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PubMed1989

Time preference for health in cost-effectiveness analysis.

In program evaluation, should a predicted health status gain of 1 quality-adjusted life year (QALY) occurring 10 years from now be valued the same as a 1-QALY increase realizable 5 years from now? Or 1 year from now? If not, how should these future gains (or losses) be evaluated from a present-time perspective? Such questions arise frequently in cost-effectiveness analyses of disease prevention-health promotion programs. This report argues there are actually two distinct interpretations of time preference jointly relevant in many multiperiod program evaluations. 1) In ongoing programs where both present and future population cohorts are, in effect, vying for resources, decision makers must establish a relative social weighting of cohorts by specifying (now) the dollar worth of any unit QALY gain achievable in each. This is a problem of intergenerational equity in the resource allocation process. 2) Individuals, in any cohort, may possess a time preference for the sequence of events comprising their own multiperiod health outcomes. Current models, typically discounting future health gains to present value at some constant rate (r), can well accommodate the first interpretation but not (simultaneously) the second. In response, this report introduces a two-step evaluation procedure featuring the "scenario strategy," a holistic multiattribute preference approach to evaluating multiperiod health outcomes. It allows one to isolate statistically time preference effects at the individual or group level and to incorporate them naturally into the overall evaluation of multiperiod outcomes. A survey-based example and an appendix illustrate the main points.

Attitude to Health↗
PubMed1988

Intergeneric rosettes: sequestered surface recognition among human periodontal bacteria.

The human oral bacteria, Streptococcus sanguis and Bacteroides loescheii, when mixed in equal numbers in vitro, formed large settling coaggregates. As the relative number of each cell type was changed, coaggregates became smaller until at cell-type ratios of 10 to 1, rosettes formed. Rosettes consisting of a streptococcal cell in the center surrounded by bacteroides cells exhibited surface recognition properties of only the bacteroides, which coaggregated with many other cell types such as Actinomyces naeslundii, and formed large settling multigeneric aggregates. The ecological significance of these results derives from the following: (i) the direct demonstration that intergeneric coaggregates can protect the central cell from or prevent its access to other cells in the environment, and (ii) the potential for these effects to occur during bacterial succession of various cell types observed in progressively more severe stages of human periodontal disease.

Bacterial Adhesion↗
PubMedDate not supplied

Improving intergenerational health care communication.

The relationship between health care providers and their older adult patients may suffer from miscommunication problems stemming from agist stereotyping. Stereotypes of older adults by younger adults may be revealed through patronizing speech--or elder-speak, which is the overaccommodation of speech interaction. Over- and underaccommodation strategies based on these stereotypes are often used by young health care providers when communicating with older adults. As the population ages and the demand for health care services increases, health care providers must improve their communicative effectiveness with their older patients. Attention to the individual needs of health care consumers, cognizance of age or role stereotyping, and proper training of health care providers would increase communicative effectiveness and enhance the patient-provider relationship.

Adult↗
PubMed2005

The lasting impact of childhood health and circumstance.

We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age-the years in which they themselves become parents.

Adult↗
PubMed1997

The status of ORT (oral rehydration therapy) in Bangladesh: how widely is it used?

During 1980-1990 BRAC, a Bangladeshi non-governmental organization, taught over 12 million mothers how to prepare oral rehydration therapy (ORT) at home with lobon (common salt) and gur (unrefined brown sugar). This was followed by a strong promotion and distribution of prepackaged ORS by various agencies including the government. In 1993 we assessed knowledge of ORT preparation, its local availability and its use for the management of diarrhoea. Over 9000 households in 90 villages were revisited; 306 government outreach health workers, 296 drug sellers, and 237 village doctors were interviewed; 152 government facilities and 495 pharmacies/shops were visited. ORT prepared by mothers in a sub-sample of the households was analyzed for chloride content and interviewers collected information on use of ORT for diarrhoeal episodes occurring in the preceding two weeks. The data quality was assessed through a resurvey of sample respondents within two weeks of the first interview. Over 70% of the mothers could prepare a chemically 'safe and effective' ORS. A significant proportion of these mothers were very young at the time of the mass campaigns using house to house teaching, implying an intergenerational transfer of the knowledge on ORT. ORT was found to be used in 60% of all diarrhoeal episodes, but the rate varied with the type of diarrhoea, being highest for daeria (severe watery diarrhoea) and lowest for amasha (dysentery). Drug sellers and village doctors now recommend ORT much more frequently than before. Members of the medical profession (qualified and unqualified) still lag behind in prescribing the use of ORT. The availability of pre-packaged ORS in rural pharmacies has improved enormously. There is convincing evidence that the widescale promotion in the past of ORS for dehydration in diarrhoea has led to this marked improvement today. Nevertheless the use of rice-based ORS, culturally appropriate messages and the promotion of ORS with food offer opportunities to further improve the utilization of ORT.

Adolescent↗
PubMed2006

Engaging youth in participatory research and evaluation.

Although participatory research has been applied by a wide range of disciplines, the engagement of youth as partners in research and evaluation efforts is relatively new. The positive youth development movement has influenced scholars and practitioners to include youth as partners in the design and implementation of research involving issues that affect their lives. Engaging youth in research and evaluation not only generates useful knowledge for communities and individuals but also provides opportunities for the development and empowerment of youth participants, leading to benefits for young people, organizations, the broader community, and the research process. However, there has been little systematic study to establish an evidence base for these effects. This article describes four projects that illustrate active youth participation in research. These examples demonstrate opportunities for positive youth development, create a context for intergenerational partnerships, and generate research findings to inform future interventions and organizational improvements, including community mobilization.

Adolescent↗
PubMed1987

Grandparents as interactive and social support agents for families with young infants.

The role of grandparents in infancy was examined in a comparative analysis of grandparent-infant grandchild and parent-infant interaction patterns. A second focus of the study was an exploration of the extent to which grandparents function as social support agents for their adult children and infant grandchildren. Grandparents (30 grandmothers and 21 grandfathers) and parents (30 mothers and 30 fathers) of seven-month-old infants were observed in individual five-minute dyadic play sessions with the infant in the parents' homes, yielding twenty minutes of agent-infant interaction. The observations were scored using both time-sampling and global coding schemes. Information on grandparental support to the young parents and infants, relative to other social support sources, were also obtained from grandparents and parents. Results indicated that both grandmothers and grandfathers are active interactive and support agents, with a pattern of similarities and differences in interactive style across generation and gender. Although there was a high degree of overlap in parent and grandparent interaction styles, parents were rated as more competent. Gender consistencies were found between female agents (mothers and grandmothers) and male agents (fathers and grandfathers). High levels of intergenerational contact were reported, with both parents and grandparents highly satisfied with the contact. The results of this study support an expanded view of the effects of various agents in young children's social environment.

Adult↗
PubMed2001

The adjustment of children of Australian Vietnam veterans: is there evidence for the transgenerational transmission of the effects of war-related trauma?

OBJECTIVE: The presence of posttraumatic stress disorder (PTSD) in trauma survivors has been linked with family dysfunction and symptoms in their children, including lower self-esteem, higher disorder rates and symptoms resembling those of the traumatized parent. This study aims to examine the phenomenon of intergenerational transfer of PTSD in an Australian context. METHOD: 50 children (aged 16-30) of 50 male Vietnam veterans, subgrouped according to their fathers' PTSD status, were compared with an age-matched group of 33 civilian peers. Participants completed questionnaires with measures of self-esteem, PTSD symptomatology and family functioning. RESULTS: Contrary to expectations, no significant differences were found between the self-esteem and PTSD symptomatology scores for any offspring groups. Unhealthy family functioning is the area in which the effect of the veteran's PTSD appears to manifest itself, particularly the inability of the family both to experience appropriate emotional responses and to solve problems effectively within and outside the family unit. CONCLUSION: Methodological refinements and further focus on the role of wives/mothers in buffering the impact of veterans' PTSD symptomatology on their children are indicated. Further effort to support families of Veterans with PTSD is also indicated.

Adaptation, Psychological↗
PubMed1997

Familial aggregation of leisure-time physical activity -- a three generation study.

Studies of parental influence on children's physical activity have had different results. Parental effect on physical activity during adolescence is less studied, and three generation studies have not been carried out. The purpose of our study was to examine intra- and intergenerational associations of leisure time physical activity among family members in three generations. Due to the major changes in society during this time, we also took into consideration the socioeconomic status of the adult subjects. The material consisted of 3254 twins at the age of 16, their parents and grandparents. Twins and their parents received a questionnaire in 1991-1993, which included questions about the health and lifestyle, socioeconomic status and leisure time physical activity. The parents' questionnaire also included questions about their own parents' leisure time physical activity and socioeconomic status. Based on these questions adolescents, parents and grandparents were classified into physical activity classes. The socioeconomic classification of parents and grandparents was based on their occupation. Intragenerational physical activity patterns were significantly associated with each other. Among adolescents the strongest correlation were between monozygotic boys (0.720) and monozygotic girls (0.638). Physical activity patterns were not associated between generations, but there was a significant difference between very active and inactive mothers concerning their daughters' physical activity. Farmers had the lowest proportion of very active subjects only among the parental generation. Because physical activity patterns do not appear to be transmitted from one generation to the next, it is probable that by constant training and education we can obtain the benefits of physical activity.

Adolescent↗
PubMed1998

Slipping through sky holes: Yurok body imagery in northern California.

Yurok perceptions of the body as the inscribed surface of social and environmental change are explored in this paper. To the violence and brutality of Spaniards, fur traders, gold miners, American soldiers, and Indian policies of the US government since the eighteenth century, Yurok women attribute the high incidence of degenerative diseases, drug abuse and criminality in northern California. This piece contemplates the lives of eight generations of sixteen Yurok extended families, mapping intergenerational shifts in Yurok social relations and political practices. It considers the mutation of knowledge in the constitution of the natural and social sciences and the effects of this knowledge when implemented in Yurok country. Here, Foucault's genealogical method values what anthropology and biomedicine, for example, tend to disregard in the analysis of descent: the correlation between body and history. This historico-critical investigation shows how certain events mark their power and engrave memories on individuals' bodies. It is within a hybrid set of cross-cultural and interdisciplinary practices that a more fruitful understanding of Yurok body imagery can be fashioned.

Body Image↗
PubMed2003

Transgenic mouse models for myotonic dystrophy type 1 (DM1).

The study of animal models for myotonic dystrophy type 1 (DM1) has helped us to 'de- and reconstruct' our ideas on how the highly variable multisystemic constellation of disease features can be caused by only one type of event, i.e., the expansion of a perfect (CTG)(n) repeat in the DM1 locus on 19q. Evidence is now accumulating that cell type, cell state and species dependent activities of the DNA replication/repair/recombination machinery contribute to the intergenerational and somatic behavior of the (CTG)(n) repeat at the DNA level. At the RNA level, a gain-of-function mechanism, with dominant toxic effects of (CUG)(n) repeat containing transcripts, probably has a central role in DM1 pathology. Parallel study of DM2, a closely related form of myotonic dystrophy, has revealed a similar mechanism, but also made clear that part of the attention should remain focused on a possible role for candidate loss-of-function genes from the DM1 locus itself (like DMWD, DMPK and SIX5) or elsewhere in the genome, to find explanations for clinical aspects that are unique to DM1. This review will focus on new insight regarding structure-function features of candidate genes involved in DM1 pathobiology, and on the mechanisms of expansion and disease pathology that have now partly been disclosed with the help of transgenic animal models.

Animals↗
PubMed1987

Issues in the study of the quality of the elderly mother-adult daughter relationship.

The quality of intergenerational relationships seems to be a relevant factor in assessing both the family's capacity to continue to provide care for elderly family members and the effectiveness with which it performs caregiving functions. The purpose of this paper is first, to raise several questions with regard to the quality of family ties to which we believe research should address itself. These include the implications of recent sociodemographic trends for quality, and the effects which variations in quality may have for various dimensions of the caregiving process. The literature and research on qualitative aspects of family relationships seems to suffer from basic conceptual and methodological limitations. Thus, this paper also aims at presenting a multidimensional conceptualization of quality which we believe is essential for identifying those specific aspects of relationships most significant in their impact on caregiving.

Adult↗
PubMedDate not supplied

Evaluation of an intergenerational program for pregnant and parenting adolescents.

PROBLEM: Poor life outcomes for teenage mothers SUBJECTS: Young mothers (N = 65) several years after the birth of their first child. Half had mothers (called grandmothers) who attended the Teenage Mothers-Grandmothers program. METHODS: A long-term evaluation study of the effects of the Teenage Mothers-Grandmothers Program on outcomes for the teens. Instruments used: demographic questionnaire, the Rosenberg Self-Esteem Scale, the Arizona Social Support Inventory Schedule, and an open-ended questionnaire. FINDINGS: Teens whose mothers participated in the program were significantly less likely to drop out of school and had significantly better self-esteem. CONCLUSIONS & IMPLICATIONS FOR NURSING: Including the mothers of pregnant and parenting adolescents in programs can be beneficial.

Adolescent↗
PubMed2003

Central and total obesity in middle aged men and women in relation to lifetime socioeconomic status: evidence from a national birth cohort.

STUDY OBJECTIVE: To investigate the influence of social class in childhood, young adulthood and middle age, and intergenerational mobility, on adult central and total obesity. DESIGN: Prospective, population based, birth cohort study. PARTICIPANTS AND SETTING: 1472 men and 1563 women born in 1946 in England, Scotland, and Wales. OUTCOME MEASURES: Waist-hip ratio, waist-height ratio, waist circumference, and body mass index at age 53 years. MAIN RESULTS: Father's social class at participant's age 4 years was inversely associated with adult central and total obesity at age 53 years in men and women. For example, the mean difference of waist-hip ratio (95% confidence intervals) between father's professional social class I and unskilled manual social class V was 2.6% (0.7 to 4.6) for men and 2.5% (0.5 to 4.4) for women. The effect of father's social class remained after adjustment for participant's own social class in young adulthood and middle age. Both adult social classes were inversely related to obesity among women, but not men, after adjustment for childhood circumstances. Upwardly mobile men and women were less obese than participants remaining in their father's social class and their levels of obesity tended to be between the class they left and the class they joined. CONCLUSIONS: The effect of social class on adult obesity differed according to the stage in the life course at which social class was measured, and gender. Childhood circumstances had enduring influences on adult obesity, although our results on intergenerational mobility indicate potential reversibility of early life disadvantage.

Anthropometry↗
PubMed1996

Genetic analysis of sex and generation differences in plasma lipid, lipoprotein, and apolipoprotein levels in adolescent twins and their parents.

In a sample of Dutch families consisting of parents aged 35-65 years and their twin offspring aged 14-21 years, a significant difference between generations was observed in phenotypic variances and in genetic heritabilities for plasma levels of total cholesterol, triglycerides, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, and apolipoproteins (apo) A1, A2, B, and E. For all traits parents were more variable than their offspring. This increase in phenotypic variance was best explained by a genetic model in which individual specific environmental variance increased with increasing age. Genetic variance was the same across generations for nearly all traits except triglycerides and apoE, for which a decrease in genetic variance was observed. This model led to large intergenerational differences in genetic heritabilities. Heritabilities for children were between 65 and 87%, while heritabilities for their parents were between 10 and 50%. No evidence was found for effects of a shared family environment.

Adolescent↗
PubMed1994

Immigrant skills and ethnic spillovers.

"This paper investigates the hypothesis that ethnicity has spillover effects on the human capital accumulation process. It extends previous research by documenting the extent to which the relative importance of parental inputs and ethnic spillovers in the intergenerational transmission of skills differs both within and across immigrant and U.S.-born ethnic groups. Using data drawn from the General Social Surveys, the study documents that the second and third generations (i.e., the children and grandchildren of immigrants) experience relatively more rapid economic advancement than do other generations, and that ethnic spillovers play a stronger role in households which are at the extremes of the skill distribution."

Americas↗
PubMed2006

Early maternal rejection affects the development of monoaminergic systems and adult abusive parenting in rhesus macaques (Macaca mulatta).

This study investigated the effects of early exposure to variable parenting style and infant abuse on cerebrospinal fluid (CSF) concentrations of monoamine metabolites and examined the role of monoaminergic function in the intergenerational transmission of infant abuse in rhesus monkeys (Macaca mulatta). Forty-three infants reared by their biological mothers and 15 infants that were cross-fostered at birth and reared by unrelated mothers were followed longitudinally through their first 3 years of life or longer. Approximately half of the infants were reared by abusive mothers and half by nonabusive controls. Abused infants did not differ from controls in CSF concentrations of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), or 3-methoxy-4-hydroxyphenylgycol (MHPG). Abused infants, however, were exposed to higher rates of maternal rejection, and highly rejected infants had lower CSF 5-HIAA and HVA than low-rejection infants. The abused females who became abusive mothers in adulthood had lower CSF 5-HIAA than the abused females who did not. A similar trend was also observed among the cross-fostered females, suggesting that low serotonergic function resulting from early exposure to high rates of maternal rejection plays a role in the intergenerational transmission of infant abuse.

Age Factors↗
PubMed2002

Inhibitory effect of a high-molecular-weight constituent of cranberry on adhesion of oral bacteria.

A high-molecular-weight nondialysable material (NDM) isolated from cranberry juice at a concentration of 0.6 to 2.5 mg/ml dissociated coaggregates formed by many intergeneric oral bacteria. A lower concentration of NDM was required to inhibit formation of such coaggregates. NDM acted preferentially on pairs of oral bacteria in which one or both members are Gram-negative anaerobes. The high-molecular-weight material from blueberry also inhibited the coaggregation, although its activity was weaker, whereas such materials obtained from other fruits were inactive. Saliva did not interfere with the ability of NDM to inhibit coaggregation. A preliminary clinical trial showed that NDM reduces S. mutans counts in saliva. The antiadhesion activity of cranberry juice has a potential for altering the oral microbial flora resulting in improved oral hygiene.

Bacterial Adhesion↗