1
|
Menezes D, Sonnenberg P, Willis M, Mercer CH, Mitchell K, Field N. Compliance with COVID-19 rules on intimate physical contact between households. Sex Transm Infect 2024; 100:54. [PMID: 38071580 DOI: 10.1136/sextrans-2023-055948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/21/2023] [Indexed: 12/22/2023] Open
Affiliation(s)
- Dee Menezes
- Institute of Health Informatics Research, University College London, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Malachi Willis
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | - Nigel Field
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
2
|
Candal-Pedreira C, Ross JS, Marušić A, Ruano-Ravina A. Research misconduct as a challenge for academic institutions and scientific journals. J Epidemiol Community Health 2023; 78:61-64. [PMID: 37666652 DOI: 10.1136/jech-2023-220554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
Research misconduct refers to a set of unethical practices in research and publication and is the main reason for retraction of articles published in the academic literature. Research misconduct has negative consequences and has generated public scepticism about research, which has led to increasing distrust in science. In this context, a joint effort by the scientific community, academic institutions, scientific journals and research funders is needed to identify and prevent research misconduct. In this paper, we will evaluate what has already been done and what is needed to do to better address research misconduct. The focus of this paper will be on the actions taken by academic institutions, as the first line of defence, and scientific journals, as the gatekeepers of science. However, scientific journals and academic institutions are only a part of a much larger and multistakeholder effort needed to address the challenges scientific research is facing.
Collapse
Affiliation(s)
- Cristina Candal-Pedreira
- Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
| | - Joseph S Ross
- Section of General Internal Medicine and National Clinican Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Ana Marušić
- Center for Evidence-based Medicine and Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Alberto Ruano-Ravina
- Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| |
Collapse
|
3
|
Muchomba FM, Teitler JO, Reichman NE. Municipal social expenditures and maternal health disparities: a study of linked birth and hospitalisation records. J Epidemiol Community Health 2023; 78:jech-2023-220558. [PMID: 37875339 PMCID: PMC11039565 DOI: 10.1136/jech-2023-220558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Local government expenditures provide services and benefits that can affect health but the extent to which they are associated with narrowing or widening of racial/ethnic and socioeconomic disparities in health is unknown. We examined race/ethnicity-stratified and education-stratified associations between municipal social expenditures-those on housing, transportation, education, and other society-wide needs-and serious life-threatening maternal health conditions in a large US state. METHODS In this cross-sectional study, we used individual birth records for 1 003 974 births in the state of New Jersey from 1 January 2008 to 31 December 2018 linked to individual maternal hospital discharge records and municipality-level characteristics for 564 municipalities. Severe maternal morbidity (SMM) was identified in the discharge records using a measure developed by the US Centers for Disease Control and Prevention. Associations between municipal-level social expenditures per capita and SMM were estimated using multilevel logistic models. RESULTS Residing in a municipality with higher social expenditures was associated with lower odds of SMM across all racial/ethnic groups and education levels. Overall, 1% higher annual social expenditures per capita was associated with 0.21% (95% CI -0.29 to -0.13) lower odds of SMM. The associations were greater for individuals with less than a high school education than for those in the other educational groups in both relative (lnOR -0.53; 95% CI -0.74 to -0.31) and absolute (β -0.013; 95% CI -0.019 to -0.008) terms. CONCLUSION Municipal-level spending on social services is associated with narrowing socioeconomic disparities in SMM. Narrowing racial/ethnic disparities in maternal health will likely require intervening beyond the provision of services to addressing historical and ongoing structural factors.
Collapse
Affiliation(s)
- Felix M Muchomba
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Julien O Teitler
- School of Social Work, Columbia University, New York, New York, USA
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| |
Collapse
|
4
|
Frías R. Let's do it right: Eight steps to competence in laboratory animal science in the European Union. Lab Anim 2023; 57:112-116. [PMID: 36960677 PMCID: PMC10155278 DOI: 10.1177/00236772231157455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Demonstrated competence in laboratory animal science (LAS) is a prerequisite in Directive 2010/63/EU to work with animals used in scientific procedures, as it is essential to increase animal welfare, improve the quality of science, promote the acceptability of animal research and meet the demands of free movement of personnel and scientific exchange. Although since 2010 there have been eight clear steps to achieving the required competence of personnel working with animals used in science, it is not uncommon to see documentation for individuals who have just completed an LAS course that contains only education and training elements (three steps), for which the status of competence in LAS is granted. Here, a simplified summary of how competence in LAS should be delivered in eight steps according to EU recommendations is presented.
Collapse
Affiliation(s)
- Rafael Frías
- Unit for Education and Training, Comparative Medicine, Karolinska Institute, Sweden
| |
Collapse
|
5
|
Walsh D, Dundas R, McCartney G, Gibson M, Seaman R. Bearing the burden of austerity: how do changing mortality rates in the UK compare between men and women? J Epidemiol Community Health 2022; 76:1027-1033. [PMID: 36195463 PMCID: PMC9664129 DOI: 10.1136/jech-2022-219645] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/06/2022] [Indexed: 12/17/2022]
Abstract
Background Mortality rates across the UK stopped improving in the early 2010s, largely attributable to UK Government’s ‘austerity’ policies. Such policies are thought to disproportionately affect women in terms of greater financial impact and loss of services. The aim here was to investigate whether the mortality impact of austerity—in terms of when rates changed and the scale of excess deaths—has also been worse for women. Methods All-cause mortality data by sex, age, Great Britain (GB) nation and deprivation quintile were obtained from national agencies. Trends in age-standardised mortality rates were calculated, and segmented regression analyses used to identify break points between 1981 and 2019. Excess deaths were calculated for 2012–2019 based on comparison of observed deaths with numbers predicted by the linear trend for 1981–2011. Results Changes in trends were observed for both men and women, especially for those living in the 20% most deprived areas. In those areas, mortality increased between 2010/2012 and 2017/2019 among women but not men. Break points in trends occurred at similar time points. Approximately 335 000 more deaths occurred between 2012 and 2019 than was expected based on previous trends, with the excess greater among men. Conclusions It remains unclear whether there are sex differences in UK austerity-related health effects. Nonetheless, this study provides further evidence of adverse trends in the UK and the associated scale of excess deaths. There is a clear need for such policies to be reversed, and for policies to be implemented to protect the most vulnerable in society.
Collapse
Affiliation(s)
- David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Science, University of Glasgow, Glasgow, UK
| | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, UK.,Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Marcia Gibson
- MRC/CSO Social and Public Health Science, University of Glasgow, Glasgow, UK
| | - Rosie Seaman
- MRC/CSO Social and Public Health Science, University of Glasgow, Glasgow, UK
| |
Collapse
|
6
|
Leifheit KM, Schwartz GL, Pollack CE, Linton SL. Building health equity through housing policies: critical reflections and future directions for research. J Epidemiol Community Health 2022; 76:jech-2021-216439. [PMID: 35701105 PMCID: PMC9279751 DOI: 10.1136/jech-2021-216439] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/28/2022] [Indexed: 12/02/2022]
Abstract
Housing may be at once the most powerful and underused tool at our disposal to improve population health. Using examples from the USA, we argue that current levels of housing insecurity are the result of clear and inequitable policy choices, leading to the entrenchment of health inequities-particularly, across race and class. Solutions to housing insecurity must, therefore, be structural. The COVID-19 pandemic has opened a window of opportunity for these structural housing policy reforms. Through justice- and action-oriented research, health researchers can inform the development and implementation of housing policies that advance health equity. We offer a series of recommendations to better position our field to achieve this goal.
Collapse
Affiliation(s)
- Kathryn M Leifheit
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, California, USA
| | - Craig Evan Pollack
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Walsh D, Wyper GMA, McCartney G. Trends in healthy life expectancy in the age of austerity. J Epidemiol Community Health 2022; 76:jech-2022-219011. [PMID: 35667853 PMCID: PMC9279837 DOI: 10.1136/jech-2022-219011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Worrying changes in life expectancy trends have been observed recently in the UK, largely attributed to austerity policies introduced over the last decade. To incorporate changes to quality, rather than just length of, life, our aim was to describe trends in healthy life expectancy (HLE) for the relevant period. METHODS In the absence of available long-term trends, we calculated new estimates of HLE for Scotland for the period 1995-2019, using standard HLE methodologies based on mortality and national survey data, and stratified by sex and socioeconomic deprivation. RESULTS Overall, male and female HLE increased markedly between 1995 and 2009, but then decreased by approximately 2 years between 2011 and 2019. A decline was observed for the most and least deprived groups, but this was larger for those living in the 20% most deprived areas, where the decrease was 3.5 years. CONCLUSIONS Our findings are further evidence of changing levels of pre-pandemic population health in the UK. An increasing body of UK and international evidence have attributed these changes to UK Government austerity policies. There is an urgent need, therefore, to reverse cuts to social security and protect the income and health of the poorest across all of the UK.
Collapse
Affiliation(s)
- David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | | | | |
Collapse
|
8
|
Murphy P, Glynn D, Dias S, Hodgson R, Claxton L, Beresford L, Cooper K, Tappenden P, Ennis K, Grosso A, Wright K, Cantrell A, Stevenson M, Palmer S. Modelling approaches for histology-independent cancer drugs to inform NICE appraisals: a systematic review and decision-framework. Health Technol Assess 2022; 25:1-228. [PMID: 34990339 DOI: 10.3310/hta25760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The first histology-independent marketing authorisation in Europe was granted in 2019. This was the first time that a cancer treatment was approved based on a common biomarker rather than the location in the body at which the tumour originated. This research aims to explore the implications for National Institute for Health and Care Excellence appraisals. METHODS Targeted reviews were undertaken to determine the type of evidence that is likely to be available at the point of marketing authorisation and the analyses required to support National Institute for Health and Care Excellence appraisals. Several challenges were identified concerning the design and conduct of trials for histology-independent products, the greater levels of heterogeneity within the licensed population and the use of surrogate end points. We identified approaches to address these challenges by reviewing key statistical literature that focuses on the design and analysis of histology-independent trials and by undertaking a systematic review to evaluate the use of response end points as surrogate outcomes for survival end points. We developed a decision framework to help to inform approval and research policies for histology-independent products. The framework explored the uncertainties and risks associated with different approval policies, including the role of further data collection, pricing schemes and stratified decision-making. RESULTS We found that the potential for heterogeneity in treatment effects, across tumour types or other characteristics, is likely to be a central issue for National Institute for Health and Care Excellence appraisals. Bayesian hierarchical methods may serve as a useful vehicle to assess the level of heterogeneity across tumours and to estimate the pooled treatment effects for each tumour, which can inform whether or not the assumption of homogeneity is reasonable. Our review suggests that response end points may not be reliable surrogates for survival end points. However, a surrogate-based modelling approach, which captures all relevant uncertainty, may be preferable to the use of immature survival data. Several additional sources of heterogeneity were identified as presenting potential challenges to National Institute for Health and Care Excellence appraisal, including the cost of testing, baseline risk, quality of life and routine management costs. We concluded that a range of alternative approaches will be required to address different sources of heterogeneity to support National Institute for Health and Care Excellence appraisals. An exemplar case study was developed to illustrate the nature of the assessments that may be required. CONCLUSIONS Adequately designed and analysed basket studies that assess the homogeneity of outcomes and allow borrowing of information across baskets, where appropriate, are recommended. Where there is evidence of heterogeneity in treatment effects and estimates of cost-effectiveness, consideration should be given to optimised recommendations. Routine presentation of the scale of the consequences of heterogeneity and decision uncertainty may provide an important additional approach to the assessments specified in the current National Institute for Health and Care Excellence methods guide. FURTHER RESEARCH Further exploration of Bayesian hierarchical methods could help to inform decision-makers on whether or not there is sufficient evidence of homogeneity to support pooled analyses. Further research is also required to determine the appropriate basis for apportioning genomic testing costs where there are multiple targets and to address the challenges of uncontrolled Phase II studies, including the role and use of surrogate end points. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 76. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Peter Murphy
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Glynn
- Centre for Health Economics, University of York, York, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lindsay Claxton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Beresford
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Katy Cooper
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Kate Ennis
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
9
|
Yang Y, Langellier BA, Stankov I, Purtle J, Nelson KL, Reinhard E, Van Lenthe FJ, Diez Roux AV. Public transit and depression among older adults: using agent-based models to examine plausible impacts of a free bus policy. J Epidemiol Community Health 2020; 74:875-881. [PMID: 32535549 DOI: 10.1136/jech-2019-213317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Daily transport is associated with mental health. A free bus policy (FBP) may be effective in promoting the use of public transit in older adults and be associated with reductions in depressive symptoms. METHODS We developed an agent-based model and grounded it using empirical data from England to examine the impact of an FBP on public transit use and depression among older adults. We also used the model to explore whether the impact of the FBP bus use and depression is modified by the type of income segregation or by simultaneous efforts to improve attitudes towards the bus, to reduce waiting times or to increase the cost of driving via parking fees or fuel price. RESULTS Our model suggests that improving attitudes towards the bus (eg, campaigns that promote bus use) could enhance the effect of the FBP, especially for those in proximity to public transit. Reducing wait times could also significantly magnify FPB impacts, especially in those who live in proximity to public transit. Contrary to expectation, neither fuel costs nor parking fees significantly enhanced the impact of the FBP. The impact of improving attitudes towards the bus and increasing bus frequency was more pronounced in the lower-income groups in an income segregation scenario in which destination and public transit are denser in the city centre. CONCLUSION Our results suggest that the beneficial mental health effects of an FBP for older adults can be magnified when combined with initiatives that reduce bus waiting times and increased spatial access to transit.
Collapse
Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Erica Reinhard
- Department of Global Health and Social Medicine, School of Global Affairs, King's College London, London, UK
| | - Frank J Van Lenthe
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Affiliation(s)
- Daniel Richardson
- Brighton & Sussex University NHS Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
| | | |
Collapse
|
11
|
Affiliation(s)
- Ilora Finlay
- Cardiff University, and crossbench peer, House of Lords
| |
Collapse
|
12
|
Vandenberg LN, Blumberg B, Antoniou MN, Benbrook CM, Carroll L, Colborn T, Everett LG, Hansen M, Landrigan PJ, Lanphear BP, Mesnage R, vom Saal FS, Welshons WV, Myers JP. Is it time to reassess current safety standards for glyphosate-based herbicides? J Epidemiol Community Health 2017; 71:613-618. [PMID: 28320775 PMCID: PMC5484035 DOI: 10.1136/jech-2016-208463] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 01/06/2023]
Abstract
Use of glyphosate-based herbicides (GBHs) increased ∼100-fold from 1974 to 2014. Additional increases are expected due to widespread emergence of glyphosate-resistant weeds, increased application of GBHs, and preharvest uses of GBHs as desiccants. Current safety assessments rely heavily on studies conducted over 30 years ago. We have considered information on GBH use, exposures, mechanisms of action, toxicity and epidemiology. Human exposures to glyphosate are rising, and a number of in vitro and in vivo studies challenge the basis for the current safety assessment of glyphosate and GBHs. We conclude that current safety standards for GBHs are outdated and may fail to protect public health or the environment. To improve safety standards, the following are urgently needed: (1) human biomonitoring for glyphosate and its metabolites; (2) prioritisation of glyphosate and GBHs for hazard assessments, including toxicological studies that use state-of-the-art approaches; (3) epidemiological studies, especially of occupationally exposed agricultural workers, pregnant women and their children and (4) evaluations of GBHs in commercially used formulations, recognising that herbicide mixtures likely have effects that are not predicted by studying glyphosate alone.
Collapse
Affiliation(s)
- Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts—Amherst, Amherst, Massachusetts, USA
| | - Bruce Blumberg
- Department of Developmental and Cell Biology, University of California, Irvine, California, USA
| | - Michael N Antoniou
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Charles M Benbrook
- University of Newcastle, Newcastle, UK
- Benbrook Consulting Services, Enterprise, Oregon, USA
| | - Lynn Carroll
- TEDX, The Endocrine Disruption Exchange, Paonia, Colorado, USA
| | - Theo Colborn
- TEDX, The Endocrine Disruption Exchange, Paonia, Colorado, USA
| | | | | | - Philip J Landrigan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce P Lanphear
- Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin Mesnage
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Frederick S vom Saal
- Division of Biological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Wade V Welshons
- Department of Biomedical Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - John Peterson Myers
- Environmental Health Sciences, Charlottesville, Virginia, USA
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
13
|
Kokkinen L, Shankardass K, O'Campo P, Muntaner C. Taking health into account in all policies: raising and keeping health equity high on the political agenda. J Epidemiol Community Health 2017; 71:745-746. [PMID: 28416570 DOI: 10.1136/jech-2016-207736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Lauri Kokkinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Ketan Shankardass
- Wilfrid Laurier University, Waterloo, Ontario, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Abstract
OBJECTIVES To examine how population-level socioeconomic health inequalities developed during childhood, for children born at the turn of the 21st century and who grew up with major initiatives to tackle health inequalities (under the New Labour Government). SETTING The UK. PARTICIPANTS Singleton children in the Millennium Cohort Study at ages 3 (n=15 381), 5 (n=15 041), 7 (n=13 681) and 11 (n=13 112) years. PRIMARY OUTCOMES Relative (prevalence ratios (PR)) and absolute health inequalities (prevalence differences (PD)) were estimated in longitudinal models by socioeconomic circumstances (SEC; using highest maternal academic attainment, ranging from 'no academic qualifications' to 'degree' (baseline)). Three health outcomes were examined: overweight (including obesity), limiting long-standing illness (LLSI), and socio-emotional difficulties (SED). RESULTS Relative and absolute inequalities in overweight, across the social gradient, emerged by age 5 and increased with age. By age 11, children with mothers who had no academic qualifications were considerably more likely to be overweight as compared with those with degree-educated mothers (PR=1.6 (95% CI 1.4 to 1.8), PD=12.9% (9.1% to 16.8%)). For LLSI, inequalities emerged by age 7 and remained at 11, but only for children whose mothers had no academic qualifications (PR=1.7 (1.3 to 2.3), PD=4.8% (2% to 7.5%)). Inequalities in SED (observed across the social gradient and at all ages) declined between 3 and 11, although remained large at 11 (eg, PR=2.4 (1.9 to 2.9), PD=13.4% (10.2% to 16.7%) comparing children whose mothers had no academic qualifications with those of degree-educated mothers). CONCLUSIONS Although health inequalities have been well documented in cross-sectional and trend data in the UK, it is less clear how they develop during childhood. We found that relative and absolute health inequalities persisted, and in some cases widened, for a cohort of children born at the turn of the century. Further research examining and comparing the pathways through which SECs influence health may further our understanding of how inequalities could be prevented in future generations of children.
Collapse
Affiliation(s)
- Emeline Rougeaux
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Steven Hope
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine Law
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anna Pearce
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
15
|
Sund R, Lahtinen H, Wass H, Mattila M, Martikainen P. How voter turnout varies between different chronic conditions? A population-based register study. J Epidemiol Community Health 2016; 71:475-479. [PMID: 27965314 DOI: 10.1136/jech-2016-208314] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND While poor self-rated health is known to decrease an individual's propensity to vote, disaggregation of the components of health on turnout has thus far received only little attention. This study deepens on the understanding of such relationships by examining the association between chronic diseases and voting. METHODS The study uses an individual-level register-based data set that contains an 11% random sample of the entire electorate in the 1999 Finnish parliamentary elections. With information on hospital discharge diagnoses and reimbursements for drugs prescribed, we identify persons with chronic hospital-treated diseases (coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma, depression, cancer, psychotic mental disease, diabetes, cerebrovascular disease, rheumatic disease, epilepsy, arthrosis, alcoholism, dementia, atherosclerosis, Parkinson's disease, other degenerative brain diseases, multiple sclerosis and kidney disease). RESULTS After adjusting for gender, age, education, occupational class, income, partnership status, cohabitation with underaged children and hospitalisation during Election Day, neurodegenerative brain diseases had the strongest negative relationship with voting (dementia OR=0.20, 95% CI 0.18 to 0.22; others up to OR=0.70). Alcoholism (OR=0.66) and mental disorders also had a negative association (depression OR=0.91; psychotic mental disease OR=0.79), whereas cancer and COPD/asthma had a positive association (both OR=1.05). Having more than one condition at a time further decreased voting probability. CONCLUSIONS By showing how different health conditions are related to voter turnout, this study provides essential information for identifying gaps in the potential for political participation and for further inquiries aiming to develop models that explain the link between health and voting probability.
Collapse
Affiliation(s)
- Reijo Sund
- Department of Social Research, University of Helsinki, Helsinki, Finland.,Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Hannu Lahtinen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Hanna Wass
- Department of Political and Economic Studies, University of Helsinki, Helsinki, Finland
| | - Mikko Mattila
- Department of Political and Economic Studies, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Department of Social Research, University of Helsinki, Helsinki, Finland.,Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden.,The Max Planck Institute for Demographic Research, Rostock, Germany
| |
Collapse
|
16
|
Reeves A, McKee M, Mackenbach J, Whitehead M, Stuckler D. Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004-2010. J Epidemiol Community Health 2016; 71:174-180. [PMID: 27965315 PMCID: PMC5284463 DOI: 10.1136/jech-2015-206257] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 04/15/2016] [Accepted: 05/23/2016] [Indexed: 11/05/2022]
Abstract
Background Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. Methods We integrated panel data on 16 European countries for years 2004–2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. Results We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI −0.55 to −1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI −1.19 to −2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=−1.21 percentage points, 95% CI −0.37 to −2.06). Conclusions Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments.
Collapse
Affiliation(s)
- Aaron Reeves
- International Inequalities Institute, London School of Economics and Political Science, UK.,Department of Sociology, University of Oxford, Oxford, UK
| | - Martin McKee
- Department of Public Health and Policy, LSHTM, London, UK
| | | | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK.,Department of Public Health and Policy, LSHTM, London, UK
| |
Collapse
|
17
|
Crammond B, Carey G. What is policy and where do we look for it when we want to research it? J Epidemiol Community Health 2016; 71:404-408. [PMID: 27864323 DOI: 10.1136/jech-2016-207945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 11/03/2022]
Abstract
Public health researchers are increasingly concerned with achieving 'upstream' change to achieve reductions in the global burden of disease and health inequalities. Consequently, understanding policy and how to change it has become a central goal of public health. Yet conceptualisation of what constitutes policy and where it can be found is very limited within this field. Our glossary demonstrates that policy is many headed. It is located in a vast array of documents, discussions dialogues and actions which can be captured variously by formal and informal forms of documentation and observation. Effectively understanding policy and its relevance for public health requires an awareness of the full range of places and contexts in which policy work happens and policy documents are produced.
Collapse
Affiliation(s)
- Brad Crammond
- Michael Kirby Centre for Public Health and Human Rights, Monash University, Melbourne, Victoria, Australia
| | - Gemma Carey
- Centre for Public Service Research, Business School, University of New South Wales Canberra, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
18
|
McLaren L, Singhal S. Does cessation of community water fluoridation lead to an increase in tooth decay? A systematic review of published studies. J Epidemiol Community Health 2016; 70:934-40. [PMID: 27177581 PMCID: PMC5013153 DOI: 10.1136/jech-2015-206502] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 04/13/2016] [Indexed: 01/21/2023]
Abstract
Background Cessation of community water fluoridation (CWF) appears to be occurring with increasing frequency in some regions. Our objective was to comprehensively review published research on the impact of CWF cessation on dental caries. Methods We searched 13 multidisciplinary databases. Results were synthesised qualitatively and quantitatively. Results We identified 15 instances of CWF cessation (‘intervention’) in 13 countries, which covered a broad time frame (1956–2003) and diverse geographical and political/economic contexts. Overall, results were mixed, but pointed more to an increase in caries postcessation than otherwise. For example, of the 9 studies with at least moderate methodological quality based on criteria we developed for this review, 5 showed an increase in caries postcessation. 3 studies did not show an increase in caries postcessation; however, important postcessation changes (eg, implementation of alternative fluoride delivery programmes) and/or large-scale social change may have contributed to those effects. Of the 3 study groupings that permitted quantitative synthesis, 2 showed statistically significant mean overall increase in caries postcessation; however, quantitative synthesis results must be interpreted cautiously. Conclusions Overall, the published research points more to an increase in dental caries post-CWF cessation than otherwise. However, the literature is highly diverse and variable in methodological quality. To build this literature, it is important to exploit research opportunities presented by CWF cessation. Remaining knowledge gaps include the impact of CWF cessation on the distribution of dental caries (ie, equitable or not) and understanding the decision-making circumstances around CWF cessation.
Collapse
Affiliation(s)
- Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sonica Singhal
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Affiliation(s)
- Bethan Davies
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| |
Collapse
|
20
|
Buba A, Fisher M, Roberts J, Youssef E, Hassan Ibrahim M, Brown M, Richardson D. The acceptability of routine HIV testing in general medical admissions using a sexual health advisor/healthcare assistant model. Sex Transm Infect 2016; 92:69. [PMID: 26792638 DOI: 10.1136/sextrans-2015-052335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amina Buba
- Department of Sexual Health & HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin Fisher
- Department of Sexual Health & HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK Brighton & Sussex Medical School, Brighton, UK
| | - Jonathan Roberts
- Department of Sexual Health & HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Elaney Youssef
- Department of Sexual Health & HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mohammed Hassan Ibrahim
- Department of Sexual Health & HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Michael Brown
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Richardson
- Department of Sexual Health & HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK Brighton & Sussex Medical School, Brighton, UK
| |
Collapse
|
21
|
Vohra J, Marmot MG, Bauld L, Hiatt RA. Socioeconomic position in childhood and cancer in adulthood: a rapid-review. J Epidemiol Community Health 2015; 70:629-34. [PMID: 26715591 PMCID: PMC4893135 DOI: 10.1136/jech-2015-206274] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/30/2015] [Indexed: 02/05/2023]
Abstract
Background The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes. Methods and results We performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest. Conclusions Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented.
Collapse
Affiliation(s)
- Jyotsna Vohra
- Department of Cancer Prevention, Cancer Research UK, London, UK
| | - Michael G Marmot
- Department of Epidemiology and Public Health, UCL Institute of Health Equity, London, UK
| | - Linda Bauld
- Institute for Social Marketing, 3Y1, University of Stirling, Stirling, UK
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
22
|
Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M. 'First, do no harm': are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. J Epidemiol Community Health 2015; 70:339-45. [PMID: 26573235 PMCID: PMC4819657 DOI: 10.1136/jech-2015-206209] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/05/2015] [Indexed: 11/09/2022]
Abstract
Background In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist—the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies. Method We used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health. Results Each additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities. Conclusions The programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.
Collapse
Affiliation(s)
- B Barr
- University of Liverpool, Liverpool, UK
| | | | | | | | | | | |
Collapse
|
23
|
Cambois E, Solé-Auró A, Brønnum-Hansen H, Egidi V, Jagger C, Jeune B, Nusselder WJ, Van Oyen H, White C, Robine JM. Educational differentials in disability vary across and within welfare regimes: a comparison of 26 European countries in 2009. J Epidemiol Community Health 2015; 70:331-8. [PMID: 26546286 DOI: 10.1136/jech-2015-205978] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/09/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes. METHODS Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30-79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups. RESULTS The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0-1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7-2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8-1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4-0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups. CONCLUSIONS The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.
Collapse
Affiliation(s)
- Emmanuelle Cambois
- Department of Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), Paris, France
| | - Aïda Solé-Auró
- Department of Political and Social Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Henrik Brønnum-Hansen
- Department of Public Health, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Viviana Egidi
- Department of Statistical Science, Sapienza University of Rome, Roma, Italy
| | - Carol Jagger
- Newcastle University Institute for Ageing and Institute of Health & Society, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Bernard Jeune
- Department of Epidemiology, Institute of Public Health, and Danish Ageing Research Center, University of Southern Denmark, Odense, Denmark
| | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Chris White
- Government Statistical Service, Office for National Statistics, Government Buildings, Newport, UK
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Pratique des Hautes Etudes (EPHE) and Institut National d'Etudes Démographiques (INED), Montpellier, France
| |
Collapse
|
24
|
Ballard PJ, Syme SL. Engaging youth in communities: a framework for promoting adolescent and community health. J Epidemiol Community Health 2015; 70:202-6. [PMID: 26443541 DOI: 10.1136/jech-2015-206110] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/20/2015] [Indexed: 11/04/2022]
Abstract
Health researchers and practitioners increasingly recognise the important role communities play in shaping individual health. Health researchers recognise the role of community factors as causes or determinants of health problems; use community-based methods for understanding complex health issues; and design community-level health solutions. In this commentary, we propose a fourth way to think about the role of communities in individual health by arguing that the community engagement process itself has implications for individual health and strong communities. This topic is especially important during adolescence, a developmental window of opportunity during which individuals need meaningful opportunities to contribute to the world around them.
Collapse
Affiliation(s)
- Parissa J Ballard
- University of California, Berkeley and University of California, San Francisco, California, USA
| | | |
Collapse
|
25
|
Abstract
A conflict of interest arises by having two conflicting goals in one's research. The primary goal of research relevant to public health is to produce impartial evidence on health hazards for humans. Several entities - including industry - may have public health as a goal among others, but this is not their primary goal. Primary goals are in those cases profit or career, that conflict with the goal of health. It is a role of the State to foster research whose primary goal is impartial evidence on factors affecting population health. Disclosure of conflicts of interest is not enough: the view that disclosure solves all problems amounts to say that a declaration of having produced unbiased evidence is a self-fulfilling guarantee that the evidence will not be affected by conflicts of interest. This concept is seriously misleading. A conflict of interest arises from the circumstances in which research occurs and does not exist only in the opinion of some people or groups (or the authors of a paper).
Collapse
Affiliation(s)
- Paolo Vineis
- School of Public Health, Imperial College London, London, UK
| | - Rodolfo Saracci
- International Agency for Research on Cancer, Lyon, France IFC-National Research Council, Pisa, Italy
| |
Collapse
|
26
|
Duff P, Shoveller J, Dobrer S, Ogilvie G, Montaner J, Chettiar J, Shannon K. The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale. J Epidemiol Community Health 2015; 69:666-72. [PMID: 25678713 PMCID: PMC4675653 DOI: 10.1136/jech-2014-204427] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/23/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to report on a newly developed Safer Indoor Work Environmental Scale that characterises the social, policy and physical features of indoor venues and social cohesion; and using this scale, longitudinally evaluate the association between these features on sex workers' (SWs') condom use for pregnancy prevention. METHODS Drawing on a prospective open cohort of female SWs working in indoor venues, a newly developed Safer Indoor Work Environment Scale was used to build six multivariable models with generalised estimating equations (GEE), to determine the independent effects of social, policy and physical venue-based features and social cohesion on condom use. RESULTS Of 588 indoor SWs, 63.6% used condoms for pregnancy prevention in the last month. In multivariable GEE analysis, the following venue-based features were significantly correlated with barrier contraceptive use for pregnancy prevention: managerial practices and venue safety policies (adjusted OR (AOR)=1.09; 95% CI 1.01 to 1.17), access to sexual and reproductive health services/supplies (AOR=1.10; 95% CI 1.00 to 1.20), access to drug harm reduction (AOR=1.13; 95% CI 1.01 to 1.28) and social cohesion among workers (AOR=1.05; 95% CI 1.03 to 1.07). Access to security features was marginally associated with condom use (AOR=1.13; 95% CI 0.99 to 1.29). CONCLUSIONS The findings of the current study highlight how work environment and social cohesion among SWs are related to improved condom use. Given global calls for the decriminalisation of sex work, and potential legislative reforms in Canada, this study points to the critical need for new institutional arrangements (eg, legal and regulatory frameworks; labour standards) to support safer sex workplaces.
Collapse
Affiliation(s)
- Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Sabina Dobrer
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, CANADA, V5Z 454
| | - Julio Montaner
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Jill Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| |
Collapse
|
27
|
Abstract
According to the Department of Social Development, disability grants are available to adult South African citizens and permanent residents who are incapacitated and unable to work due to illness or disability. A number of people living with HIV/AIDS (PWAs) have accessed disability grants once they have fulfilled the criteria set down by the Department of Social Development. Current government policies entitle PWAs, a least in theory, to access antiretroviral medications. Where PWAs have been able to access antiretroviral treatment (ART) through the government's antiretroviral programme, this has led to an improvement in their health and subsequent disqualification for a disability grant. In South Africa's highly unequal society, the disability grant often operates as the only source of income for poor families. This has created an untenable situation as many PWAs are forced to choose between receiving their disability grant and accessing life-saving medication. We explore the intersection of social security with access to ART and argue that it presents complex problems in the context of HIV/AIDS, and thus requires urgent debate and resolution. Potential solutions to this problem, including the provision of a basic income grant to all South Africans, are proposed.
Collapse
|
28
|
D'Abramo F. Biobank research, informed consent and society. Towards a new alliance? J Epidemiol Community Health 2015; 69:1125-8. [PMID: 25669218 DOI: 10.1136/jech-2014-205215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/19/2015] [Indexed: 01/18/2023]
Abstract
With the rise of -omics disciplines and biobank research, personal data and biosamples crossing national borders pose new ethical questions. In this article, informed consent, as originally conceived, is shown as not being sufficient to address aims of research and interests of patients any more. Therefore the author has, after having scrutinised issues in biobanking, sketched a model of dynamic consent and a manner of scrutinising ethical issues through empirical data.
Collapse
|
29
|
Carey G, Crammond B. A glossary of policy frameworks: the many forms of 'universalism' and policy 'targeting'. J Epidemiol Community Health 2014; 71:303-307. [PMID: 25294894 DOI: 10.1136/jech-2014-204311] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 11/04/2022]
Abstract
The recognition that certain characteristics (such as poverty, disadvantage or membership of marginalised social or cultural groups) can make individuals more susceptible to illness has reignited interest in how to combine universal programmes and policies with ones targeted at specific groups. However, 'universalism' and 'targeting' are used in different ways for different purposes. In this glossary, we define different types and approaches to universalism and targeting. We anticipate that greater clarity in relation to what is meant by 'universalism' and 'targeting' will lead to a more nuanced debate and practice in this area.
Collapse
Affiliation(s)
- Gemma Carey
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Brad Crammond
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
30
|
Kondo N, Rostila M, Yngwe MÅ. Rising inequality in mortality among working-age men and women in Sweden: a national registry-based repeated cohort study, 1990-2007. J Epidemiol Community Health 2014; 68:1145-50. [PMID: 25143429 PMCID: PMC4255670 DOI: 10.1136/jech-2013-203619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background In the past two decades, health inequality has persisted or increased in states with comprehensive welfare. Methods We conducted a national registry-based repeated cohort study with a 3-year follow-up between 1990 and 2007 in Sweden. Information on all-cause mortality in all working-age Swedish men and women aged between 30 and 64 years was collected. Data were subjected to temporal trend analysis using joinpoint regression to statistically confirm the trajectories observed. Results Among men, age-standardised mortality rate decreased by 38.3% from 234.9 to 145 (per 100 000 population) over the whole period in the highest income quintile, whereas the reduction was only 18.3% (from 774.5 to 632.5) in the lowest quintile. Among women, mortality decreased by 40% (from 187.4 to 112.5) in the highest income group, but increased by 12.1% (from 280.2 to 314.2) in the poorest income group. Joinpoint regression identified that the differences in age-standardised mortality between the highest and the lowest income quintiles decreased among men by 18.85 annually between 1990 and 1994 (p trend=0.02), whereas it increased later, with a 2.88 point increase per year (p trend <0.0001). Among women, it continuously increased by 9.26/year (p trend <0.0001). In relative terms, age-adjusted mortality rate ratios showed a continuous increase in both genders. Conclusions Income-based inequalities among working-age male and female Swedes have increased since the late 1990s, whereas in absolute terms the increase was less remarkable among men. Structural and behavioural factors explaining this trend, such as the economic recession in the early 1990s, should be studied further.
Collapse
Affiliation(s)
- Naoki Kondo
- School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mikael Rostila
- Department of Sociology, Stockholm University, Stockholm, Sweden Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Monica Åberg Yngwe
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
31
|
Parker H, Ross JDC, White JA, Wilson JD. How important is confidentiality in sexual health clinics? A survey of patients across 51 clinics in England. Sex Transm Infect 2014; 90:354-5. [PMID: 25028709 DOI: 10.1136/sextrans-2013-051369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Helen Parker
- Department of Genitourinary Medicine, Centre for Sexual Health, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan D C Ross
- Whittall Street Clinic, Birmingham University Hospital Foundation Trust, Birmingham, UK
| | - John A White
- Genitourinary Medicine, Lloyd Clinic, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Janet D Wilson
- Department of Genitourinary Medicine, Centre for Sexual Health, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | |
Collapse
|
32
|
Stafford M, Badland H, Nazroo J, Halliday E, Walthery P, Povall S, Dibben C, Whitehead M, Popay J. Evaluating the health inequalities impact of area-based initiatives across the socioeconomic spectrum: a controlled intervention study of the New Deal for Communities, 2002-2008. J Epidemiol Community Health 2014; 68:979-86. [PMID: 24942888 DOI: 10.1136/jech-2014-203902] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous evaluations of area-based initiatives have not compared intervention areas with the full range of areas from top to bottom of the social spectrum to evaluate their health inequalities impact. SETTING Deprived areas subject to the New Deal for Communities (NDC) intervention, local deprivation-matched comparator areas, and areas drawn from across the socioeconomic spectrum (representing high, medium and low deprivation) in England between 2002 and 2008. DATA Secondary analysis of biannual repeat cross-sectional surveys collected for the NDC National Evaluation Team and the Health Survey for England (HSE). METHODS Following data harmonisation, baseline and time trends in six health and social determinants of health outcomes were compared. Individual-level data were modelled using regression to adjust for age, sex, ethnic and socioeconomic differences among respondents. RESULTS Compared with respondents in HSE low deprivation areas, those in NDC intervention areas experienced a significantly steeper improvement in education, a trend towards a steeper improvement in self-rated health, and a significantly less steep reduction in smoking between 2002 and 2008. In HSE high deprivation areas, significantly less steep improvements in five out of six outcomes were seen compared with HSE low deprivation areas. CONCLUSIONS Although unable to consider prior trends and previous initiatives, our findings provide cautious optimism that well-resourced and constructed area-based initiatives can reduce, or at least prevent the widening of, social inequalities for selected outcomes between the most and least deprived groups of areas.
Collapse
Affiliation(s)
- Mai Stafford
- Reader in Social Epidemiology, MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Hannah Badland
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - James Nazroo
- Cathie Marsh Centre for Census and Survey Research, University of Manchester, Manchester, UK
| | - Emma Halliday
- Division of Health Research, University of Lancaster, Lancaster, UK
| | - Pierre Walthery
- Cathie Marsh Centre for Census and Survey Research, University of Manchester, Manchester, UK
| | - Sue Povall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Margaret Whitehead
- Department of Public Health, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jennie Popay
- Division of Health Research, Department of Sociology and Public Health, University of Lancaster, Lancaster, UK
| |
Collapse
|
33
|
Freiler A, Muntaner C, Shankardass K, Mah CL, Molnar A, Renahy E, O'Campo P. Glossary for the implementation of Health in All Policies (HiAP). J Epidemiol Community Health 2013; 67:1068-72. [PMID: 23986493 PMCID: PMC3841750 DOI: 10.1136/jech-2013-202731] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Health in All Policies (HiAP) is becoming increasingly popular as a governmental strategy to improve population health by coordinating action across health and non-health sectors. A variety of intersectoral initiatives may be used in HiAP that frame health determinants as the bridge between policies and health outcomes. The purpose of this glossary is to present concepts and terms useful in understanding the implementation of HiAP as a cross-sectoral policy. The concepts presented here were applied and elaborated over the course of case studies of HiAP in multiple jurisdictions, which used key informant interviews and the systematic review of literature to study the implementation of specific HiAP initiatives.
Collapse
Affiliation(s)
- Alix Freiler
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, , Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
34
|
Emmanuel F, Thompson LH, Salim M, Akhtar N, Reza TE, Hafeez H, Ahmed S, Blanchard JF. The size and distribution of key populations at greater risk of HIV in Pakistan: implications for resource allocation for scaling up HIV prevention programmes. Sex Transm Infect 2013; 89 Suppl 2:ii11-7. [PMID: 23843454 PMCID: PMC3756450 DOI: 10.1136/sextrans-2013-051017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background With competing interests, limited funding and a socially conservative context, there are many barriers to implementing evidence-informed HIV prevention programmes for sex workers and injection drug users in Pakistan. Meanwhile, the HIV prevalence is increasing among these populations across Pakistan. We sought to propose and describe an approach to resource allocation which would maximise the impact and allocative efficiency of HIV prevention programmes. Methods Programme performance reports were used to assess current resource allocation. Population size estimates derived from mapping conducted in 2011 among injection drug users and hijra, male and female sex workers and programme costs per person documented from programmes in the province of Sindh and also in India were used to estimate the cost to deliver services to 80% of these key population members across Pakistan. Cities were prioritised according to key population size. Results To achieve 80% population coverage, HIV prevention programmes should be implemented in 10 major cities across Pakistan for a total annual operating cost of approximately US$3.5 million, which is much less than current annual expenditures. The total cost varies according to the local needs and the purchasing power of the local currency. Conclusions By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.
Collapse
Affiliation(s)
- Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Stackpool-Moore L. 'The intention may not be cruel... but the impact may be': understanding legislators' motives and wider public attitudes to a draft HIV Bill in Malawi. Sex Transm Infect 2013; 89:285-9. [PMID: 23687129 DOI: 10.1136/sextrans-2012-050976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The law in relation to HIV has prominence in the formation and regulation of moral norms-in regard to human rights, and in regard to criminalisation, the policing of sexuality and intimate behaviours, and the production of stigma. The research focuses on the potential and impotence of the law to govern for, and enable, the human right to health in the context of HIV in Malawi. METHODS This one-country qualitative case study (Malawi) action research involved data collection during a 6-month period (October 2010-March 2011). Datasets include interviews with law commissioners (n=10), opinion leaders (n=22), life story participants who were people living with and closely affected by HIV (n=20), reflections of the action research team (n=6), and a review of the proposed HIV and AIDS (Prevention and Management) Bill, legal and policy documents. RESULTS The analysis of the perspectives of the law commissioners, who formed the Special Law Commission and drafted the Bill, revealed that stigma was consciously invoked to delineate social norms and guide governance of notions of personal responsibility. The analysis of the perspectives of the life story participants, whose lives would be most directly impacted if these provisions came into force, reveals the extent to which the stigma associating criminality and HIV is falling on fertile ground through its engagement and generation of internalised stigma; unearthing an uneasy link between stigma and the law in response to HIV in Malawi. DISCUSSION The results indicated that the proposed HIV Bill in Malawi manifests a tension between intention and impact. By incorporating criminal sanctions as part of the proposed HIV Bill, the lawmakers actively seek to use stigma to shape social attitudes and attempt to guide normative behaviour.
Collapse
|
36
|
Whelan R, Dickinson D, Murray T. Use and neglect of best-practice HIV/AIDS programme guides by South African companies. Afr J AIDS Res 2008; 7:375-388. [PMID: 25875465 DOI: 10.2989/ajar.2008.7.3.14.661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Numerous guidelines set out best-practice policies for HIV/AIDS interventions in the workplace. This study analysed 14 recognised codes and guidelines to gain an understanding of the theoretical consensus regarding the key components of best-practice workplace HIV/AIDS interventions. Nine key components of best practice were drawn from the analysis; interviews aimed to verify these components by determining the extent to which HIV/AIDS practitioners in South Africa share a similar understanding of best practice. Participants in a research questionnaire and semi-structured interviews included managers responsible for company HIV/AIDS programmes, HIV/AIDS experts, consultants, and disease management service providers. There was a high level of agreement between the practitioners who were interviewed and the codes and guidelines that were analysed concerning what best practice entails. However, reported usage of the recognised codes and guidelines to inform workplace HIV/AIDS interventions was low. Although large companies in South Africa may recognise certain interventions as examples of best practice, it appears that these are not being readily implemented. This appears to be partly because the cost-benefit of a recommended intervention is not immediately apparent or conclusive, and also because the concept of best practice with respect to workplace HIV/AIDS interventions is not yet fully accepted.
Collapse
|
37
|
Zeniou A, Ioannou A, Protopapa A, Kotsakis I, Yiallouros C, Koulermou G. The Policy of our Clinic in Early Escharectomy in Burns of the Hand. Ann Burns Fire Disasters 2007; 20:20-21. [PMID: 21991061 PMCID: PMC3188051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Indexed: 05/31/2023]
Abstract
Early escharectomy in deep partial- and full-thickness burns of the hand has proved to have an advantage over late surgical treatment. It provides an improved functional and cosmetic result. Hand deformities, the need for secondary reconstructive procedures, and morbidity are significantly reduced. In our clinic we prefer to use early escharectomy in all full-thickness burns of the hand unless the patient's condition prevents it or unless the extent of the burns in the rest of the body would prevent improvement in the general outcome.
Collapse
Affiliation(s)
- A. Zeniou
- Clinic for Plastic Surgery, Microsurgery, and Burns, New Nicosia General Hospital, Nicosia, Cyprus
| | - A. Ioannou
- Clinic for Plastic Surgery, Microsurgery, and Burns, New Nicosia General Hospital, Nicosia, Cyprus
| | - A. Protopapa
- Clinic for Plastic Surgery, Microsurgery, and Burns, New Nicosia General Hospital, Nicosia, Cyprus
| | - I. Kotsakis
- Clinic for Plastic Surgery, Microsurgery, and Burns, New Nicosia General Hospital, Nicosia, Cyprus
| | - C. Yiallouros
- Clinic for Plastic Surgery, Microsurgery, and Burns, New Nicosia General Hospital, Nicosia, Cyprus
| | - G. Koulermou
- Clinic for Plastic Surgery, Microsurgery, and Burns, New Nicosia General Hospital, Nicosia, Cyprus
| |
Collapse
|
38
|
Seidel G. Decisions and advice about infant feeding: findings from sociological work in KwaZulu-Natal, South Africa. Afr J AIDS Res 2004; 3:167-77. [PMID: 25875065 DOI: 10.2989/16085900409490331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
What are women's practices and experiences? And what are pregnant women being told about risks through breastfeeding in an area of high HIV seroprevalence? This work sets out to explore these two principal questions in terms of the implications for women, and for international and national policy guidelines on infant feeding. During a two-year sociological study in KwaZulu-Natal, semi-structured questionnaires, individual and group interviews, and an innovative storytelling element were used to probe women's decision-making concerning infant feeding. In-depth interviews were conducted with different groups of health workers, including AIDS counsellors and traditional birth attendants, and observations were made at both semi-rural and urban hospitals and clinics. The research was carried out at a time when new international and national guidelines concerning HIV and infant feeding were being circulated. The research is framed within critical and discursive theory, influenced by the work of Foucault, and located within a particular feminist theory, concerned with the modes of appropriation of 'the sexed body'. The conclusions centre on ethical considerations and the rights of women to make informed decisions about their own and their baby's health care. Reference is also made to the particular socialisation of health workers, especially maternity nurses. The importance of the earlier struggle against the unethical practices of multi-nationals is recognised, and how this has informed a robust breastfeeding culture. Scant attention has been paid to the results of studies undertaken in other African locations (mainly West Africa) where key players have introduced infant milk formula. The conclusions also engage with the question of the vertical paradigm: how women's lives have been caught up in these dilemmas and conflicts in a country with a rights' culture.
Collapse
|