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Social capital, the miniaturisation of community and consumption of homemade liquor and smuggled liquor during the past year. A population-based study.

BACKGROUND: To study the impact of social participation, trust and the miniaturisation of community, i.e. high social participation/low trust, on consumption of homemade liquor and smuggled liquor during the past year. METHODS: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13,604 persons aged 18-80 years were included. A logistic regression model was used to investigate the association between the social capital variables and illegal alcohol consumption. The multivariate analyses analysed the importance of confounders (age, country of origin, education and economic stress) on the differences in consumption of homemade and smuggled liquor according to the social capital variables. RESULTS: A 28.2% proportion of all men and 14.9% of all women had consumed homemade liquor during the past year. The proportions who had consumed smuggled liquor during the past year were even higher, 40.1% among men and 21.4% among women. Both forms of illegal alcohol consumption were significantly positively associated with social participation and negatively associated with trust. The miniaturisation of community category, i.e. high social participation/low trust, had significantly higher risks of consumption during the past year of the consumption of both forms of illegally provided alcohol compared to the high social capital (high social participation/high trust) category, while the low social participation/high trust category had significantly lower risks. CONCLUSION: High social participation combined with low trust is positively associated with consumption of illegally provided alcohol. The results have implications for alcohol prevention programs, because structural/social factors that may hinder information and norms concerning illegal alcohol have been identified in this study.

Adolescent↗

Social participation and health in a community rich in stock of social capital.

In Finland, members of the Swedish-speaking minority, many of whom live in the province of Ostrobothnia, intermingle with the Finnish-speaking majority. Although the two language communities are quite similar to each other in most societal respects, including socioeconomic status, education and use of health services, significant disparities have been reported in the morbidity, disability and mortality between the Swedish-speaking minority and the Finnish-speaking majority. Since the population genetic, ecological and socioeconomic circumstances are equal, Swedish speakers' longer active life is difficult to explain by conventional health-related risk factors. A great deal of health inequality (between the language groups) seems to derive from uneven distribution of social capital, i.e. the Swedish-speaking community holds a higher amount of social capital that is associated with their well-being and health. Factor analysis revealed four patterns of social capital measures, i.e. voluntary associational activity, friendship network, religious involvement and hobby club activity, of which associational activity, friendship network and religious involvement were significantly associated with good self-rated health. Also, trustful friendship network, hobby club activity and religious involvement as well as avoidance of intoxication-prone drinking behavior were significantly more frequent among the individuals of the Swedish-speaking community. We suggest that health promotion should seek ways of working which would encourage social participation.

Adolescent↗

Health by association? Social capital, social theory, and the political economy of public health.

Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.

Health Promotion↗

Capital necrosis, metaphyseal cyst and subluxation in coxa plana.

Three specific elements associated with a poor prognosis in Legg-Calvé-Perthes disease, i.e., capital necrosis, metaphyseal cyst and subluxation, have been selected for study to determine the effect of each on the end result. A retrospective analysis was made of 337 children who received non-weight-bearing treatment. Half of the patients were treated in abduction splints, over a third with bed rest and traction and the remainder with a variety of routines including sling and crutches, wheelchair or bed rest alone. The group was treated as representing a common pool of therapy and was analyzed statistically in this overall manner. End results were graded by the Knud Mose method (concentric circle matching plus epiphyseal quotient determinations). Good and fair results were combined into an acceptable category while the poor results were considered unacceptable. Femoral capital necrosis was present either segmentally or totally. A classification was devised of three grades of partial epiphyseal involvement and one of total necrosis. The patients with total necorsis (Group IV) had a higher percentage of poor results than those with segmental involvement (Groups I, II and III). The lowest percentage of poor results correlated with the least involvement of the femoral head (Group III). Total head involvement occurred in the unacceptable group one and one half times as frequently as it did in the acceptable group. Metaphyseal cyst formation exhibited a close relationship to the fragmentation of the capital epiphysis. It is suggested that the metaphyseal lesion itself is part of the overall necrotic process and that the "cyst" is resorption associated with revascularization as healing is taking place. We noted twice the frequency of metaphyseal cysts in patients with poor results in comparison to that found in the acceptable group. Subluxation is defined as loss of acetabular centration of the femoral head due to upward and outward displacement. Increased distance between the medial margin of the metaphysis and the lateral limb of the "tear drop" figure is practically a universal finding on early roentgenograms and was not considered "subluxation" in this prognostic evluation. In the series under study there were three times as many subluxations in the poor result group as in the group with acceptable results. A prognostic profile revealing three of the above-listed features was associated with a poor result and should constitute an objective basis of evaluation of new forms of therapy.

Bone Cysts↗

Percutaneous in situ fixation of slipped capital femoral epiphysis using two threaded Steinmann pins.

Twenty-six patients with 34 slipped capital femoral epiphyses were treated by percutaneous in situ pinning with two 5/32-inch threaded Steinmann pins. Twenty-three patients with 31 hips were followed-up until the time of epiphyseal closure and pin removal. The average time to closure was 8.5 months (range, 3-25). The average operative time for pinning was 53 min (range, 18-115). The average operative time for pin removal was 42 min (range, 12-132). Complications included two progressive slips, two poorly placed pins, one pin breakage during removal, and one case of capital necrosis. This technique is a quick, efficient means of stabilizing the slipped capital femoral epiphysis, with case of hardware removal.

Adolescent↗

Salter-Harris type II fractures of the capital femoral epiphysis.

Salter-Harris type II fractures of the capital femoral epiphysis have not been previously documented. The authors have treated three patients who sustained four such fractures. One child had a recurrent fracture two years after the first had healed satisfactorily. Two fractures were treated by spica cast immobilization, one fracture by closed reduction and internal fixation, and the other fracture healed without treatment. No patient developed avascular necrosis or other complications. Two of the children had an association with idiopathic slipped capital femoral epiphysis. An etiologic relationship with slipped capital femoral epiphysis, if any, is uncertain.

Adolescent↗

Reinvesting in social justice: a capital idea for public health nursing?

Social justice is a core ethical principle of public health nursing; yet, nurses' work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.

Ethics, Nursing↗

Valuable human capital: the aging health care worker.

With the workforce growing older and the supply of younger workers diminishing, it is critical for health care managers to understand the factors necessary to capitalize on their vintage employees. Retaining this segment of the workforce has a multitude of benefits including the preservation of valuable intellectual capital, which is necessary to ensure that health care organizations maintain their competitive advantage in the consumer-driven market. Retaining the aging employee is possible if health care managers learn the motivators and training differences associated with this category of the workforce. These employees should be considered a valuable resource of human capital because without their extensive expertise, intense loyalty and work ethic, and superior customer service skills, health care organizations could suffer severe economic repercussions in the near future.

Adult↗

Percutaneous osteotomy for deformity correction in adolescents with severe slipped capital femoral epiphysis.

Various methods of performing proximal femoral realignment in adolescents with severe slipped capital femoral epiphysis exist. We report the technique and early results of a percutaneous, opening wedge subtrochanteric femoral osteotomy using an external fixator for correcting multiplanar deformities in such patients. Nine adolescents with severe slipped capital femoral epiphysis underwent a percutaneous osteotomy at an average age of 14.5 years. Mean operative blood loss was 61 ml, with 2 days of inpatient stay and 129 days of external fixation time. At an average follow-up of 23 months, hip flexion improved from 74 to 106 degrees, internal rotation from -5 to +17 degrees, external rotation from 71 to 41 degrees and abduction from 29 to 36 degrees. Radiographs revealed an improvement in anteroposterior head shaft angle from 112 to 134 degrees and lateral head shaft angle from 72 to 15 degrees. One patient had transient chondrolysis. No fixation-related problems, deep infection, avascular necrosis or refracture occurred. On the basis of our preliminary results, this percutaneous technique offers several advantages over currently available methods for surgical correction of severe slipped capital femoral epiphysis deformities.

Adolescent↗

Investing in healthy human capital.

Although the value of human capital is not captured on company balance sheets, it may account for about half of the gap between a company's market value and book value. Yet, many companies do not focus comparable scrutiny on human capital management as compared with other large assets, nor do they systematically measure its output (ie, productivity). Methods are emerging to enable employers to assess productivity losses, including absenteeism and presenteeism, and to understand the associated costs (ie, direct medical costs, total productivity loss). This will permit employers to assess the value of programs to enhance health and productivity. We contend that the effective workforce is probably decreased by 5% to 10% because of health problems. We believe that employers who increase their investments in healthy human capital now will emerge tomorrow as the companies leading the gains in US productivity.

Efficiency, Organizational↗

Electroconvulsive therapy in Belgium: a questionnaire study on the practice of electroconvulsive therapy in Flanders and the Brussels Capital region.

OBJECTIVES: We sought to review and describe the practice of electroconvulsive therapy (ECT) in Flanders and the Brussels Capital region, Belgium, in 2003. METHODS: A 30-item questionnaire was sent to all institutions that provided psychiatric care. Besides questions on training and general attitude toward ECT, most questions concerned technical aspects, quality, and organization of this treatment modality. RESULTS: All psychiatric departments offering ECT and 58% of the hospitals that do not conduct ECT replied to the questionnaire. Forty-three percent of the departments offering ECT indicated less than 10 treatment sessions per month. Forty-three percent of hospitals set a fixed number of treatments per course. Maintenance ECT and ECT on an outpatient basis were rather rare, except for a few departments. The major indication for ECT was depression (88%) rather than schizophrenia (8%), mania (3%), or other psychiatric disorders (1%). Propofol was the anesthetic most commonly used (74%). Seven departments (30%) used a sine wave device. Bilateral electrode placement was the preferred option in 91% of all departments and both fixed high dose and dose titration strategy were used equally (both 47.8%). CONCLUSION: The present findings demonstrate that the practice of ECT in Flanders and the Brussels Capital region in 2003 generally was not performed according to the available guidelines. ECT is underused in Flanders and the Brussels Capital region compared with other countries, although it is available in both specialized psychiatric facilities and in the psychiatric departments of general hospitals.

Belgium↗

Long-term follow-up of a malunited, isolated fracture of the capitate in a 6-year-old boy.

A 6-year-old boy with an isolated fracture of the capitate was presented. First radiograghs at our clinic revealed an oblique fracture with a displacement of 5 mm on the lateral view, which we successfully treated with immobilization. When complete union was recognized in the radiographs, the capitate had a deformity consisting of a large prominence on the palmar aspect. During follow-up, the capitate showed marked remodeling and at four and a half years after injury it had regained an almost normal shape. Eleven years after injury, there were no radiographic changes such as malalignment or arthrosis in the carpal bones.

Carpal Bones↗

The problem of evaluating in situ pinning of slipped capital femoral epiphysis: an experimental model and a review of 63 consecutive cases.

Over a 3-year follow-up period, 63 hips (in 49 patients) that were pinned as treatment for slipped capital femoral epiphysis were examined and evaluated. A 36.8% incidence of unsuspected pin penetration was discovered. Four types of experimental models representing different degrees of severity of slipped capital femoral epiphysis were designed and manufactured in the bioengineering laboratory. In situ pinning was performed on each model. An extensive series of controlled test films on the models indicated the difficulty of accurately determining the true position of the pins with conventional roentgenographic views. Subsequent fluoroscopic analysis revealed a verifiable correlation between the limited visualization of conventional X-ray analysis following the pinning of a slipped capital femoral epiphysis and unrecognized pin penetration.

Bone Nails↗

Slipped capital femoral epiphysis associated with hyperparathyroidism.

Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. This report documents the second case of primary parathyroid adenoma with hyperparathyroidism and symptomatic concomitant slipped capital femoral epiphyses. In the evaluation of children with slipped capital femoral epiphysis, care must be taken to eliminate other treatable disease states that are known to be associated with this phenomenon. The capital femoral physes in this child with hyperparathyroidism promptly closed following removal of the parathyroid adenoma.

Adenoma↗

Thyroid hormone levels in patients with slipped capital femoral epiphysis.

Twelve patients with slipped capital femoral epiphysis and 12 age- and sex-matched controls were prospectively studied. Their height, weight, skeletal maturation, and thyroid status were assessed. The duration of symptoms and severity of the slip was recorded in the test group. There was no correlation between duration of symptoms and severity of the slip or delay in making the diagnosis and severity. Although 50 percent of patients with slipped capital femoral epiphysis were over the 90th percentile for weight, there was no overall significant difference in weight, height, or skeletal maturation between the two groups. There was no evidence of either overt or subclinical hypothyroidism in patients with slipped capital femoral epiphysis.

Adolescent↗

Femoral remodeling may influence patient outcomes in slipped capital femoral epiphysis.

Clinical studies of patients treated for slipped capital femoral epiphysis have found limited functional impairment and femoral neck deformity causing eventual coxarthrosis. Since patient-focused assessments minimize bias and reflect health-related quality of life status, we coupled their use to a clinical examination to obtain a more patient-centered picture of slipped capital femoral epiphyseal outcomes. The impact of residual deformity on outcomes also was examined. Of 78 patients treated for slipped capital femoral epiphyses between 1972 and 1998, 29 (38 hips) were evaluated at a mean followup of 7.6 years (range, 1.4-26 years). The average patient age was 21.8 years (range, 14.6-39 years), 55% were female, and the average body mass index was 28.7 (range, 16.1-50.2). Most slips were stable (92%, 35 of 38) and mild or moderate in severity (98%, 36 of 37). Followup examinations revealed slight deficits in range of motion, strength, and limb length. Radiographs showed slight improvements in head-shaft angle and reduced but persistent femoral neck deformity. Osteoarthritic changes were absent or negligible in 84% (32 of 38) of the hips. The average Iowa hip score was 90.5 (range, 51-100). Patient outcome scores for the AAOS Hip/Knee Questionnaire fell slightly below 50th percentile norms. Neither slip stability, severity, nor body mass index impacted outcome. Femoral neck deformity correlated with function, pain, and Boyer grade. Overall, patients had minor functional deficits and pain that may have been related to femoral neck deformity, but longer followup is warranted.

Adolescent↗

Social capital, age and religiosity in people who are lonely.

AIMS AND OBJECTIVES: The aims of the study were to (i) investigate age and loneliness, (ii) investigate the association between religiosity and loneliness, and (iii) and explore the relationship between social capital and loneliness. BACKGROUND: Loneliness is the subjective experience of social isolation and is a risk factor for a wide range of health problems including heart disease and depression. Poor self-rated health, domestic violence and poor economic conditions are associated with greater loneliness. DESIGN: The study was a cross-sectional survey of a random sample of adults aged 18 years and over. METHODS: A random sample of 1289 subjects was interviewed by computer-assisted telephone interviewing. This interview included the Loneliness Scale and items from the Social Capital Module of the General Household Survey. FINDINGS: Loneliness is more common in men and people without strong religious beliefs. An income-loneliness gradient is evident. Little support was found for the association between social capital and loneliness. CONCLUSION: The prevalence of loneliness is relatively stable in this population. Loneliness is linked to income and unemployment and as such pathways between socio-economic factors, loneliness and health need to guide interventions and future research. RELEVANCE TO CLINICAL PRACTICE: Loneliness is linked to a range of social and economic factors. Current Health Visiting practice recognizes the importance of tackling the effects of poverty and social deprivation and places community building at the core of much Health Visiting practice. This broad community level approach can usefully transfer into all community nursing and health promotion activity.

Adolescent↗

Social capital and social support on the web: the case of an internet mother site.

Do virtual communities in cyberspace foster social capital and social support? Using participant observation and discourse analysis, we examine a mothering board on a parent's website and investigate whether social capital was present, and if so, how it was developed and used. We find three main types of communication emerge from our analysis: emotional support, instrumental support--both formal and informal, and community building/protection, all of which contribute to the creation and maintenance of social capital. Additionally, using sampling with replacement, we created a final data set of 180 mothers and report descriptive statistics to identify characteristics of those on the board.

Adult↗