reduced between-country inequality and increased within-country inequality in most countries. There has been a debate about whether global inequality, which combines both between- and within-country inequalities, increased or decreased. With more adequate and updated data over the past two decades, this debate has been settled. Global inequality unmistakably diminished in the age of globalization. Underlying this reduction in aggregate global inequality is the rise of China and India into the middle strata of the global income distribution, income stagnation of the working class in rich countries, and the expansion of internal inequality in poor and rich countries. This shift in global income distribution contributed to new geopolitical conflicts and political backlash against globalization in the developed world. This global distributive politics will in turn determine the future of globalization and shape the trajectory of global income inequality change.
Evidence from theories of Developmental Origins of Health and Disease (DOHaD) suggests that experiencing adverse early life conditions subsequently leads to detrimental adult health outcomes. The bulk of empirical DOHaD literature does not consider the nature and magnitude of the impact of adverse early life conditions at the population level. In particular, it ignores the distortion of age and cohort patterns of adult health and mortality and the increased load of chronic illness and disability that ensues. In this paper, we use a microsimulation model combined with empirical estimates of incidence and prevalence of obesity, type 2 diabetes, and associated disability in low- and middle-income countries to assess the magnitude of delayed effects on adult healthy life expectancy and on compression (or expansion) of morbidity at older ages. The main goal is to determine if, in what ways, and to what extent delayed effects due to early conditions can influence cohorts’ chronic illness and disability profiles.
We examine how the shift to remote work altered responsibilities for domestic labor among partnered couples and single parents. The study draws on data from a nationally representative survey of 2,200 US adults, including 478 partnered parents and 151 single parents, in April 2020. The closing of schools and child care centers significantly increased demands on working parents in the United States, and in many circumstances reinforced an unequal domestic division of labor.
Linking electronic health record (EHR) systems with community information systems (CIS) holds great promise for addressing inequities in social determinants of health (SDH). While EHRs are rich in location-specific data that allow us to uncover geographic inequities in health outcomes, CIS are rich in data that allow us to describe community-level characteristics relating to health. When meaningfully integrated, these data systems enable clinicians, researchers, and public health professionals to actively address the social etiologies of health disparities.
This article describes a process for exploring SDH by geocoding and integrating EHR data with a comprehensive CIS covering a large metropolitan area. Because the systems were initially designed for different purposes and had different teams of experts involved in their development, integrating them presents challenges that require multidisciplinary expertise in informatics, geography, public health, and medicine. We identify these challenges and the means of addressing them and discuss the significance of the project as a model for similar projects.
Background
Loneliness is significantly related to health and wellbeing. However, there is little information on the prevalence of loneliness among people with disability or the association between disability, loneliness and wellbeing.
Objective/Hypothesis
For a nationally representative sample of adults (age 16-64) with/without disability, to examine exposure to three indicators of low social connectedness (loneliness, low perceived social support, social isolation), and to evaluate the association between low social connectedness and wellbeing. To test whether disability status moderated the relationship between low social connectedness and wellbeing.
Methods
Secondary analysis of data from three annual rounds of the cross-sectional English Community Life Survey (CLS) 2016-19.
Results
People with disability experienced loneliness, low perceived social support and social isolation at significantly higher rates than people without disability. Effect sizes were significantly greater for loneliness. Disability was associated with lower wellbeing. With one exception, low social connectedness was associated with lower wellbeing. Again, effect sizes were significantly greater for loneliness. The prevalence of loneliness was highest among adults with disability who were younger, economically inactive, living in rented or other accommodation, living alone and with low levels of access to environmental assets. There was no evidence that disability status moderated the association between exposure to low social connectedness and low wellbeing.
Conclusions
Loneliness was a particularly significant driver of poor wellbeing among people with disability. The relative independence between different indicators of social connectedness suggests that interventions to reduce loneliness will need to do more than simply increase rates of social contact or social support.
Stress is often invoked as a potential contributor to disparities in physical health as a function of social status. Although there is good reason to believe that stress exposure and stress responses may be an important pathway linking lower social status to poor health, direct evidence is lacking. We summarize the evidence for this pathway and limitations of that evidence, focusing particularly on how stress is conceptualized and measured. We argue that in addition to more direct tests of mediation, the measurement of the mediator—stress—could also be improved. We also propose that measuring theory-specific stress exposures may be more fruitful than assessing general stress exposures (e.g., life events, global perceived stress) by increasing theoretical clarity and predictive utility of stress in this context.
Homelessness poses serious health risks, and those risks may be exacerbated among slum-dwelling youth in the developing world. We administered a cross-sectional survey to youth receiving services from a community organization in Kampala, Uganda. This secondary analysis explores the relationships between homelessness and various health outcomes. We also explored possible moderating relationships between neighborhood support, homelessness, and health. Logistic regression and t-tests were used to model these relationships. Homelessness was associated with all outcomes analyzed, with youth who reported having been homeless having higher odds of reporting poor health (odds ratio [OR] = 12.4; 95% confidence interval [CI] = 6.43, 23.92), higher odds of HIV infection (OR = 1.941; 95% CI = 1.274, 2.958), and higher odds of experiencing rape (OR = 3.459; 95% CI = 2.4, 4.987). No moderation by neighborhood support was observed, though this may be due to low variability. Homelessness warrants specific investigative attention due to its strong association with a broad range of negative health outcomes among slum-dwelling youth. Interventions targeting the specific health risks faced by homeless youth in the developing world may improve social welfare service delivery.
Liver metastases and peritoneal carcinomatosis are a particular focus of surgeons in improving survival in stage IV colorectal cancer patients, with laparotomy long being the means to undertake these operations. The Louisville statement published in 2008 was the first international consensus on indications for minimally invasive liver resection. Herein we review the progress in innovative surgical techniques, including minimally invasive liver resection, robot‐assisted hepatectomy, and we also describe initial reports in pressurized intraperitoneal aerosol chemotherapy.
This review integrates scientific knowledge obtained over the past few decades on the biological mechanisms that contribute to the profound association between exposure to early adversity, including childhood trauma and prenatal stress, and the lifelong elevated risk to develop a broad range of diseases. We further discuss insights into gene-environment interactions moderating the association between early adversity and disease manifestation and we discuss the role of epigenetic and other molecular processes in the biological embedding of early adversity. Based on these findings, we propose potential mechanisms that may contribute to the intergenerational transmission of risk related to early adversity from the mother to the fetus. Finally, we argue that basic research knowledge on the biological embedding of early adversity must now be translated into novel intervention strategies that are mechanism-driven and sensitive to developmental timing. Indeed, to date, there are no diagnostic biomarkers of risk or mechanism-informed interventions that we can offer to victims of early adversity in order to efficiently prevent or reverse adverse health outcomes. Such translational efforts can be expected to have significant impact on both clinical practice and the public health system, and will promote precision medicine in pediatrics and across the lifespan.
Background
There is increasing evidence of an association between social relationships and morbidity in general, and cardiovascular disease in particular. However, recent syntheses of the evidence raise two important questions: is it the perceived quality or the more objective quantity of relationships that matters most; and what are the implications of changes in relationships over time? In this study, we investigate the cumulative effects of loneliness and social isolation on incident cardiovascular disease.
Design
A secondary analysis of prospective follow-up data from the English Longitudinal Study of Ageing (ELSA).
Methods
To assess the association between social isolation or loneliness and incident cardiovascular disease, lagged values of exposure to loneliness and isolation were treated as time-varying variables in discrete time survival models controlling for potential confounders and established cardiovascular disease risk factors.
Results
A total of 5397 men and women aged over 50 years were followed up for new fatal and non-fatal diagnoses of heart disease and stroke between 2004 and 2010. Over a mean follow-up period of 5.4 years, 571 new cardiovascular events were recorded. We found that loneliness was associated with an increased risk of cardiovascular disease (odds ratio 1.27, 95% confidence interval 1.01–1.57). Social isolation, meanwhile, was not associated with disease incidence. There was no evidence of a cumulative effect over time of social relationships on cardiovascular disease risk.
Conclusions
Loneliness is associated with an increased risk of developing coronary heart disease and stroke, independently of traditional cardiovascular disease risk factors. Our findings suggest that primary prevention strategies targeting loneliness could help to prevent cardiovascular disease.
The history of biostatistics could be viewed as an ongoing dialectic between continuity and change. Although statistical methods are used in current clinical studies, there is still ambivalence towards its application when medical practitioners treat individual patients. This article illustrates this dialectic by highlighting selected historical episodes and methodological innovations - such as debates about inoculation and blood - letting, as well as how randomisation was introduced into clinical trial design. These historical episodes are a catalyst to consider assistance of non-practitioners of medicine such as statisticians and medical writers. © 2016, European Medical Writers Association. All rights reserved.
Methods, just as diseases or scientists, have their own history. It is important for scientists to be aware of the genesis of the methods they use and of the context in which they were developed.
A History of Epidemiologic Methods and Concepts is based on a collection of contributions which appeared in "SPM International Journal of Public Health", starting in January 2001. The contributions focus on the historical emergence of current epidemiological methods and their relative importance at different points in time, rather than on specific achievements of epidemiology in controlling plagues such as cholera, tuberculosis, malaria, typhoid fever, or lung cancer. The papers present the design of prospective and retrospective studies, and the concepts of bias, confounding, and interaction. The compilation of articles is complemented by an introduction and comments by Prof. Alfredo Morabia which puts them in the context of current epidemiological research.
Getting funding from the NIH for research is one of the most important skills required of all academic researchers, and here, Otto O. Yang offers a fully updated second edition to his straightforward, common-sense Guide to Effective Grant Writing. Yang shares his perspectives from both ends: as a pioneering researcher applying for funding as well as an NIH scientific consultant reviewing grants. He provides the reader with a step-by-step account on how to write a successful grant application, while highlighting common errors. This definitive guide to the NIH review process is a must for any pioneering researcher.
From the foreword:
The bane of academic existence is grant writing, now more than ever given new economic realities that change an already challenging landscape. Yet without grants most of us would not be able to continue to ply our trade. With this enormous importance of grants, it is surprising that we are so well trained to do research, with so little attention given to grant writing, which is the lifeblood of academic research.
Help became available with the first publication of this inspired book from Otto Yang MD, and now in its second edition it becomes even more invaluable. The book will be of great help to anyone writing a grant, even those of us who are more seasoned grant writers. The new edition is organized in similar fashion to the newly modified official NIH grant, readily helping the reader to navigate an entirely new terrain. Moreover, it outlines in very readable fashion specific suggestions for convincing study sections that the ideas being presented are worthy of funding, turning the reviewer into an advocate for the project being proposed. It also points out common errors that make reviewers lose enthusiasm even when the experiments are highly worthy of funding. Frequent use of examples makes the points very clear, and the clear style makes the book an enjoyable read.
- Bruce D. Walker, Professor of Medicine and Director of the Partner’s AIDS Research Center at Harvard Medical School; Boston Massachusetts
Former Chairman of an NIAID/NIH study section
The advent of modern antibiotics contributed enormously to the dramatic extension of human lifespan since their discovery by virtue of their lethal and selective action against pathogenic microbes. And yet despite our powerful arsenal of weapons against these pathogens, the war against them has not been won. And it may never be. Drug resistance is still menacing the society with many lives being lost due to deadly infections caused by continuously evolving strains spread beyond our means to eradicate them or prevent their spreading. Herein, the emergence and evolution of antibiotics is briefly reviewed, and a select number of total syntheses of naturally occurring antibiotics from the authors’ laboratories are highlighted. The article concludes with a strong endorsement of the current efforts to intensify our fight against these dangerous pathogens with the hope that, this time, these initiatives will be sufficiently focused and serious enough so as to achieve our set goals of, at least, being prepared and ahead of them as part of our drive to improve humanity’s healthcare and wellbeing.
Between 1800 and 2000 life expectancy at birth rose from about 30 years to a global average of 67 years, and to more than 75 years in favored countries. This dramatic change was called a health transition, characterized by a transition both in how long people expected to live, and how they expected to die. Rising Life Expectancy examines the way humans reduced risks to their survival, both regionally and globally, to promote world population growth and population aging.
Aim:
There is a knowledge gap about the disability-free life expectancy (DFLE) in low- and middle-income countries. The present study aimed to compute and compare DFLE in six such countries, and examine sex differences in DFLE in each country.
Methods:
Based on data from the World Health Organization Study on Global Aging and Adult Health wave 1 survey, we used the Sullivan method to estimate DFLE among persons aged years 50 years and older. Disability was divided into moderate disability and severe disability during the calculation.
Results:
Of the six countries, China had the highest DFLE and lowest expected average lifetime with disability. India had the lowest DFLE and highest life years with moderate and severe disability. In each country, women live longer than men, but with more disabilities in both absolute and proportional terms. The huge sex difference in Russia requires special attention. In addition, most of the life expectancy lived with disability was spent with severe disability, rather than moderate disability.
Conclusions:
The study has shed some light on the disparities across the six countries with regard to DFLE at old ages. The low percentage of DFLE in life expectancy in some countries, such as India, calls for effective policies on healthy aging. The "sex disability-survival paradox" in DFLE is supported by our results. To differentiate the severity of disability should be routine in calculating DFLE. Geriatr Gerontol Int 2016; ••: ••-••.
Evidence that social and biological processes are intertwined in producing health and human behavior is rapidly accumulating. Using a feminist approach, this research explores how gender moderates the interaction between biological processes and men’s and women’s behavioral and emotional responses to similar social environments. Using data from the Collaborative Study on the Genetics of Alcoholism, the influence of gender, social integration, and genetic risk on nicotine and alcoholdependence is examined.Three-way interaction models reveal gender-specific moderation of interactions between genetic risk score and social integration.Namely, being currently married and reporting positive social psychological integration are predictive of reduced risk of nicotine dependence among men with genetic susceptibility to strong nicotine cravings in the presence of social cues like stress. In contrast, the protective effects of marital status and social integration are substantially attenuated and absent, respectively, among womenwith high-risk genotypes. This pattern reflects the dualism i.e., simultaneous costs and benefits inherent in social integration for women, which may disproportionately affect those with a genetic sensitivity to stress. These findings contest the notion of genotype as static biological hardwiring that is independent from social and cultural systems of gender difference.
We argue that prominent macro-quantitative studies in economics, medicine and public health, and political science fail to test for the effect of improved sanitation, on countries’ average life expectancy scores. Our study adds sanitation to a basic model focusing on income and democracy as central explanatory factors. We use a cross-sectional design and ordinary least squares (OLS) regression with the most recent data, i.e., 2012 or the latest available numbers, and work with the Economist Intelligence Unit 2012 democracy data. All other data are derived from the CIA World Factbook. Including sanitation in a cross-sectional model with recent country-level data and controlling for income and democracy increases the explained variance by as much as 11% points. This work identifies sanitation as a crucial variable omitted from existing work on life expectancy. Future studies should aim at the effects of additional public goods apart from sanitation and work with panel data.