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PubMed2003

Is parental sense of coherence associated with child health?

Antonowsky's concept of sense of coherence (SOC) has, during recent years, gained increased attention as a salutogenic model on the relationship between health and disease. However, only sparse information connecting child chronic health conditions to parental SOC is yet available. This article presents results from a cross-sectional study of about 10,000 children aged 2-17 years in the five Nordic countries in 1996. Factors associated with parental SOC were analysed, with focus on child chronic health conditions. Sense of coherence was measured according to a short and condensed three-item instrument based on Antonovsky's original 29-item instrument. Overall, about 23% of parents in Nordic countries had a poor sense of coherence, the lowest proportion found among Icelandic parents. Compared to the higher social classes, poor SOC was more common in the lower social classes. The association of child chronic health conditions with parental poor SOC was found to be disability specific. Parents of children with diabetes, epilepsy or psychiatric/nervous problems had approximately 2-5 higher odds of having poor SOC compared to parents of children without a specific diagnosis. The overall effect of having a child with chronic health conditions was, however, low, lower than the effect of the parents' own health complaints.

Adaptation, Psychological↗

PubMed2005

[Socioeconomic class as a risk factor for cardiovascular diseases].

It's been known for a long time, that certain diseases are more frequent in lower socioeconomic classes. But knowledge about the nature of this association, its main risk factors and how to improve health outcomes in lower social groups is still limited. Social class has been defined by different indicators by e.g. occupation and job position or the highest school qualification achieved. For international comparisons different classifications such as "The Registrar General's Social Class Classification " or the "International Standard Classification of Education" have been used. Several European Studies show a higher prevalence of cardiovascular diseases and cardiovascular risk factors including smoking, obesity, physical inactivity, hypertension and hypercholesterolemia in lower socioeconomic classes. But this studies also show that all socioeconomic groups have access to medical services. The Data from the Swiss Health Survey show the distribution of cardiovascular risk factors and diseases by three levels of education: Behaviouralfactors such as smoking, obesity and physical inactivity are more commonly present in the lower socioeconomic groups. People with a lower educational level visit their GP more often, whereas people with a higher level of educational consult specialists more frequently. Medical services are often used to check of blood pressure, blood sugar and cholesterol. An indication of state of health may be shown by medication and treatment for cardiovascular disease which is more prevalent in lower socioeconomic groups. The present discussion of explanations of the poorer state of health in lower socioeconomic groups goes beyond the classical risk factors for cardiovascular disease. Studies have shown that after the correction for risk factors a correlation remains between social class and state of health. It is believed, that psychosocial factors such as self-esteem, control in the workplace or coping-strategies play an additional important role in staying healthy. Therefore prevention of cardiovascular disease should not be restricted to minimisation of risk factors or to the measurement of certain blood-values and treatments. Efforts must also go into creating the conditions for a healthier life and promote possibilities for healthier behaviour in all socioeconomic classes.

Cardiovascular Diseases↗

PubMed1975

Social background and diagnosis. Survey of Male Clinic Registrations.

The usual reservations concerning the reliability of information received from clinic patients must be made, although we have no evidence of systematic distortion in the data provided, apart from the understatement of previous clinic attendances. Analysis of the 3,045 male registrations included in the survey revealed that: (1)More than half were of patients under 25 years of age. This age group included almost one-third of the cases of syphilis, 56-3% of the cases of gonorrhoea, and 49-7% diagnoses of NGU. (2) Some 30% of registrations were of married men living with their wives. The proportion of registrations in this category increased substantially through the upper age groups. (3) The incidence of gonorrhoea and of syphilis was higher among the separated or divorced than among single, married, or widowed men. (4) The incidence of gonorrhoea was higher among patients in their teens and twenties than in succeeding age groups; NGU was diagnosed most frequently among patients in their forties. (5) The incidence of NGU varied inversely to that of gonorrhoea in relation to social class. Gonorrhoea was diagnosed more frequently among manual than among non-manual workers, while the incidence of NGU was higher among white-collar workers (including students). The highest incidence of gonorrhoea was recorded among registrations in the semi- and unskilled categories where the incidence of NGU was lowest, while the lowest and highest frequencies of gonorrhoea and NGU respectively were recorded among registrations in Social Class III (N)-comprising mainly clerical and sales workers. Some of the above findings may be of mainly local significance, and much additional evidence is required before the influence of such factors as marital status and social class can be adequately interpreted.

Adolescent↗

PubMed1998

A community-based study of the epidemiology of Helicobacter pylori infection and associated asymptomatic gastroduodenal pathology.

OBJECTIVES: To document the epidemiology of Helicobacter pylori infection in a normal population, to assess asymptomatic H. pylori positive individuals for the presence of gastroduodenal disease, and to compare the macroscopic and microscopic findings at endoscopy in this group with those of patients presenting with dyspepsia. DESIGN/METHODS: Serum was collected from blood donors and assessed for the presence of anti-H. pylori IgG antibodies. A randomly selected group of asymptomatic blood donors and dyspeptic patients underwent endoscopy. RESULTS: The seroprevalence of H. pylori in 1000 subjects was 43.0%. The prevalence of infection increased from 29% in 18-30 year olds to 62% in 46-60 year olds (P < 0.01). The infection was more prevalent in individuals from social classes IV and V (50.0%) than social classes I and II (36.9%) (P < 0.01). There was no difference between the H. pylori positive asymptomatic individuals (n = 37) and matched dyspeptic patients (n = 29) at endoscopy with regard to duodenal ulcer (13.5% vs. 17.2%) or gastroduodenal erosions (24.3% vs. 20.7%) while 5.4% of the former had gastro-oesophageal reflux compared to 27.6% of the latter. Overall, 56.8% of the H. pylori positive asymptomatic group had a normal macroscopic endoscopy compared with 31% of the dyspeptic group. Histology of the gastric mucosa did not reveal any significant differences between the two groups. In H.pylori negative asymptomatic individuals (n = 13) 92.3% had a normal endoscopy (7.7% had grade I gastro-oesophageal reflux) compared with 61.5% of a matched dyspeptic group (n = 13). CONCLUSION: H.pylori infection, symptomatic and asymptomatic, is associated with significant pathology, and screening for the infection may be indicated for the prevention of gastroduodenal diseases.

Adolescent↗

PubMed2006

Health, economy and social capital in Nordic children and their families: a comparison between 1984 and 1996.

OBJECTIVE: The aim of the study was to analyse the development in the health of children that occurred in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) between 1984 and 1996 and relate it to the changes in economic growth and social capital in these countries during the same period. METHODS: Two cross-sectional studies covered a representative sample of children, aged 2-17 years in each country, a total of 10,291 in 1984 and 10,317 in 1996. The data were collected by mailed questionnaires. Statistical associations between a health indicator (the absence of psychosomatic complaints), economic indicators (social class, housing and disposable income) and social capital indicators (parents' and children's organized group activities, parents playing with their children and the absence of bullying) within samples and between corresponding values in different samples across subgroups (defined by country and area of residence) were evaluated using multiple linear regression. RESULTS: In both surveys, there was a statistically highly significant association between the health indicator and the social capital indicators, whereas the economy indicators were not related to either of the other two types of measure. Change in health was associated positively with change in social capital and negatively with change in economy. CONCLUSION: The study provides strong support for the concept of social capital as an important determinant of children's health.

Adolescent↗

PubMed1986

The similarity principle underlying social bonding among female rhesus monkeys.

Twenty adult female rhesus monkeys (Macaca mulatta) were observed over a three-year period. They lived in a mixed captive group with kinship relations known for three generations. The study's aim was to test Seyfarth's [J. theor. Biol. 65: 671-698, 1977] model of rank-related grooming and to investigate two other possible determinants of social bonding, i.e. relative age and the group's stratification into two social classes. Data on affiliation, coalitions, and social competition were collected by means of both focal observation and instantaneous time sampling. Whereas certain elements of the existing model were confirmed, its explanatory principles were not. Social competition did not result in more contact among close-ranking females (the opposite effect was found), and the relation between affiliative behavior and coalitions was more complex than predicted. Based on multivariate analyses and a comparison of theoretical models, we propose a simpler, more encompassing principle underlying interfemale attraction. According to this 'similarity principle', rhesus females establish bonds with females whom they most resemble. The similarity may concern genetical and social background, age, hierarchical position and social class. Effects of these four factors were independently demonstrated. The most successful model assumed that similarity factors influence female bonding in a cumulative fashion.

Aggression↗

PubMed2001

[Socioeconomic aspects and cardiovascular risk factors: experience at the Cardiovascular Epidemiologic Observatory].

BACKGROUND: Cardiovascular diseases are more frequent among the poorer social classes of the population. Studies including social and economic factors offer useful information when planning the strategy required in primary prevention. The aim of this investigation was to evaluate the association between socio-economic levels and cardiovascular risk factors in 3198 women and 3218 men aged 35-74 years enrolled for a cross sectional study within the Cardiovascular Epidemiologic Observatory, carried out in 1998 to evaluate the distribution of risk factors and the prevalence of cardiovascular risk conditions. METHODS: The level of education was used to determine the socio-economic status; the distribution of the risk factors and the prevalence of risk conditions were analyzed for the different levels of education. Models of logistic regression were used to evaluate the relation between the socio-economic status and obesity, cigarette smoking, hypertension, and hypercholesterolemia. RESULTS: A higher level of education is significantly protective against both obesity and cigarette smoking. With regard to obesity among males compared to those with a university degree the odds ratio increased to 1.6 for those with an upper secondary education diploma (95% confidence interval--CI 1.09-2.51) and to 3.5 for those without any qualification (95% CI 1.97-6.21). Among women the odds ratio increased to 3.2 (95% CI 1.81-5.81) and to 4.8 (95% CI 2.55-8.98) for the same levels of education. With regard to smoking among males compared to those with a university degree the odds ratio increased to 1.4 for those holding an upper secondary education diploma (95% CI 1.07-1.94) and to 2.3 for those without any qualification (95% CI 1.40-3.68). For men living in central or southern Italy, the odds ratio for cigarette smoking increased to 1.3 (95% CI 1.06-1.57) and to 1.5 (95% CI 1.24-1.82) and the odds ratio for hypercholesterolemia decreased to 0.8 (95% CI 0.62-0.95) and to 0.7 (95% CI 0.58-0.89); with regard to women, living in the same geographic areas the odds ratio for obesity increased to 1.3 (95% CI 1.03-1.65) and to 2.3 (95% CI 1.81-2.83). CONCLUSIONS: In primary prevention it is important to focus the attention on obesity and on smoking habits among the poorer social classes.

Adult↗

PubMed1988

Prediction of intellectual deficits in children with acute lymphoblastic leukemia.

Possible predictors of reported lower cognitive functioning in irradiated children with acute lymphoblastic leukemia (ALL) were investigated. Thirty-four subjects, 5-14 years old, with ALL in continuous complete remission and without evidence of current or past central nervous system disease, were examined 9-110 months after diagnosis, using standard measures of intelligence and academic achievement. Subjects with a history of post-irradiation somnolence syndrome were significantly older at diagnosis than nonsomnolent subjects. Intelligence (IQ) was found to be unrelated to history of somnolence syndrome. IQ and achievement were unrelated to age at irradiation, irradiation-examination interval, and radiation dosages. The strongest predictor of IQ by far is parental social class. The importance of controlling for social class differences when searching for treatment effects on IQ and achievement is stressed.

Achievement↗

PubMed1977

Grocery purchases as a function of obesity and assumed food deprivation.

Six hundred and four grocery shoppers were observed unobtrusively at three supermarkets to investigate the relationship between grocery purchasing and the factors of obesity, assumed food deprivation, social class, and meal hour. It has been suggested that shoppers will purchase more if they shop prior to eating rather than after (Stuart & Davis, 1972), although such a notion conflicts with Schachter's (1971) internal-external hypothesis and with the conclusions of one field study (Nisbett & Kanouse, 1969). We found that female shoppers who shopped prior to standard meal times consistently purchased more than those who shopped after meal times (P less than 0.001), regardless of social class or meal hour. Males displayed the same tendency though differences were not significant. No obese-normal differences were found for either sex. A negative relationship between obesity and social class was found amoung females (P less than 0.001).

Adult↗

PubMed1998

Height velocity, body fat and menarcheal age of Indian girls.

OBJECTIVE: To understand the onset of menarche in relation to changes in physical measurements that take place during adolescence, especially the changes in height velocity and changes in body fat. DESIGN: Adolescent girls in the 9-16 year age group were observed longitudinally every six months for a period of two years. SETTING: Girls from schools catering to urban high socio-economic class (HSE, n = 135) and those catering to low socio-economic class (LSE, n = 398) were evaluated. METHODS: Six monthly measurements of weight, height and triceps skinfold thickness (TSFT) were done. Menarcheal age was recorded by recall method for the girls who were menstruating at the beginning of the study and prospectively for girls whose onset was after the initiation of the study. Body fat (%) was estimated using weight, height and TSFT. RESULTS: The girls from LSE not only had lower attained weight, height, skinfold thickness at triceps and body fat but also had a significant difference (p < 0.05) in menarcheal age (15.4 yr) as compared to girls from HSE (12.1 yr). Although social class differences delayed the occurrence of the event by chronological age, the time between peak height velocity (PHV) and onset of menarche remained similar (1.5 yr) irrespective of social class. The mean weight at menarche, at group level (but not at individual level), was around 38 kg in both socio-economic classes, irrespective of age at onset. Further menarche represented the point of maximum deceleration in height velocity and maximum acceleration in body fat in both social classes. CONCLUSION: Our data indicated a partial support for critical weight hypothesis and suggested that these limits vary from community to community. The analysis revealed that rather than absolute values of weight, height and body fat, changes in these measurements are of significance with regard to onset of menarche.

Adipose Tissue↗

PubMed2003

Meta-analysis of social inequality and the risk of cervical cancer.

Previous studies of the relationship between socio-economic status and cervical cancer have been mainly based on record linkage of routine data, such as cancer registry incidence rates and regional measures of social class based on census data. These routine data are liable to substantial misclassification with respect to socio-economic status. Previous reports are also primarily from developed countries, whereas the major burden of cervical cancer is in developing countries. We have therefore pooled the data from previously reported case-control studies of cervical cancer or dysplasia, which contain individual-level information on socio-economic characteristics to investigate the relationship between cervical cancer, social class, stage of disease, geographical region, age and histological type. Based on 57 studies, we found an increased risk of approximately 100% between high and low social class categories for the development of invasive cervical cancer, and an increased risk of approximately 60% for dysplasia, including carcinoma in situ. Although the difference was observed in all countries, it was stronger in low/middle income countries and in North America than in Europe. No clear differences were observed between squamous cell carcinoma and adenocarcinoma, or between younger and older women. These results indicate that both cervical infection with human papillomavirus, which is linked to both female and male sexual behaviour, and access to adequate cervical cancer screening programmes are likely to be important in explaining the large cervical cancer incidence rates observed in different socio-economic groups, and that the importance of these factors may vary between different geographical regions.

Adult↗

PubMed1995

An assessment of approximal bone height in the posterior segments of 15-16-year-old children using bitewing radiographs.

The alveolar bone height in a total of 713 15-16-year-old children consisting of 364 males and 349 females was assessed using posterior bitewing radiographs. The distance between the alveolar crest (AC) and amelo-cemental junction (ACJ) on all molar and premolar teeth was determined from magnified images of the radiographs. Analyses of variance models were fitted in order to assess the dependence of the overall ACJ to AC distance on the inter-subject variables of gender and social class and the intrasubject variables of site, missing adjacent tooth, condition of the approximal tooth surface, and for mesial surfaces, gingivitis and pocket depth. The overall geometric mean for bone height for the whole population was 0.542 mm. The ACJ to AC distance for the vast majority of sites was below 2 mm. Site had a highly significant effect on bone height (P < 0.001): ACJ to AC distances were greater in the maxilla compared to the mandible (P < 0.001), greater for distal sites compared to mesial (P < 0.001) and significantly affected by tooth type (P < 0.001). Sites with missing adjacent teeth also had significantly increased distances (P < 0.001). The condition of the approximal tooth surface and the presence of pocketing or gingivitis did not have a significant association with bone height. The geometric mean AC to ACJ distance, adjusted for subject, site and social class was 0.577 mm for males and 0.506 mm for females (P < 0.001), but the main effect of social class was not significant.

Adolescent↗

PubMed1990

Health checks in general practice: another example of inverse care?

OBJECTIVE: To assess attendance at and the characteristics of patients attending health checks for cardiovascular disease offered in a general practice over a period of five years (1984-9). DESIGN: Medical record audit and postal questionnaire survey. SETTING: One general practice in Oxfordshire with a socially diverse population. PARTICIPANTS: 1101 Men and 1110 women aged 35-64 registered with the practice. MAIN OUTCOME MEASURES: Age, sex, marital state, social class, smoking habits, alcohol consumption, and diet. RESULTS: Of the 2211 men and women in the target age group (35-64) in 1989, 1458 (65.9%) had been offered screening and 963 (43.6%) had attended for a health check. Attenders were more likely to be women, aged greater than or equal to 45, married, non-smokers, and of higher social class than patients who did not respond to the invitation. The relative likelihood of non-attendance was 1.24 for smokers, 1.20 for the overweight, 1.16 for heavy drinkers, and 1.28 for those with a less healthy diet, even after adjustment for age, sex, marital state, and social class. CONCLUSIONS: After five years of offering health checks, opportunistically (to men) and in the context of cervical smear tests (to women), less than half of the eligible patients had attended. The likelihood of acceptance of an invitation to attend was inversely related to the patient's cardiovascular risk for all factors measured except age. A coherent strategy to reduce cardiovascular disease depends on more careful targeting of scarce health service resources and more emphasis on public health measures (such as dietary regulation and tobacco taxation). Doctors should be careful not to absolve the government of its public health obligations by substituting unproved preventive interventions aimed at the individual patient.

Adult↗

PubMed1999

Radiomorphometric indices of the mandible in a British female population.

OBJECTIVES: To examine the radiomorphometric indices of the mandible on panoramic radiographs in a population of British female patients, to identify their normal ranges and to investigate their relationships with age, detentition and social class. METHODS: Five indices, cortical width at the gonion (GI) and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) and one new index (measurement of cortical width at the antegonion; AI), were measured bilaterally on 500 panoramic radiographs of females by one trained observer. The measurements were analysed for ease of application, repeatability, relationships with age, dentition and social class and interrelationships between the variables. RESULTS: All quantitative indices (GI, MI, PMI, AI), showed a significant, negative correlation with age. MCI showed an age-related distribution. Mandibular dentition exerted a significant influence on some indices, but social class had no influence. Intra-observer repeatability of MI, PMI and AI was fair (precision < 20%) but that for GI was poor. Intra-observer agreement in MCI assessments was excellent. CONCLUSIONS: The age-related changes in mandibular radiomorphometric indices and their variation within each age band lend support to their potential use in identification of skeletal osteopenia. However, problems with repeatability and measurement precision identified in the pilot study, notably with GI, may be a considerable obstacle to their use in general practice.

Adult↗

PubMed2004

[The productive sector].

In the last 25 years, the production sector in Spain has undergone important changes. Among these changes, the important growth of the services sector at the expense of the primary sector, the increasing flexibility of the labour market, and the rise in the female workforce could be considered as the most relevant ones. Spanish women have higher rates of unemployment, temporary jobs and part time contracts than Spanish men. Moreover, job access and work conditions are highly related to gender and social class. Because women are forced to compensate for the scarcity of social services for caring for young children and for dependent elderly, they become informal and socially unrecognised caregivers, preventing them from getting or holding a job, and significantly limiting their opportunities for professional development. These social conditions are closely related with the fact that work conditions for women involve higher temporality rates and shorter contracts than those of men, given the sectors and jobs in which they tend to work (due to segregation). Similarly, workers of the less privileged social classes have poorer work conditions. Thus, women of the lower income class are mainly suffering the worst job contracts and the poorest work conditions. More social services are needed to make it possible to attend to family needs and still be able to access and maintain a job contract. Policies tending to conciliate labour and family life are indispensable and should incorporate measures to equally distribute the house keeping activities between women and men.

Family↗

PubMed2005

On class differentials in educational attainment.

Social class differentials in educational attainment have been extensively studied in numerous countries. In this paper, we begin by examining class differentials in the progression to higher secondary education among 16-year-old children in England and Wales. As has been shown for other countries, the differentials result both from the primary effects of differing levels of academic performance of children of different class background and from the secondary effects of differences in the educational choices that these children make at given levels of performance. Through counterfactual analyses in which the performance distribution of one class is combined with the choice distribution of another, primary and secondary effects are decomposed and the former are shown to be roughly three times the size of the latter.

Adolescent↗

PubMed1996

Association between incidence of non-Hodgkin's lymphoma and solar ultraviolet radiation in England and Wales.

OBJECTIVES: To examine whether the incidence of non-Hodgkin's lymphoma in different areas of England and Wales is associated with levels of solar ultraviolet radiation. DESIGN: Geographically based study examining the association between incidence of non-Hodgkin's lymphoma and estimated levels of solar ultraviolet radiation, controlling for social class and employment in agriculture. SETTING: 59 counties in England and Wales. SUBJECTS: All registered cases of non-Hodgkin's lymphoma during the period 1968-85. MAIN OUTCOME MEASURE: Age and sex adjusted odds ratio for non-Hodgkin's lymphoma in each county. RESULTS: Incidence of non-Hodgkin's lymphoma was significantly associated with solar ultraviolet radiation levels (P < 0.001), even after social class and employment in agriculture were controlled for (P = 0.004). In a comparison of counties in the highest and lowest quarters of solar ultraviolet radiation, the relative risk of non-Hodgkin's lymphoma was 1.27 (95% confidence interval 1.24 to 1.29), rising to 1.34 (1.32 to 1.37) after adjustment for social class and employment in agriculture. CONCLUSIONS: The incidence of non-Hodgkin's lymphoma in different areas of England and Wales is positively associated with levels of solar ultraviolet radiation. These results are consistent with the hypothesis that exposure to solar ultraviolet radiation increases the risk of non-Hodgkin's lymphoma.

Agricultural Workers' Diseases↗

PubMed1998

Aspirin after myocardial infarction: the importance of over-the-counter use.

BACKGROUND: Regular aspirin is beneficial after myocardial infarction (MI). Community-based surveys appear to show unsatisfactory uptake of aspirin after MI. This could be due to over-the-counter (OTC) use not being recorded. In a pilot study in one practice, 39% of patients on aspirin after MI used OTC preparations. In addition, women and older patients were less likely to use aspirin. OBJECTIVES: We aimed to describe aspirin use following MI in general practices in West London, including regimens and OTC use, and to demonstrate any association between aspirin use and gender, age or social class. METHODS: We used a postal questionnaire survey. The setting was a random sample of six general practices in Ealing, Hammersmith and Hounslow Health Authority who use Egton Medical Information Systems (EMIS) to store morbidity data. The subjects were registered patients with a history of MI. The main outcome measures were questionnaire data on aspirin use, regimen, OTC use, prescription charge exemption, age, gender, ethnic group and social class. RESULTS: The prevalence of previously recorded MI in all age groups was 0.64%. The response rate was 89%. Regular aspirin was used by 80%. Of these, 22% use OTC aspirin. OTC use was significantly more common in those paying prescription charges. Aspirin use was not associated with gender, age or social class. CONCLUSION: This study demonstrated a high uptake of aspirin among patients with previous MI as recorded by computer. OTC aspirin use was significant, and should be inquired about and recorded.

Age Distribution↗