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PubMed1993

Poverty and the course of schizophrenia: implications for research and policy.

Interest in the relationship between social class and schizophrenia has diminished in recent years. However, these issues can usefully be reconsidered in light of increased recognition that schizophrenia has a protean course, that deinstitutionalization and community support of persons with schizophrenia are linked to welfare programs, and that conceptualizations and measurements of social class and its impact on the daily life of persons with schizophrenia have been rudimentary. The author examines the role that social class, especially poverty, plays in the course and outcome of schizophrenia. He reviews literature on the contributions of social structure and policy to the economic status of persons with schizophrenia, identifies variables associated with poverty that are found disproportionately among persons with schizophrenia, and examines the psychological significance of those variables. The overview is used to develop three approaches to research: examining the role of the chronic stress of poverty in the vulnerability model of schizophrenia, using poverty as a point of departure for investigation by considering persons with schizophrenia as primarily indigent rather than primarily mentally ill, and delineating how poverty and elements of schizophrenia influence each other.

Causality↗
PubMed1979

Do autistic children come from upper-middle-class parents?

Most studies have reported autistic children as coming from upper social economic status (SES) families. A few studies have not found any such social class bias. In order to resolve these contradictory findings, an empirical study was conducted on a statewide sample of families with autistic children. It was hypothesized that autistic children from high SES families would be associated with seven social class selection factors: (1) early age of onset, (2) early age of treatment admission, (3) normal cognitive potential, (4) complex rituals with maintenance of sameness, (5) long distance traveled for treatment, (6) limited availability of services, and (7) very detailed child history. Factors 1, 5, 6, and 7 distinguished high SES from low SES families in the predicted direction. Implications for research and treatment are discussed.

Adolescent↗
PubMed1978

Leucocyte ascorbic acid and pregnancy.

1. Leucocyte ascorbic acid concentrations have been measured in 1147 females during early pregnancy and in smaller numbers of women before conception, throughout pregnancy and at 6 months post partum. 2. The leucocyte concentration in the 1st trimester was found to be affected by season, social class and smoking. Selecting individuals by extremes of social class, season and smoking produced two small populations with almost separate ascorbic acid distributions and mean concentrations of 21.7 and 45.1 microgram/10(8) leucocytes. 3. Early pregnancy had little effect on leucocyte ascorbic acid concentrations but values decreased in the second trimester. However, this was associated with a leucocytosis so that the total leucocyte ascorbic acid content of blood was unchanged. 4. Low ascorbic acid concentrations during the 1st trimester were not associated with subsequent spontaneous abortions, still-births or neonatal deaths, but there was an increased frequency of low values in women who gave birth to infants smaller than 3250 g. 5. The adequacy of ascorbic acid reserves in early pregnancy is discussed.

Adult↗
PubMed1985

Deaths from abuse of volatile substances: a national epidemiological study.

A survey of the United Kingdom detected 282 deaths from abuse of volatile substances during 1971-83. Deaths appeared to have increased in the most recent years, reaching 80 in 1983. Age at death ranged from 11 to 76 years but most deaths (72%) occurred under 20 years. Ninety five per cent of the subjects were male, and in 1983 deaths from volatile substance abuse accounted for 2% of all deaths in males aged 10-19. All areas of the United Kingdom were affected, the rates being highest in Scotland and urban areas. All social classes were affected, though rates were highest in social class V and the armed forces. The volatile substances abused were gas fuels (24%), mainly butane; aerosol sprays (17%); solvents in glues (27%); and other volatile substances, such as cleaning agents (31%). In 51% of cases death was attributed to the direct toxic effects of the substance abused, in 21% to plastic bag asphyxia, in 18% to inhalation of stomach contents, and in 11% to trauma. Deaths associated with the abuse of glues were more likely to be traumatic, but all substances appeared capable of killing directly by their toxic effects, probably by a cardiac mechanism. Only a small proportion of deaths (6%) were due to the abuse of glues among children under 16; hence current attempts to limit access of children to glues will probably have little impact on overall mortality.

Adhesives↗
PubMed2005

South Asian participation in clinical trials: the views of lay people and health professionals.

There is little UK-based empirical research on South Asian participation in clinical trials. The predominantly US literature rarely engages with mainstream debates about ethnicity, diversity and difference. This study was prompted by a lack of knowledge about how South Asian people perceive trial involvement and the risks and benefits involved. Face to face interviews were conducted with 25 health professionals (consultants, GPs, nursing staff, academics, non-medically trained trial co-ordinators, LREC and MREC members) and 60 South Asian lay people (20 Indians, 20 Pakistanis and 20 Bangladeshis) who had not taken part in a trial. The study took place in the Leeds and Bradford areas of England. It was found that lay South Asian attitudes towards clinical trial participation focused on similarities rather than differences with the general UK population, suggesting that the relevance of ethnicity should be kept in perspective. There was no evidence of antipathy amongst South Asians to the concept of clinical trials, and awareness was a correlate of social class, education and younger age. Lay factors that might affect South Asian participation in clinical trials included: age; language, social class; feeling of not belonging/mistrust; culture and religion. Approachable patients (of the same gender, social class and fluent in English) tended to be 'cherry picked' to clinical trials. This practice was justified because of a lack of time, resources and inadequate support. South Asian patients might be systematically excluded from trials due to the increased cost and time associated with their inclusion, particularly in relation to the language barrier. Under-representation might also be due to passive exclusion associated with cultural stereotypes. The paper concludes by applying the theoretical framework of institutional racism as a means of making sense of policy and practice. At the same time, caution is advocated against using ethnicity as the only form of discrimination facing minority ethnic populations.

Adult↗
PubMed1993

Health inequalities: new concerns about the children of single mothers.

OBJECTIVES: To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities. DESIGN: Reanalysis of data published in the childhood supplement of the registrar general's decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census. RESULTS: Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15. CONCLUSION: Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation's health should acknowledge the importance of material and social deprivation more explicitly.

Adolescent↗
PubMedDate not supplied

Current status of female circumcision among Nigerian Igbos.

The incidence of circumcision in 256 pregnant Nigerian Igbo women was 124 (48.4%). This incidence increased with increasing social class (circumcision index (C.I), 0.06 to 16.50, for social class 1 to 5); was least among the least age range, 16-20 years (C.I, 0.45); and among the primigravidae (C.I, 0.36) compared to the grandmultipara (C.I, 4.43) (P < 0.05.). Simple excision was the commonest type of circumcision, 122 (98.4%). The genital introitus was mildly scarred in 48 (38.7%) respondents, moderately scarred in 47 (37.9%) and severely scarred in 29 (23.4%). Ninety four (36.7%) of the respondents were not aware of their circumcision status, while 91 (96.8%) of the circumcised women had it performed during infancy. On the question of continued practice of female circumcision in their villages, 43 (16.8%) respondents replied, "yes"; 138 (53.9%), "no"; 25 (9.8%) "Sometimes"; and 50 (19.5%), "don't know". The incidence of episiotomy during delivery was similar for both circumcised, 47 (18.4%)and uncircumcised, 46 (18.0%) respondents (P = 0.05). More uncircumcised respondents, 31 (12.1%) were sexually satisfied during intercourse than the circumcised, 11 (4.3%) (P < 0.05). Of the 118 female offsprings of the respondents, 109 (92.4%) were not circumcised while 9 (7.6%) were. Increased public enlightenment on the risks of female circumcision is expected to eradicate the practice by the next generation

Adolescent↗
PubMed2001

Self-reported medication use for older people in England and Wales.

OBJECTIVES: To describe the patterns of self-reported medication use, including both prescription and non-prescription drugs, for older people in five areas in England and Wales, and to identify the effects of socio-demographic features on medication use. DESIGN: A cross-sectional survey on population random samples of people aged 65 and over. The survey is a part of the screening interviews at the first stage of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) carried out between 1991 and 1994. The sample was stratified to provide equal numbers in the 65-74 years and 75 years and over age groups. SETTING: Three urban (Newcastle, Nottingham and Oxford) and two rural (Cambridgeshire and Gwynedd) centres. Older people living in both the general community and institutions were included. PARTICIPANTS: 12489 older people whose medication data were collected among the 13009 participants of the CFAS, of which the participation rate is 80%. RESULTS: Overall prevalence of medication use was 75% (95% confidence interval 74-76%) for people aged 65-74 and 84% (83-85%) for people aged 75 and over, with a mean number of 2.03 (standard deviation 1.95) and 2.47 (2.02) drugs reported per respondent in each group, respectively. Concurrent use of five or more drugs (polypharmacy) was found in 11% (10-12%) of people in the 65-74 age group and in 15% (14-16%) in the 75 and over age group. People aged 75 and over were more likely to be taking at least one drug than people aged 65-74 (OR=1.69, 1.54-1.85), and women were more likely to be so compared with men (OR=1.43, 1.30-1.56). Centre variation was found but none of the centres consistently showed higher or lower usage of medications across the major drug categories. People living in institutions were more likely to be taking gastrointestinal drugs, central nervous system drugs and experience polypharmacy. The use of respiratory and central nervous system drugs (except hypnotics and anxiolytics) increased in lower social class and decreased in people attending full-time education for 10 years or more. The use of haematology/dietetic drugs (85% of which were vitamin and mineral preparations) decreased in lower social class. CONCLUSION: This study provides representative estimates of medication usage among older people in England and Wales and identified associated factors and regional variations for medication use in a category-specific manner. The findings, suggesting the existence of centre variation and the association between type of accommodation, social class and medication use warrant further investigation.

Age Factors↗
PubMed1998

The association of urbanisation with the prevalence of dental caries among schoolchildren in Nigeria new capital territory.

The aim of this study was to examine the association of urbanisation and social class with dental caries. A multi-stage stratified cluster sampling technique was used to select schoolchildren (n = 915). Clinical examination was carried out in daylight according to WHO criteria. The distribution of the subjects between strata was: 315 (urban); 303 (semi-urban) and 297 (rural). The mean age of subjects in each strata was 11.4 years. The mean number of decayed teeth (DT) in the respective strata were 27 per cent; 24 per cent; and 12 per cent. Urban children and semi-urban had higher risk for caries than their rural reference group. Urbanisation had no significant effect on the caries prevalence when social class was controlled except among subjects from the low social class in semi-urban areas. The development of satellite towns around big cities do have implications for planning oral health services.

Child↗
PubMed1990

Mortality at early ages in Scottish communities, 1959-83: geographical distributions and associations with selected socioeconomic indices.

Mortality at early ages has long been known to reflect the general health of communities, and derived epidemiological parameters have been used to indicate those communities to which policies of environmental improvement and health promotion should be directed. The geographical distributions of stillbirths, and perinatal, neonatal, post-neonatal and infant mortalities in Scottish communities were analysed for the years 1959-63, 1969-73 and 1979-83. For all categories of mortality, urban-rural gradients were present in the earlier periods, but had disappeared by 1979-83. Several communities were identified which had high rates for at least two categories of mortality, and which may benefit, therefore, from intervention programmes. For 1979-83 only, bivariate correlation coefficients were calculated between the five categories of mortality and four socio-economic variables: social class, overcrowding (over 1.5 persons per room and persons per hectare), single parent households and housing tenure. For stillbirths and perinatal mortality, significant correlations were found with persons per room, housing tenure and social class. Neonatal and postneonatal mortalities were significantly correlated with council house tenure and persons per hectare respectively, whereas infant mortality was not significantly correlated with any variable. Multiple regression, using the five categories of mortality as dependent variables and social class, persons per room, persons per hectare, housing tenure and single parent families as the independent variables, showed that these socioeconomic characteristics explained between 10-32% of the variation in mortality.

Fetal Death↗
PubMed1985

Health, health risks and inequalities: an exploratory study of women's perceptions.

Recent theoretical and empirical research has highlighted the importance of understanding the relationship between social structure and health beliefs. The empirical study described here explores the relationships between occupational social class and two dimensions of health beliefs which were concepts of health and perception of vulnerability to disease. Both the dimensions are claimed to be associated with decisions to carry out health behaviour and thus one of the aims was to shed some light on the social class gradient in patterns of preventive health behaviour and risk-taking behaviour. The findings showed a more marked social class differentiation in concepts of health when they were defined in the abstract compared with when they were defined in relation to personal health. The concept of personal vulnerability itself was shown to be problematic and theories about vulnerability were similar for both classes. Explanations for the findings are discussed.

Attitude to Health↗
PubMed1987

Obstetric care, pregnancy risk factors and perinatal outcome in the province of Uusimaa, Finland, in 1980-1981.

The study was carried out in order to learn about the present state of obstetric care and perinatal outcome in the province of Uusimaa, Finland. The material consisted of 29,061 pregnant women, including 313 multiple pregnancies and 29,374 newborn infants born in the years 1980 and 1981. The information gathered was mostly retrospective. The overall frequency of LBW children was 3.9 percent, of very LBW children 0.8, of preterm children 5.8, of very preterm children 0.7, and of post-term children 4.7 percent. The overall frequency of neonatal transfers to a pediatric ward was 8.6 percent. Centralization of high risk deliveries has increased in Uusimaa since 1975, as judged by the frequencies of LBW children born at the two largest delivery units and four district hospitals. Almost 95 percent of mothers-to-be began their antenatal classes before 16 weeks of gestation. Late admission to antenatal care after week 15 was an independent risk factor for unfavorable pregnancy outcome. The cesarean section rate was 16.5 percent. The frequencies were highest at the State Maternity Hospital (19.7%) and Helsinki University Central Hospital (18.2%). The frequency varied largely in district hospitals (5.9-16.3%). This resulted partly from different indications for cesarean sections in these hospitals. The mean age of the parturients was 28.5 years. The best pregnancy outcome was observed in women aged 25-29 years. Almost half of the parturients were primiparous, and only 4.0 percent were quadri- or grand multiparous. Secundiparous women had the best pregnancy outcome. Terti-parity or more was not a risk factor per se; the difference in the frequency of unfavorable outcome between secundiparas and terti-paras or more disappeared after those with unsuccessful histories were excluded, while the difference still remained significant between primi- and secundiparas. Of all pregnant women, 23 percent had experienced one and 6.4 percent several spontaneous or legally induced abortions. The effect of the number of abortions on the frequency of preterm and very preterm deliveries was linear both in singleton and multiple pregnancies. Almost 70 percent of the parturients belonged to the two highest social classes and 86 percent were married. Children of married women from higher social classes had the best perinatal outcome. Unmarried women from lower social classes more often had 'behavioral' risk factors--they were more often heavy smokers, were uncertain about the dates, had had two or more abortions and neglected maternity care.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Multiple↗
PubMed1978

Social factors and height of primary schoolchildren in England and Scotland.

In 1972 the height of 7601 children aged five to 11.5 years in England and of 2214 in Scotland was measured. Their parents were asked to complete a questionnaire to provide social and antrhopometric information. A sequence of linear models was fitted to the data to assess the associations between social and biological factors and height. At the time of the study it was found that sibship size, father's social class, and his employment status all had a significant relationship with child's height; however, parents' height and child's birthweight both accounted for relatively more of the variance in child's height than father's social class and employment status. In England, sibship size significantly influenced the height of children of manual workers, but not that of nonmanual workers' children. In Scotland, sibship size was associated with height in all social groups. Surveillance and possibly intervention in a wide range of activities should be directed at socially more deprived groups; for example, in Social Class V, in which there are more large families and unemployment is more common.

Birth Weight↗
PubMed2001

Is the incidence of tonsillectomy influenced by the family medical or social history?

Previous reports have suggested that the incidence of tonsillectomy, and/or tonsillitis in children, is influenced by factors such as parental smoking, maternal health and previous parental tonsillectomy. The reports have considered single factors and have not considered the possible confounding effect of the factors upon one another. Previous studies have not investigated the influence of social class. This paper uses the background of a large case-control trial of children awaiting tonsillectomy for recurrent tonsillitis, and a normal control group to study the influence of parental smoking, parental surgical history, parental tonsillectomy, family atopy and social class upon the reported incidence of sore throats and tonsillitis. A multivariate analysis is used. The paper shows that parental smoking, previous parental surgery and social class have no effect upon the number of sore throat episodes. A history of parental tonsillectomy and a family history of atopy are both significant predictive factors for the number of reported sore throats and episodes of tonsillitis in children.

Case-Control Studies↗
PubMed1995

Biosocial factors in early infancy as predictors of competence in adolescents who were born prematurely.

In a prospective longitudinal study of a cohort of 105 subjects born prematurely, competence was assessed from infancy through late adolescence. A biosocial model guided the research. Neonatal neurobehavioral organization (a composite of term visual attention, amount of time in active sleep, and 407 EEG pattern) and early social stimulation (the amount of talking the mother addressed to the infant during a home observation when the infant was 1 month old) in conjunction with social class were used to predict competence at key age periods through late adolescence. Intellectual competence, school achievement, social competence, and self perception of cognitive competence were studied. The results indicate that measures taken in the early infancy period were predictive of later competence, particularly intellectual competence, above and beyond social class. Twenty-eight percent of the variance in 18-year IQ scores was explained by the predictor variables. The study highlights the importance of directing efforts to improve the social environment of both the infant and the family.

Achievement↗
PubMed2004

[Adult health].

The objective of this study is to analyse the social inequalities in health status, health related behaviours and mortality among the 25-64 years Spanish population. Data come from the 1997 Spanish National Health Survey, the 1999 Spanish National Survey on Working Conditions, the 2001 Yearbook of Labour and Social Affairs Statistics and the 1998 Mortality Statistics. Most health-related behaviours are more unfavourable for men (smoking, alcohol consumption and overweight) and for less privileged social classes. Among women, entrance into the labour market is associated with more unhealthy behaviours except for overweight. Low weight, however, is more frequent among employed females. Self-perceived health status is better among men, more privileged social class persons and among workers. Whereas classical physical job hazards and work injuries mostly affect men, the impact of psychosocial job hazards and of exposures derived from the domestic work is higher for women. As in other developed countries, the paradox exists that whereas women have a poorer self-perceived health status, mortality is higher among men. The male excess in mortality is related to health-related behaviours that to a great extent are determined by traditional values assigned to masculinity, with higher consumption of tobacco (lung cancer), alcohol (cirrhosis), drugs (HIV and AIDS) and risky behaviours related to injuries. Health policies should take into account social inequalities in health determined by gender, social class and employment status. For doing so, it is important to increase the development of research on social inequalities and of health information systems sensitive to social inequalities.

Adult↗
PubMed2006

Leg length, cognitive impairment and cognitive decline in an African-Caribbean population.

BACKGROUND: Shorter leg length is associated with an adverse environment in early childhood and has been found to be associated with a variety of disorders occurring in mid- to late-life, including dementia in a Korean population. In a community population of African-Caribbean elders, in whom leg length had been measured, we sought to compare associations with cognitive impairment at baseline and cognitive decline over a three-year follow-up period. METHODS: Of 290 African-Caribbean residents in south London recruited at baseline, 216 (74%) were re-interviewed after a three-year period and 203 had sufficient data for this analysis. Cognitive impairment was derived as a binary category from a battery of cognitive tests administered at baseline and cognitive decline was derived from change in performance on a subset of these tests. Leg length (iliac crest to lateral malleolus) was also measured. RESULTS: Shorter leg length was associated with female sex, lower occupational social class and reported hypertension and diabetes. Shorter leg length (lowest quartile) was significantly associated with cognitive impairment but there were no apparent associations with cognitive decline. The association with cognitive impairment was independent of age, sex and education. Social class appeared to be an important mediating factor. CONCLUSIONS: Shorter leg length may be a marker of early life stressors which result in reduced cognitive reserve. Interestingly this association was mediated more strongly by social class (previous occupational status) than by education in this population.

Aged↗
PubMed2005

[Workplace injuries and professional mobility correlated with health problems. The potential and limitations of the ISTAT Labour Force survey--July 1999].

BACKGROUND: Knowledge on the occupational and social factors that influence the relationship between illness, absence from work and occupational mobility is at present insufficient. OBJECTIVES: To map out, by social class and occupational group, the impact of health problems on work and the distribution of accidents and morbidity associated with occupation. METHODS: Using data from the National Survey of the Italian Labour Force (ISTAT, 1999), covering a sample of 200,384 subjects, prevalence odds ratios of morbidity, work injuries and change of occupation due to health problems were calculated by social class and occupation, adjusting for age and residence. RESULTS: The working class showed a higher risk, due to health problems, of a reduction in time worked (OR = 3.70 in men and OR = 4.10 in women), of choosing to work part-time (OR = 2.04 in men and OR = 2.27 in women), or of withdrawing from the workforce (for artisans, skilled manual workers, farmers and agricultural labourers OR = 1.63 in men and OR = 1.47 in women). This class was also at a greater disadvantage not only with respect to accident rates (OR = 1.85 in men and OR = 1.88 in women), but also with respect to the time needed for post-trauma rehabilitation and return to work (for absences of one week to one month: OR = 1.67 and 1.83 for men and women, respectively; for absences of more than one month: OR = 1.29 and OR = 1.69). Moreover, the working class, when compared to other social classes, had a higher rate of suffering from illness, physical impairment or other physical and psychological problems caused or aggravated by working activity (25% in men and 32% in women). CONCLUSIONS: The ISTAT National Survey provides an estimate of minor accidents with prognoses of less than three days, including those not reported to the National Institute for Insurance against Occupational Accidents and Diseases (INAIL). This allows a preliminary exploration of the relationship between health problems and occupational mobility; however, it seems necessary to collect more detailed information in order to more exhaustively explore the mechanisms which generate the inequalities observed.

Accidents, Occupational↗