Intergenerational class mobility in contemporary Britain: political concerns and empirical findings

In Britain in recent years social mobility has become a topic of central political concern, primarily as a result of the effort made by New Labour to make equality of opportunity rather than equality of condition a focus of policy. Questions of the level, pattern and trend of mobility thus bear directly on the relevance of New Labour's policy analysis, and in turn are likely be crucial to the evaluation of its performance in government. However, politically motivated discussion of social mobility often reveals an inadequate grasp of both empirical and analytical issues. We provide new evidence relevant to the assessment of social mobility - in particular, intergenerational class mobility - in contemporary Britain through cross-cohort analyses based on the NCDS and BCS datasets which we can relate to earlier cross-sectional analyses based on the GHS. We find that, contrary to what seems now widely supposed, there is no evidence that absolute mobility rates are falling; but, for men, the balance of upward and downward movement is becoming less favourable. This is overwhelmingly the result of class structural change. Relative mobility rates, for both men and women, remain essentially constant, although there are possible indications of a declining propensity for long-range mobility. We conclude that under present day structural conditions there can be no return to the generally rising rates of upward mobility that characterized the middle decades of the twentieth century - unless this is achieved through changing relative rates in the direction of greater equality or, that is, of greater fluidity. But this would then produce rising rates of downward mobility to exactly the same extent - an outcome apparently unappreciated by, and unlikely to be congenial to, politicians preoccupied with winning the electoral 'middle ground'.

Does the choice of risk-adjustment model influence the outcome of surgeon-specific mortality analysis? A retrospective analysis of 14,637 patients under 31 surgeons

OBJECTIVES

To compare implications of using the logistic EuroSCORE and a locally derived model when analysing individual surgeon mortality outcomes.

DESIGN

Retrospective analysis of prospectively collected data.

SETTING

All NHS hospitals undertaking adult cardiac surgery in northwest England.

PATIENTS

14,637 consecutive patients, April 2002 to March 2005.

MAIN OUTCOME MEASURES

We have compared the predictive ability of the logistic EuroSCORE (uncalibrated), the logistic EuroSCORE calibrated for contemporary performance and a locally derived logistic regression model. We have used each to create risk-adjusted individual surgeon mortality funnel plots to demonstrate high mortality outcomes.

RESULTS

There were 458 (3.1%) deaths. The expected mortality and receiver operating characteristic (ROC) curve values were: uncalibrated EuroSCORE -5.8% and 0.80, calibrated EuroSCORE -3.1% and 0.80, locally derived model -3.1% and 0.82. The uncalibrated EuroSCORE plot showed one surgeon to have mortality above the northwest average, and no surgeon above the 95% control limit (CL). The calibrated EuroSCORE plot and the local model showed little change in surgeon ranking, but significant differences in identifying high mortality outcomes. Two of three surgeons above the 95% CL using the calibrated EuroSCORE revert to acceptable outcomes when the local model is applied but the finding is critically dependent on the calibration coefficient.

CONCLUSIONS

The uncalibrated EuroSCORE significantly overpredicted mortality and is not recommended. Instead, the EuroSCORE should be calibrated for contemporary performance. The differences demonstrated in defining high mortality outcomes when using a model built for purpose suggests that the choice of risk model is important when analysing surgeon mortality outcomes.

Associations between family circumstance and weight status of Australian children

OBJECTIVE

To examine associations between weight status and multiple indicators of family circumstance in Australian elementary school children.

METHODS

Data were combined from the 2001 Children's Leisure Activities Study (CLAS Study) and 2002/3 Health, Eating and Play Study (HEAP Study), involving 2520 children in Grades Prep (mean age 6 years) and 5-6 (mean age 11 years) in Melbourne, Australia. Children's body mass index (BMI) was calculated from measured height and weight. Weight status (non-overweight or overweight) was determined according to International Obesity Taskforce cut-off points and BMI was transformed to z-scores based on the 2000 US growth chart data. Parents reported family circumstance (number of parents in the home, marital status, presence of siblings, parental education, parental employment status, parental work hours [HEAP Study only]) and parental BMI. Regression analyses were conducted for the sample overall and separately for young girls, young boys, older girls and older boys.

RESULTS

Children in single-parent homes, those without siblings, and those with less educated mothers and fathers tended to have higher z-BMIs (p=0.002, p=0.003, p<0.001 and p<0.001, respectively) and were more likely to be overweight (p=0.003, p<0.001, p<0.001 and p=0.02, respectively). Associations were stronger for older children. Parental employment and work hours were not consistently associated with child weight status. The multivariable models did not demonstrate a cumulative explanatory effect (R(2)=0.02), except when maternal BMI was included (R(2)=0.07).

CONCLUSIONS

Individual measures of family circumstance were differentially associated with child weight status and appeared to be largely independent of other measures of family circumstance. Childhood overweight interventions may need to be tailored based on the age, gender, maternal BMI and family circumstances of the target group.

How far merit selection? Social stratification and the labour market

The question of how societies allocate occupational positions and subsequent rewards has long been of interest to sociologists. According to one influential theory, the needs of modern industrial societies and economies demand that high-level and functionally important occupational positions are allocated according to meritocratic principles. I argue that, ultimately, employers get the final say about which characteristics are rewarded in the labour market. In order to examine which skills and attributes are required by employers for particular occupations I analyse data drawn from a content analysis of c.5000 British newspaper job advertisements. The results show that both merit and non-merit characteristics are requested by employers in job advertisements, even for occupations falling within the higher classes. I also find evidence that employers have similar requirements for similar occupations, cross-cutting class boundaries.

Cellular response to modulated radiation fields

Cell survival following exposure to spatially modulated beams, as created by intensity-modulated radiotherapy (IMRT), is investigated. In vitro experiments were performed using malignant melanoma cells (MM576) exposed to a therapeutic megavoltage photon beam. We compared cell survival in modulated fields with cell survival in uniform control fields. Three different spatial modulations of the field were used: a control 'uniform' field in which all cells in a flask were uniformly exposed; a 'quarter' field in which 25% of cells at one end of the flask were exposed and a 'striped' field in which 25% of cells were exposed in three parallel stripes. The cell survival in both the shielded and unshielded regions of the modulated fields, as determined by a clonogenic assay, were compared to the cell survival in the uniform field. We have distinguished three ways in which cell survival is influenced by the fate of neighbouring cells. The first of these (type I effect) is the previously reported classical Bystander effect, where cell survival is reduced when communicating with irradiated cells. We find two new types of Bystander effect. The type II effect is an observed increase in cell survival when nearby cells receive a lethal dose. The type III effect is an increase in the survival of cells receiving a high dose of radiation, when nearby cells receive a low dose. These observations of the Bystander effects emphasize the need for improved radiobiological models, which include communicated effects and account for the effects of modulated dose distribution.

Course and outcome of acute limbic encephalitis with negative voltage-gated potassium channel antibodies

BACKGROUND

Limbic encephalitis is a potentially treatable immunological condition. The presence of voltage-gated potassium channel antibodies (VGKC-Ab) in the cerebrospinal fluid (CSF) and serum of patients with the condition is a marker of the disease associated with a non-paraneoplastic form and good response to treatment. Recent work has highlighted absent serum VGKC-Ab and distinct immunology in patients with the paraneoplastic form of limbic encephalitis.

METHODS

The cases of four patients with the typical clinical presentation, neuropsychological features and brain imaging of acute limbic encephalitis, in the absence of any evidence for associated cancer during a follow-up of at least 18 months are described here.

RESULTS

All patients had negative testing for VGKC-Ab measured during their acute presentation. All patients made some recovery, although they were left with marked cognitive deficits and persistent seizures.

CONCLUSION

These cases demonstrate that the absence of VGKC-Ab in limbic encephalitis does not necessarily imply a paraneoplastic form. Further work is required to establish the immunological basis for the disorder in these patients, and the optimal treatment regimen.

Diet and overweight and obesity in populations of African origin: Cameroon, Jamaica and the UK

OBJECTIVES

To determine the relationship of diet to overweight and obesity among populations of African origin.

DESIGN AND SETTING

Cross-sectional data were obtained from adults aged 25-74 years in rural Cameroon (n = 686), urban Cameroon (n = 975), Jamaica (n = 924) and Afro-Caribbeans in the UK (n = 257). Dietary data were collected using food-frequency questionnaires specifically designed for each site. Body mass index (BMI) was used as a measure of overweight.

RESULTS

The expected gradient in the distribution of overweight across sites was seen in females (rural Cameroon, 9.5%; urban Cameroon, 47.1%; Jamaica, 63.8%; UK, 71.6%); however, among males overweight was less prevalent in Jamaica (22.0%) than urban Cameroon (36.3%). In developing countries increased risks of overweight (BMI > or = 25 kg m(-2) were influenced by higher energy (urban Cameroonian men) and protein (Jamaican women) intakes. No dietary variables were associated with obesity (BMI > or = 30 kg m(-2) in Cameroon or Jamaica. In the UK, energy intakes were inversely related with overweight whereas increased risks of being overweight were associated with higher protein (men) and fat (women) intakes. Similarly, whereas higher protein and fat intakes in UK men and women were associated with obesity, carbohydrate intakes were associated with decreased risks of obesity in men.

CONCLUSIONS

Diet and overweight were associated in the UK but few dietary variables were related to overweight in Jamaica and the Cameroon. These findings suggest that associations between diet and overweight/obesity are not generalisable among populations.

A novel high-amylose barley cultivar (Hordeum vulgare var. Himalaya 292) lowers plasma cholesterol and alters indices of large-bowel fermentation in pigs

Hordeum vulgare var. Himalaya 292 is a new barley cultivar with altered starch synthesis and less total starch but more amylose, resistant starch (RS) and total and soluble NSP including β-glucan. To determine its nutritional potential, young pigs were fed diets containing stabilised wholegrain flours from either Himalaya 292, Namoi (a commercial barley), wheat bran or oat bran at equivalent dietary NSP concentrations for 21 d. Serum total cholesterol was significantly lowered by the Himalaya 292 diet relative to wheat bran, indicating that Himalaya 292 retained its hypocholesterolaemic potential. In all groups SCFA concentrations were highest in the proximal colon and decreased towards the rectum. Digesta pH was lowest in the proximal colon and highest in the distal colon. Large-bowel and faecal pH were significantly lower in the pigs fed the barley and oat diets, indicating greater bacterial fermentation. Caecal and proximal colonic pH was lowest and SCFA pools highest in the pigs fed Himalaya 292. Total and individual SCFA were lowest in the mid- and distal colon of the pigs fed Himalaya 292 or oat bran. These data suggest the presence of more RS in Himalaya 292 and suggest that its fermentation was rapid relative to transit. Differences in faecal and large-bowel anaerobic, aerobic, coliform and lactic acid bacteria were relatively small, indicating a lack of a specific prebiotic action. These data support the potential of this novel barley cultivar to improve health through plasma cholesterol reduction and increased large-bowel SCFA production.

The National Tuberculosis Curriculum Consortium: a model of multi-disciplinary educational collaboration

The National Tuberculosis Curriculum Consortium (NTCC) seeks to instill knowledge, skills, and appropriate attitudes in the management and control of tuberculosis (TB) among students in the health professions. Unlike other organizations that have produced quality educational materials aimed at practicing clinicians, public health workers, and the general public, the NTCC is primarily focused on undergraduate and graduate education. The NTCC includes geographically disparate faculty from schools of medicine, nursing, pharmacy, public health, respiratory therapy, clinical laboratory sciences, and physician assistant who are experts in the areas of TB, curriculum development, and educational computing. Collaboration occurs through meetings, phone conferences and an innovative web portal that provides a work zone used to develop, organize, and archive products and resources. A critical accomplishment of the Consortium has been the development of core competencies for TB education for graduates in each of the health care disciplines. Those for medical schools are presented in this article. Current NTCC efforts are directed at developing interactive materials for TB education that can be accessed by multi-disciplinary faculty, nationally and abroad. The collaborative effort of the NTCC serves as a model for future endeavors to strengthen curricula, particularly pertaining to health concerns that are best served by multi-disciplinary approaches.

Tension pneumoperitoneum resulting from endoscopic duodenal perforation: a case report

Tension pneumoperitoneum is defined as an accumulation of free air within the peritoneal cavity sufficient to cause respiratory or hemodynamic compromise. We report a case of a 75-year-old woman who underwent upper endoscopy for evaluation of severe upper gastrointestinal hemorrhage. During the procedure, she developed massive abdominal distension, raising concern about possible perforation. Endoscopy was terminated and prompt surgical consultation obtained. This revealed massive abdominal distension, hypotension, and elevated airway pressures. Tension pneumoperitoneum was suspected. There was immediate decompression via a small umbilical incision, after which the patient's condition stabilized. A full exploration was then carried out, allowing definitive surgical treatment of both the source of bleeding and the perforation. We review the literature regarding this unusual event.

Curvature and tortuosity of the superficial femoral artery: a possible risk factor for peripheral arterial disease

Atherosclerosis in the superficial femoral artery (SFA) resulting in peripheral arterial disease is more common in men than women and shows a predilection for the region of the adductor canal. Blood flow patterns are related to development of atherosclerosis, and we investigated if curvature and tortuosity of the femoral artery differed between young men and women and if differences resulted in adverse flow patterns. Magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) were combined in 18 young adult volunteers (9 men) to assess the relationship of flow features to likely sites of future atherosclerosis formation. Subjects underwent MRI of the right SFA, three-dimensional vascular geometry was reconstructed, and measures of tortuosity and curvature were calculated. Tortuosity and curvature were significantly greater for men than women, and this was related to increased body surface area, body mass index, or weight in men. In both sexes, “tortuosity” increased from the midthigh to the popliteal fossa. The greatest curvature was found within the distal quarter of the SFA. CFD modeling was undertaken on MRI-based reconstructions of the SFA. Wall shear stresses (WSS) were extracted from the computations. WSS showed greater spatial variation in the men than in the women, and the men exhibited lower mean WSS. These data indicate that sex differences related to body size and anatomical course of the femoral artery may contribute to the enhanced risk of focal atherosclerosis in the adductor canal.

Comparison of methods of assessment of renal function in cystic fibrosis (CF) patients

Renal failure is increasingly being recognised in CF patients, usually as a consequence of long-term nephrotoxic therapy. There is a need for a simple method of assessment of renal function in this patient group. We compared measured creatinine clearance from validated timed urine collections (the generally accepted practical test of glomerular filtration) with 10 formulae used to estimate creatinine clearance in a group of 74 CF adult patients and 29 matched normal controls. Compared to direct measurement, formulae gave a range of values (95% CI for mean bias -13 to +27.9 ml/min). Even those with the best correlation (r=0.7) gave wide error ranges (limits of agreement: -42.3 to 45.9 ml/min). The most commonly used formulae (Cockroft-Gault [CGF] and abbreviated Modification of Diet in Renal Disease [aMDRD]) were not superior to most other formulae tested. Both CGF and aMDRD-derived estimates compared less favourably in CF patients than controls (mean bias: 9.7 vs 3.4 ml/min (p<0.05) and 4.9 vs 1.4 (p<0.05) respectively; 78% vs 95% (p<0.01) and 77% vs 97% (p<0.01) of estimates within 33% of measurement respectively). In particular, both CGF and aMDRD grossly overestimated renal function (mean bias 18.3 and 15.8 ml/min respectively, p<0.001) in CF patients with reduced creatinine clearance (<80 ml/min). CGF, aMDRD and other formulae cannot be used to reliably assess renal function in CF patients, since they will fail to detect those with renal impairment. Some form of carefully supervised direct measurement is still required.

Mental well-being of doctors and nurses in two hospitals in kingston, Jamaica

Hospital work involves some of the most stressful situations found in any workplace. Furthermore, hospital workers may be affected by non-work-related stress such as family responsibilities and financial difficulties, leading to impaired mental well-being and suboptimal performance. The aim of this study was to assess the level of general mental well-being among doctors and nurses from two hospitals in Kingston, Jamaica. A total of 212 doctors and nurses at the Kingston Public Hospital and the University Hospital of the West Indies were studied yielding a participation rate of 83.1%. A self-administered questionnaire was used to gather social and biomedical data and the General Health Questionnaire 30 (GHQ 30) used to determine general mental well-being. Probable caseness was defined as a GHQ 30 score > 5. Focus group discussions were also held with staff at both hospitals. A total of 27.4% of the study population met the GHQ-30 criteria (caseness) defining them as probable cases of mental distress. Cases and non-cases were not different in age, gender or hospital of employment. However, caseness was associated with years of professional experience, work-related and non-work-related stress, serious financial difficulties and fears of coming to work. Significant predictors of increased risk of caseness were fear of coming to work (OR 3.06; CI 1.40, 6.70); professional experience in excess of five-years and high non-work-related stress. High work-related stress was associated with reduced risk of being classified a case, suggesting that work may have been therapeutic. Focus group discussions suggested that non-work stress was related to financial difficulties, commuting and child care, especially among nurses. Intervention to improve general mental well-being should be targeted at new employees and should address child care, commuting and financial management.