Search

Background:\ud Children from Black and South Asian ethnic groups are at risk for childhood obesity in the UK. To inform local action for childhood obesity prevention, it is crucial to explore the basis of ethnic disparities and consider the perspectives of children. This study aimed to understand cultural and contextual factors influencing childhood obesity in an ethnically diverse population using child‐centred methodology.\ud \ud Methods:\ud ‘Draw, write and tell’ interviews were held with children aged 9‐10 years in Coventry, an urban, multi‐ethnic city in the UK. Data were analysed thematically using framework analysis.\ud \ud Results:\ud Twenty‐six children participated (85% from Black or Minority Ethnic Groups). Children’s perspectives revealed universal themes around health, diet, physical activity and weight and highlighted issues specific to ethnic groups and those living in deprived areas. An underlying feature was weight‐based stigmatisation and group stereotyping, and an emphasis on internal factors as the cause of obesity. Children described some experiences of social disadvantage, but did not regard these as a barrier to being physically active. Children identified cultural or religious practices or experiences of migration that influenced diet and physical activity.\ud \ud Conclusions:\ud These findings allow a broad range of children’s perspectives to inform future intervention design. In addition, the study was able to identify the many similarities and small amount of diversity in children’s perspectives across ethnic groups.

Background and objectives Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness. Methods From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data. Results A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores. Conclusions Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.

Digital fingerprints are increasingly used for patient care and treatment delivery, health system monitoring and evaluation, and maintaining data integrity during health research. Yet, no evidence exists about the use of fingerprinting technologies in maternal healthcare services in urban slum contexts, globally. The present study aimed to explore the recently delivered women’s willingness to give digital fingerprints to community health workers to access healthcare services in the urban slums of Bangladesh and identify the associated factors. Employing a two-stage cluster random sampling procedure, we chose 458 recently delivered women from eight randomly selected urban slums of Dhaka city, Bangladesh. Chi-square tests were performed for descriptive analyses, and binary logistic regression analyses were performed to explore the factors associated with willingness to provide fingerprints. Overall, 78% of the participants reported that they were willing to provide digital fingerprints if that eased access to healthcare services. After adjusting for potential confounders, the sex of the household head, family type, and household wealth status were significantly associated with the willingness to provide fingerprints to access healthcare services. The study highlighted the potentials of using fingerprints for making healthcare services accessible. Focus is needed for female-headed households, women from poor families, and engaging husbands and in-laws in mobile health programs.

Intimate partner violence (IPV) is a pervasive public health problem. Within the U.S., urban emergency department (ED) patients have elevated prevalence of IPV, substance use, and other social problems compared to those in the general household population. Using a social-ecological framework, this cross-sectional study analyzes the extent to which individual, household, and neighborhood factors are associated with the frequency of IPV among a socially disadvantaged sample of urban ED patients. Confidential survey interviews were conducted with 1037 married/partnered study participants (46% male, 50% Hispanic, 29% African American) at a public safety-net hospital. Gender-stratified multilevel Tobit regression models were estimated for frequency of past-year physical IPV (perpetration and victimization) and frequency of severe IPV. Approximately 23% of participants reported IPV. Among men and women, impulsivity, adverse childhood experiences, substance use, and their spouse/partner&rsquo, s hazardous drinking were associated with IPV frequency. Additionally, household food insufficiency, being fired or laid off from their job, perceived neighborhood disorder, and neighborhood demographic characteristics were associated with IPV frequency among women. Similar patterns were observed in models of severe IPV frequency. IPV prevention strategies implemented in urban ED settings should address the individual, household, and neighborhood risk factors that are linked with partner aggression among socially disadvantaged couples.

A large body of research affirms the fact that there are racial disparities in healthcare. Overall, literature shows that Black men and women suffer higher rates of death and lower life expectancy at birth than people who self-identify as White.1 A significant portion of the disparity in health status relates to social disadvantage caused by the legacy of discrimination and racism. For example, compared to White people, Black people have dramatically lower levels of wealth to shield them against financial uncertainties, and this inequity impacts health across the life course.

Group-based physical activity (PA) in community-based settings represents a promising avenue for promoting healthy ageing, however, lower levels of adherence have been found to be associated with aspects of social disadvantage. Providers are in a key position to provide important insights about strategies to improve adherence, however, few studies have examined their perspectives. In this study, 30 community service providers were interviewed, and 42 older people participated in focus groups to identify actions perceived as effective for promoting adherence to organised PA, with a focus on factors relevant to older people experiencing socio-economic disadvantage, social isolation, living with a disability or from culturally and linguistically diverse backgrounds. Data were analysed thematically. Adherence barriers included deteriorating health, lack of belonging and loss of motivation. Helpful strategies for addressing deteriorating health included maintaining programme flexibility, facilitating access to health and other services, and supporting participants to adapt to acquired limitations. Belonging can be fostered by creating positive and inclusive experiences, ensuring safe and stigma-free environments, providing opportunities to forge personal connections and demonstrating care. Motivation may be enhanced by ensuring activities are of interest and functional benefit, programme settings are suitable and appealing, and enjoyment is prioritised. In conclusion, a range of strategies is likely to be necessary to mitigate risks to adherence and support continued participation in organised PA among socially disadvantaged older people.

Objective: The interplay between genetic and environmental factors on risk for psychotic illness remains poorly understood. The aim of this study was to estimate independent and combined effects of familial liability for schizophrenia and exposure to obstetric complications on risk for developing psychotic illness, covarying with exposure to other environmental stressors. Methods: This whole-population birth cohort study used record linkage across Western Australian statewide data collections (midwives, psychiatric, hospital admissions, child protection, mortality) to identify liveborn offspring ( n = 1046) born 1980–1995 to mothers with schizophrenia, comparing them to offspring of mothers with no recorded psychiatric history ( n = 298,370). Results: Both maternal schizophrenia and pregnancy complications were each significantly associated with psychotic illness in offspring, with no interaction. Non-obstetric environmental stressors significantly associated with psychotic illness in offspring included the following: being Indigenous; having a mother who was not in a partnered relationship; episodes of disrupted parenting due to hospitalisation of mother, father or child; abuse in childhood; and living in areas of greatest socioeconomic disadvantage and with elevated rates of violent crime. Adjustment for these other environmental stressors reduced the hazard ratio for maternal schizophrenia substantially (from hazard ratio: 5.7, confidence interval: 4.5–7.2 to hazard ratio: 3.5, confidence interval: 2.8–4.4), but not the estimate for pregnancy complications (hazard ratio: 1.1, confidence interval: 1.0–1.2). The population attributable fraction for maternal schizophrenia was 1.4 and for pregnancy complications was 2.1. Conclusion: Our finding of a substantial decrease in risk of psychotic illness associated with familial liability for psychosis following adjustment for other environmental stressors highlights potentially modifiable risk factors on the trajectory to psychotic illness and suggests that interventions that reduce or manage exposure to these risks may be protective, despite a genetic liability.

Systemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with substantial morbidity and mortality. Although improved diagnostics and therapeutics have contributed to declining mortality rates, important disparities exist in SLE survival rates by race, ethnicity, gender, age, country, and social disadvantage. This review highlights the burden of SLE and lupus nephritis among Medicaid beneficiaries, outlines barriers in access to high-quality SLE care and medication adherence in the Medicaid SLE population, and summarizes disparities in adverse outcomes among SLE patients enrolled in Medicaid.

AimsThe theory of ‘what matters most’ (WMM) has been developed to understand differences in mental illness stigma between cultures, postulating that stigma becomes most pervasive in situations that matter most in a specific cultural context. The rise of populism in Western societies demonstrates that also within one cultural context, different values ‘matter most’ to different groups. We expand the WMM framework to explore the spectrum of stigma manifestations within Western societies, relating it to both conservative/authoritarian and liberal/modern values. From our findings, we will develop hypotheses on how further research into value orientations and stigma might address potential blind spots in stigma research.MethodsBased on a narrative review of the literature on mental illness stigma and value orientations, we apply the WMM framework to cultural mechanisms of stigma within modern Western societies.ResultsThere are several studies showing an association between traditional, authoritarian, conservative values with stronger mental illness stigma, while studies examining the stigma within liberal, modern value orientations are scarce. We hypothesise on situations where encountering a person with mental illness could threaten liberal values and thus might provoke stigma among persons with such value orientations. For example, living with a person with mental illness could be seen as consuming energy and time, thereby jeopardising ‘self-actualisation’, the modern value of realising one's own full potential. As a result, a person highly valuing self-actualisation might try to avoid contact with persons with mental illness. Instances of potential ‘liberal stigma’ also include structural stigma or self-stigma, when, e.g. changing assumptions of what is considered ‘normal’ increase perceptions of being fundamentally different when experiencing mental illness.Conclusions‘WMM’ appears to be a useful framework to direct research to potential blind spots within the field of stigma research. Looking at instances where liberal values conflict with dealing with a person with mental illness could provide a more comprehensive understanding of stigma experiences among persons with mental illness. However, for measuring stigma, tapping into liberal variations of mental illness stigma is methodologically challenging. Qualitative work could be the first step to elicit potential stigma experiences based on conflicts with liberal values.

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years), Kupang, Indonesia, three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p &lt, 0.01) and r = 0.43 (p &lt, 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p &lt, 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p &lt, 0.01) and in underprivileged children (r = 0.20, p &lt, 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project was funded by grant agreement Health-F2-2010-241909 (Project EU-GEI) from the European Community’s Seventh Framework programme., Tarricone, I., D'Andrea, G., Jongsma, H.E., Tosato, S., Gayer-Anderson, C., Stilo, S.A., Suprani, F., Iyegbe, C., Van Der Ven, E., Quattrone, D., Di Forti, M., Velthorst, E., Rossi Menezes, P., Arango, C., Parellada, M., Lasalvia, A., La Cascia, C., Ferraro, L., Bobes, J., Bernardo, M., Sanjuán, I., Santos, J.L., Arrojo, M., Del-Ben, C.M., Tripoli, G., Llorca, P.-M., De Haan, L., Selten, J.-P., Tortelli, A., Szöke, A., Muratori, R., Rutten, B.P., Van Os, J., Jones, P.B., Kirkbride, J.B., Berardi, D., Murray, R.M., Morgan, C.

Aims Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups. Method Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts. Results Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to – or at the best passive acceptance of – intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives. Conclusions Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.

Background Children who are born preterm and those who are socially disadvantaged tend to have increased morbidity in childhood. Few studies are large enough and have sufficient follow-up to explore the size of these separate effects across childhood. We explored whether birth before full term (gestation 39–41 weeks) and social disadvantage represent a double jeopardy by comparing the size of these separate effects on rates of hospital admission from birth to 10 years. Methods We linked routine data from birth registration and hospital admissions for all live, singleton births in England in 2005–2006. Children (n=1,018,136) were followed up from discharge from their birth admission to age 10 years, death or study end (31st March 2015). Negative binomial regression models were used to estimate adjusted rate ratios (aRR) with 95% confidence intervals (CI) for the effect of gestational age ( Results Hospital admission rates increased strongly with prematurity and area deprivation, even after adjustment for other factors. The effect of gestation was most marked in infancy, when even being born at ‘early term’ (gestation 37–38 weeks) had a stronger effect than living in the most deprived areas (aRR=1.37, 95% CI 1.35–1.39 for 37–38 versus 39–41 weeks; aRR=1.26, 95% CI 1.24–1.28 for the most versus least deprived areas). The effect of gestation persisted though was less marked at age 5–10 years, although even being born ‘late preterm’ (gestation 34–36 weeks) had a stronger effect than living in the most deprived areas (aRR=1.39, 95% CI 1.35–1.43 for 34–36 versus 39–41 weeks; aRR=1.29, 95% CI 1.26–1.31 for the most versus least deprived areas). In infancy, the PAF for birth before full term ( Conclusion Gestational age and social deprivation were independent risk factors for hospital admissions throughout childhood. The impact of being born even a few weeks early is of similar magnitude to living in the most deprived areas. Children born early and living in more deprived areas have a double jeopardy.

BackgroundUnderstanding the epidemiology of SARS-CoV-2 is essential for public health control efforts. Social, demographic, and political characteristics at the US county level might be associated with the trajectories of SARS-CoV-2 case incidence.ObjectiveTo understand how underlying social, demographic, and political characteristics at the US county level might be associated with the trajectories of SARS-CoV-2 case incidence.DesignRetrospective analysis of the trajectory of reported SARS-CoV-2 case counts at the US county level during June 1, 2020 – June 30,2020 and social, demographic, and political characteristics of the county.SettingUnited States.ParticipantsReported SARS-CoV-2 cases.ExposuresMetropolitan designation, Social Deprivation Index (SDI), 2016 Republican Presidential Candidate Victory.Main Outcomes and MeasuresSARS-CoV-2 case incidence.Results1023/3142 US counties were included in the analysis. 678 (66.3%) had increasing SARS-CoV-2 case counts between June 1 – June 30, 2020. In univariate analysis, counties with increasing case counts had a significantly higher SDI (median 48, IQR 24 – 72) than counties with non-increasing case counts (median 40, IQR 19 – 66; p=0.009). In the multivariable model, metropolitan areas of 250,000 – 1 million population, higher percentage of Black residents and a 10-point or greater Republican victory were independently associated with increasing case counts.LimitationsThe data examines county-level voting patterns and does not account for individual voting behavior, subjecting this work to the potential for ecologic fallacy.ConclusionIncreasing case counts of SARS-CoV-2 in the US are likely driven by a combination of social disadvantage, social networks, and behavioral factors. Addressing social disadvantage and differential belief systems that may correspond with political alignment will be essential for pandemic control.

Black and Hispanic communities in the U.S. have endured a disproportionate burden of COVID-19-related morbidity and mortality. Racial and ethnic health disparities such as these are frequently aggravated by inequitable access to healthcare resources in disadvantaged communities. Yet, no known studies have investigated disadvantaged communities' access to COVID-19-related healthcare resources. The current study accordingly examined racial and ethnic differences in (1) April 2020 COVID-19 total and positive viral test rates across 177 New York City (NYC) ZIP Code Tabulation Areas (ZCTA); and (2) November 2019-April 2020 licensed and intensive care unit (ICU) hospital bed access across 194 NYC ZCTAs. Pairwise analyses indicated higher COVID-19 total and positive test rates per 1000 persons in majority Black and Hispanic vs. majority White ZCTAs (CI [0.117, 4.55]; CI [2.53, 5.14]). Multiple linear regression analyses indicated that higher percentage of Black and Hispanic residents predicted more total COVID-19 tests per 1000 persons (p&nbsp

Background The study aimed to explore the association between early life and life-course exposure to social disadvantage and later life body mass index (BMI) accounting for genetic predisposition and maternal BMI. Methods We studied participants of Helsinki Birth Cohort Study born in 1934–1944 (HBCS1934–1944, n = 1277) and Northern Finland Birth Cohorts born in 1966 and 1986 (NFBC1966, n = 5807, NFBC1986, n = 6717). Factor analysis produced scores of social disadvantage based on social and economic elements in early life and adulthood/over the life course, and was categorized as high, intermediate and low. BMI was measured at 62 years in HBCS1934–1944, at 46 years in NFBC1966 and at 16 years in NFBC1986. Multivariable linear regression analysis was used to explore associations between social disadvantages and BMI after adjustments for polygenic risk score for BMI (PRS BMI), maternal BMI and sex. Results The association between exposure to high early social disadvantage and increased later life BMI persisted after adjustments (β = 0.79, 95% CI, 0.33, 1.25, p p = 0.181), and in HBCS1934–1944 there was no association between high early social disadvantage and increased later life BMI (β 0.22, 95% CI –0.91,1.35, p = 0.700). In HBCS1934–1944 and NFBC1966, participants who had reduced their exposure to social disadvantage during the life-course had lower later life BMI than those who had increased their exposure (β − 1.34, [− 2.37,-0.31], p = 0.011; β − 0.46, [− 0.89,-0.03], p = 0.038, respectively). Conclusions High social disadvantage in early life appears to be associated with higher BMI in later life. Reducing exposure to social disadvantage during the life-course may be a potential pathway for obesity reduction.

No study has evaluated the utility of different classifications of chronic obstructive pulmonary disease (COPD) airflow limitation (AFL) in terms of the refined “ABCD” classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) or in terms of the impacts on quality of life. This study aimed to compare some relevant health outcomes (i.e., GOLD classification and quality-of-life scores) between COPD patients having “light” and “severe” AFL according to five COPD AFL classifications. It was a cross-sectional prospective study including 55 stable COPD male patients. The COPD assessment test (CAT), the VQ11 quality-of-life questionnaire, a spirometry, and a bronchodilator test were performed. The patients were divided into GOLD “A/B” and “C/D.” The following five classifications of AFL severity, based on different post-bronchodilator forced expiratory volume in 1 s (FEV1) expressions, were applied: FEV1%pred: “light” (≥50), “severe” (1z-score: “light” (≥−3), “severe” (1/height2: “light” (≥0.40), “severe” (1/height3: “light” (≥0.29), “severe” (1Quotient: “light” (≥2.50), “severe” (1z-score], 63.6 [FEV1%pred], 41.8 [FEV1/height3], 40.0 [FEV1Quotient], and 25.4 [FEV1/height2]; Cochrane test = 91.49, df = 4). The CAT and VQ11 scores were significantly different between the patients having “light” and “severe” AFL. In GOLD “C/D” patients, only the FEV1Quotient was able to distinguish between the two AFL severities. To conclude, the five classifications of COPD AFL were not similar when compared with regard to some relevant health outcomes.

Over a 3-month period, a homeless person was admitted several times to emergency departments after displaying severe behavioral changes and paranoia. No psychiatric tests were performed but all other tests were repeatedly normal; antianxiety treatments or painkillers were the common outcome. It may seem that any diagnosis rested on the patient's immediately apparent social circumstances. Indeed, the patient was admitted to our internal medicine department after a diagnosis of acute delirium within a context of social disadvantage. This social predicament, namely, the patient's evident homelessness, proved to be a false but significant and overarching influence on several misdiagnoses until that moment. Subsequently, actual psychological observations, assessments and tests indicated and confirmed the presence of Creutzfeldt-Jakob disease. Creutzfeldt-Jakob disease is an uncommon and fatal disease; however, early diagnosis can enable the implementation of an important palliative care program. The starkly impoverished social circumstances of a patient should never distract a medical practitioner from a comprehensive diagnosis. Homelessness, for example, may invite certain physical and mental considerations, but it must not overdetermine our response and must not obscure or detract from a wider diagnosis. Homelessness is not a medical condition.

PurposeMyopia prevalence is influenced by environmental factors including heritability and social disadvantage. The current prevalence of myopia among disadvantaged school children in Australia has not been reported. Therefore, this study analyses refractive data for children from rural and outer suburban areas.MethodsThe records of 4,365 children aged 6-15 visiting a city-based government-school respite care center during the years 2014/2016/2018 were analyzed for right eye non-cycloplegic spherical equivalent refraction (SER). The prevalence of myopia (SER≤-0.50D) was compared with historical data.ResultsThe prevalence of myopia was 3.5%, 4.4% and 4.3% in 2014, 2016 and 2018, respectively. The prevalence of myopia increased with age (P0.05). The overall mean SER was 0.89±0.86D, 0.62±0.89D and 0.56±0.95 in 2014, 2016 and 2018, respectively. Mean SER was associated with year of testing, age (all P ConclusionsMyopia prevalence increased with age. The mean SER decreased slightly from 2014 to 2018. Sex differences in the rate of change with age was observed. Compared with 40 years ago, the prevalence of myopia has doubled, but it remains significantly lower than in school children of a similar age living in established urban areas that are regarded as having a higher socioeconomic status.

This paper presents an exploration of my experiences and unique positioning as a blind, White South African woman. It explores the complex intersections of multiple axes of identity in my own experience to do with disability, race, class and language and, in so doing, presents some ideas about the ways in which disability complicates and disturbs simplistic identity categories. It draws, in particular, on the experience of my first year of formal schooling which took place in 1994 as South Africa held its first democratic election, bringing a politico-legal, if not actual, end to decades of racial segregation. Using this experience, I explore the ways in which, against the sociopolitical backdrop of apartheid’s racial segregation, ideas about race and disability, that is, Blackness and blindness, became entangled and how this entanglement impacted my ability to claim a place as either blind or sighted. Through this critical engagement I hope to be able to offer a perspective, not only on how the apartheid system operated, forcing the projection of negative characteristics onto Black people, but also on how this legacy continues to impact those of us who occupy unstable positions, at the intersection of privilege and marginality. Central to the argument is the position that the wholesale binding up of social disadvantage with race in the South African context prohibits and manages the status that persons with disabilities are able, or not able, to claim.

International audience; Près de 10% des femmes enceintes françaises déclarent avoir ressenti un mal-être psychologique au cours de leur grossesse. Cette prévalence peut être doublée ou triplée parmi les femmes présentant des facteurs de vulnérabilité sociale. Parmi ces femmes, 81.3% n'ont pas consulté un professionnel de santé au cours de leur grossesse pour ces difficultés. Le projet Bien-être vise à améliorer le repérage précoce des vulnérabilités psychologiques ou sociales et le parcours de soin actuel des femmes enceintes vulnérables, et à évaluer l'intérêt de l'entretien prénatal précoce dans l'accompagnement de ces femmes. Nombre de mots: 115 2 The "Wellbeing" project: To better identify and support pregnant women with psychological or social vulnerabilities ABSTRACT Perinatality is one of the most critical periods in the life cycle. The health of the mother and children are strongly and permanently influenced by events occurred during pregnancy, delivery or the first ages of infancy. In psychological terms, nearly 10% of the women reported poor self-rated mental health during pregnancy. Moreover, socio-demographic characteristics indicative of social disadvantage are associated with a higher risk of poor self-rated mental health. Among them, 81.3% did not consult a healthcare professional for psychological problems. The well-being project aims at optimising pregnant women care with psychological or socioeconomic vulnerabilities on the one hand, and at assessing the early prenatal interview's interest on the other hand. Nombre de mots : 93

Natural disaster impacts on populations already experiencing significant health, income, and social disadvantage, are both more intense and longer lasting than for the general population. The inter...

Information on the association between socioeconomic status (SES) throughout life and sarcopenic obesity is scarce, whereas no study has been focused on the association between SES and frail obesity. This analysis estimated the prevalence of sarcopenic obesity and frail obesity, and their associations with SES in older adults. Data were collected in 2012 from 1,765 non-institutionalized individuals aged ≥65 participating in the Seniors-ENRICA study in Spain, by using standardized techniques and equipment. SES throughout life was evaluated with the father's occupation, participant's educational level, former own occupation, and current poor housing condition. Overall, 17.2% of participants had sarcopenic obesity, and 4.0% frail obesity. No association was found between SES and sarcopenic obesity. In contrast, the prevalence of frail obesity was higher in those with lower education, having worked in manual job, and currently having poor housing condition. Having ≥1 social disadvantages throughout life was associated with higher prevalence of frail obesity. The prevalence of this disorder increased by 1.49 (95% CI: 1.21-1.85) times for each social disadvantage added. The OR (95% CI) of frail obesity was 3.13 (1.71-5.7) for those having 3 or 4 vs. 0 or 1 social disadvantages, implying a more complex process beginning early in life., Data collection was funded by the following grants: PI13/0288; PI14/0009; PI16/01460; PI16/01512; and PI16/00609 (State Secretary of R+D and FEDER/FSE). BM-F was supported by a CIBERCV contract, RFP-T was supported by the National Government of Ecuador through the National Institution of Higher Education, Science, Technology and Innovation-SENESCYT, and ML research activity is funded by Agencia Aragonesa para la Investigación y el Desarrollo (ARAID)

Physical fitness seems to be related to academic performance, at least when taking the role of executive functioning into account. This assumption is highly relevant for the vulnerable population of low academic achievers because their academic performance might benefit from enhanced physical fitness. The current study examined whether physical fitness and executive functioning are independent predictors of low mathematics and spelling achievement or whether the relation between physical fitness and low achievement is mediated by specific executive functions. In total, 477 students from second- and third-grade classes of 12 primary schools were classified as either low or average-to-high achievers in mathematics and spelling based on their scores on standardized achievement tests. Multilevel structural equation models were built with direct paths between physical fitness and academic achievement and added indirect paths via components of executive functioning: inhibition, verbal working memory, visuospatial working memory, and shifting. Physical fitness was only indirectly related to low achievement via specific executive functions, depending on the academic domain involved. Verbal working memory was a mediator between physical fitness and low achievement in both domains, whereas visuospatial working memory had a mediating role only in mathematics. Physical fitness interventions aiming to improve low academic achievement, thus, could potentially be successful. The mediating effect of executive functioning suggests that these improvements in academic achievement will be preceded by enhanced executive functions, either verbal working memory (in spelling) or both verbal and visuospatial working memory (in mathematics).

Background: Sickle Cell Disease (SCD) has established socioeconomic disadvantage resulting in increased healthcare utilization. Among the pediatric population, the implementation of preventative care measures within the medical home model has improved outcomes and lifespan. Area deprivation index (ADI) is an established method for quantifying socioeconomic disadvantage and has been shown to be associated with increased hospital readmission in adults and pediatric patients with chronic disease (Singh Am J Public Health. 2003, Kind et al. Ann Intern Med. 2014). ADI has been applied to adults with SCD and vaso-occlusive events (VOE) but has not been investigated in pediatric patients. We explored the role of ADI in pediatric patients with SCD admitted with VOE in order to characterize disadvantage and the hospitalization characteristics that impact hospital readmission. Methods: This retrospective review included 675 consecutive emergency department and hospital admissions for VOE among 101 pediatric (≤ 21 years old) patients with SCD from 2016-2019 at a single urban, US-based medical center. One hospital admission for each patient was selected at random. Information extracted included demographics, SCD characteristics, admission complications, entry and discharge pain scores, length of stay, and management characteristics. Variables were compiled in a descriptive table and compared in logistic regression models against a primary outcome of 7-day readmission. The 2018 ADI dataset was used to assign an ADI value based on the census block corresponding to the patient-reported zip-code for the specific hospital admission (https://www.neighborhoodatlas.medicine.wisc.edu). ADI values were grouped by most and least deprived with higher scores (6-10) indicating more deprivation. Summary statistics described patient and disease characteristics in these groups. Results: Within our cohort, the state and national ADI was calculated for 101 patients with a median age of 14 years (50.4% female; 98.0% Black) (Table 1). Most patients were publicly insured (80.2%). The Hb SS genotype was the most common genotype, followed by Hb SC (22.7%). Median ADI rank was 9 with 11 patients (10.9%) classified as less disadvantaged (ADI 1-5) and 90 patients (89.1%) as more disadvantaged (ADI 6-10). We found the less disadvantaged group had even numbers of public and private insurance use while 83.3% of the patients in the more disadvantaged group had public insurance. The Hb SS genotype was more common in the less disadvantaged (90.9%) than the more disadvantaged (74.4%), where Hb SC was overrepresented (24.4%). Greatest prevalence of mental health disease and hospital complications, including acute chest syndrome, avascular necrosis, and pneumonia, were observed in the more disadvantaged. Additionally, the more disadvantaged group included a greater number of patients with scheduled follow-up (61.1%) and shorter time to follow-up (median: 31 days). For treatment and management, both groups had high numbers of prescriptions for hydroxyurea (HU) and opiates, with slightly higher numbers in the less disadvantaged group (82% HU; 100% opioids) compared to the more disadvantaged (61% HU; 81% opioids). Length of hospital-stay and pain scores were similar across groups. The 7-day readmission rate was 9% for the less disadvantaged group and 14% for the more disadvantaged group. Conclusions: We applied a validated measure of socioeconomic disadvantage to a group of pediatric patients with SCD and VOE. Our cohort consists of more disadvantaged patients across ADI scales. Readmission rate was low for both groups and there was no relationship between greater ADI scores and hospital readmission. Within the more disadvantaged group, the higher prevalence of mental health illness as well as associated disease complications may have been countered by protective factors including established follow-up, shorter time to follow-up, and high number of prescriptions for hydroxyurea and opiates. Our results are consistent with the protective effect of ADI on recurrent acute chest syndrome in pediatric SCD patients (Alishlash et al. Pediatr. Blood Cancer. 2021) highlighting the importance of preventative care within the SCD medical home. Further research is warranted on identifying key protective factors that may reduce acute care utilization and social disparity in this population. Figure 1 Figure 1. Disclosures Novelli: Novartis Pharmaceuticals: Consultancy.

Social disadvantage—a state of low-income, limited education, poor living conditions, or limited social support—mediates chronic health conditions, including cerebrovascular disease. Social disadvantage is a key component in several health impact frameworks, providing explanations for how individual-level factors interact with interpersonal and environmental factors to create health disparities. Understanding the association between social disadvantage and vascular neuropathology, brain lesions identified by neuroimaging and autopsy, could provide insight into how one’s social context interacts with biological processes to produce disease. The goal of this scoping review was to evaluate the scientific literature on the relationship between social disadvantage and cerebrovascular disease, confirmed through assessment of vascular neuropathology. We reviewed 4049 titles and abstracts returned from our search and included records for full-text review that evaluated a measure of social disadvantage as an exposure variable and cerebrovascular disease, confirmed through assessment of vascular neuropathology, as an outcome measure. We extracted exposures and outcomes from 20 articles meeting the criteria after full-text review, and described the study findings and populations sampled. An improved understanding of the link between social factors and cerebrovascular disease will be an important step in moving the field closer to addressing the fundamental causes of disease and towards more equitable brain health.

Objective in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997–2009. Design a retrospective, descriptive analysis of data routinely collected over the 12.5 year period was undertaken including changes over time and outcomes by demographic features. Setting and participants all women booked with the Albany Midwifery Practice were included. Findings of the 2568 women included over the 12.5 year period, more than half (57%) were from Black, Asian and Minority Ethnic (BAME) communities; one third were single and 11.4% reported being single and unsupported. Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. There were high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. The overall rate of caesarean section was 16%. The preterm birth rate was low (5%). Ninety-five per cent of babies had an Apgar score of 8 or greater at 5minutes and 6% were admitted to a neonatal unit for more than two days. There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. There were no intrapartum intrauterine deaths. Key conclusions this analysis has shown that the Albany Midwifery Practice demonstrated positive outcomes for women and babies in socially disadvantaged and BAME groups, including those with complex pregnancies and perceived risk factors. Implications for practice consideration should be given to making similar models of care available to all women.

Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for mental health care in the past, this Personal View addresses what their role might be in the future. We (DG, PH, and SP) did a survey of professional stakeholders and then used a scenario planning technique in an international expert workshop to address this question. The workshop developed four distinct but not mutually exclusive scenarios in which the social aspect is central: mental health care will be patient controlled; it will target people's social context to improve their mental health; it will become virtual; and access to care will be regulated on the basis of social disadvantage. These scenarios are not intended as fixed depictions of what will happen. They could, however, be useful in guiding further debate, research, and innovation.

Children of parents with severe mental illness have an increased risk of offending. Studies suggest that risk factors such as parental offending and social disadvantage may be associated with the increased risk. This paper assesses the impact of these risk factors on offending rates in the offspring of women with severe mental illness compared to offspring of unaffected women.This is part of a longitudinal record-linked whole-population study of 467,945 children born in Western Australia from 1980 to 2001 to mothers with severe mental illness and mothers with no recorded psychiatric illness. These data were linked to Western Australia corrective services data producing a dataset of 12,999 people with at least one offence (3.7% of birth cohort). Cox proportional hazard was used to calculate incidence rate ratios of offspring offending.The offending rate for offspring of mothers with severe mental illness (cases) was almost three times the rate for offspring of unaffected mothers (comparison) with an unadjusted incidence rate ratio of 2.75 (95% confidence interval: [2.58, 2.93]). Adjusting for sex, indigenous status, socio-economic status and geographical remoteness reduced the rate ratio by 24% to incidence rate ratio 2.10, 95% confidence interval: [1.97, 2.23]. Adjusting for parental offending further reduced the rate ratio by 23% to incidence rate ratio 1.62, 95% confidence interval: [1.52, 1.72]. The mean age at first recorded offence was significantly lower for cases compared to comparison offspring.Children of mothers with a severe mental illness have a higher rate of offending than children of unaffected mothers, and social disadvantage and parental offending have a major impact on this rate. Services supporting these vulnerable children need to focus on improving the social environment in which they and their families live in.

Background Tobacco smoking is highest among population groups which are the most socially disadvantaged. Internet-based smoking cessation programs have been found to be effective, though rates of internet access are not well known in these groups. This study describes the rates of internet use and types of technology used to access the internet by a population of socially disadvantaged smokers. The study also examined relationships between sociodemographic and smoking behaviours with amount of internet use and type of device used. Methods A cross-sectional survey of 369 clients (response rate 77%) from two non-government community service organisations in metropolitan New South Wales, Australia was conducted using touchscreen computers. Descriptive statistics and logistic regressions were used to examine results. Results Eligible participants ranged from 19 to 88 years old current tobacco users. Over half (58%) of the participants reported weekly or more frequent use of the internet with less than a third (28%) not having any access. The odds of using the internet at least weekly decreased with age and as heaviness of smoking increased (OR = 0.94, p $400 per week). Device use differed for age and income. Conclusions Internet-based interventions appear to reach the majority of socially disadvantaged populations. It is expected that this reach will continue to grow, making internet-based interventions a potential platform for providing care to low socioeconomic individuals who smoke, however inequalities may be exacerbated for those individual without internet access. Implications Internet use among socially disadvantaged tobacco users is moderate (58%). An internet-based smoking cessation intervention for socially disadvantaged tobacco users may be an effective intervention however, older, heavier tobacco users may not benefit as easily due to limited internet access and therefore acknowledging these limitations when developing an intervention can help to acknowledge limitation of intervention reach.

Aboriginal Australians have relatively high rates of intellectual disability, a situation that is probably due mainly to poor health and social disadvantage. Populations with high rates of intellectual disability are more at risk of developmental disorders and mental ill health. We explore the training needs for psychiatrists working with indigenous people and how they can be met.

Background: Residents of rural and regional areas, compared to those in urban regions, are more likely to experience geographical difficulties in accessing healthcare, particularly specialist services. We investigated associations between region of residence, socioeconomic status (SES) and utilisation of all-cause revision hip replacement or revision knee replacement surgeries. Methods: Conducted in western Victoria, Australia, as part of the Ageing, Chronic Disease and Injury study, data from the Australian Orthopaedic Association National Joint Replacement Registry (2011–2013) for adults who underwent a revision hip replacement (n = 542; 54% female) or revision knee replacement (n = 353; 54% female) were extracted. We cross-matched residential addresses with 2011 census data from the Australian Bureau of Statistics (ABS), and using an ABS-derived composite index, classified region of residence according to local government areas (LGAs), and area-level SES into quintiles. For analyses, the control population (n = 591,265; 51% female) was ABS-determined and excluded adults already identified as cases. Mixed-effects logistic regression was performed. Results: We observed that 77% of revision hip surgeries and 83% of revision knee surgeries were performed for residents in the three most socially disadvantaged quintiles. In adjusted multilevel models, total variances contributed by the variance in LGAs for revisions of the hip or knee joint were only 1% (SD random effects ±0.01) and 3% (SD ±0.02), respectively. No differences across SES or sex were observed. Conclusions: No differences in utilisation were identified between SES groups in the provision of revision surgeries of the hip or knee, independent of small between-LGA differences. Refereed/Peer-reviewed

Summary Congenital syphilis (CS) is caused by Treponema pallidum infection in utero. There is a need to develop new tools to diagnose CS: the diagnostic value of PCR is difficult to assess. The aim of this study was to describe the clinical and laboratory characteristics of mothers and infants with CS as diagnosed by PCR tests on various maternal and neonatal samples. Patients and methods We included all infants epidemiologically linked to a mother diagnosed with syphilis whose samples were referred to the Syphilis Reference Center, and for whom at least one positive PCR result was obtained. Results Twenty-two mother-infant pairs (8.3%) with assay performed on samples from one to four different anatomic sites were included between February 2011 and April 2018. Seven mothers (31.8%) were born abroad, fifteen (68.2%) presented psychological and/or social problems, eight (36.4%) had not been screened for syphilis prior to delivery, and eleven (50%) were referred from French overseas departments or territories, or from the Paris region. Six infants (27.3%) were stillborn and six were born preterm, while fifteen infants (68.2%) presented clinical features of CS. All infants born preterm were symptomatic. Infant VDRL/RPR titer was no greater than four times that in the mother's serum, except in two cases. Discussion Lack of antenatal care, social disadvantage and psychological issues were common. There is a need for enhanced surveillance both in the French overseas departments/territories and in the Paris region. A larger study is required to assess the sensitivity and specificity of PCR. The best site for sampling has yet to be established. We recommend the collection of as many samples as possible to avoid underdiagnosis of CS.

The identification and treatment of youth at risk for the development of psychotic disorders is a current priority in the mental health field, given the potential to prevent or mitigate negative outcomes. Although there are no established standards for preventive intervention for psychosis, the issue is receiving increasing attention from clinical researchers. Research findings in the United States suggest that African Americans experience higher rates of psychosis, exhibit more severe positive symptoms, and experience different pathways to care compared to Caucasian individuals. Current theoretical conceptualizations postulate that greater exposure to discrimination, social disadvantage, and other forms of stress contribute to elevated rates of psychosis among African Americans. Despite established differences among racial/ethnic groups in cultural values, beliefs, help-seeking behaviors, pathways to care, and treatment preferences, culturally adapted interventions to treat African American youth at risk for psychosis have not been developed. The purpose of this chapter is to discuss the key socio-contextual and clinical factors that mental health providers should consider when assessing and treating African American youth experiencing attenuated psychosis syndromes. Based on our discussion, we provide specific recommendations for clinicians working with this population, as well as future directions for research to continue to investigate causal mechanisms and develop culturally sensitive interventions.

An inability or difficulty communicating can have a profound impact on a child's future ability to participate in society as a productive adult. Over the past few years the number of interventions for children with speech and language problems has almost doubled; the majority are targeted interventions delivered by speech pathologists. In this paper we examine the distribution of speech pathology services in metropolitan Melbourne and how these are aligned with need as defined by vulnerability in language and social disadvantage. We identified three times as many private sector services compared to public services for the 0-5 year age group. Overall there was poorer availability of services in some of the most vulnerable areas. The profound and long-term impact of impoverished childhood language, coupled with the considerable limitations on public spending, provide a strong impetus to deliver more equitably distributed speech pathology services.

There is consistent evidence that inflammation is involved in mental disorders pathogenesis. Herein, using data from the High Risk Cohort Study for Psychiatric Disorders, we investigated the relationship between parental mood disorders (PMD), environmental factors, serum interleukin-6 (IL6) and mental health problems in children aged 6–12. We measured the serum levels of IL6 in 567 children. Information related to socio-demographic characteristics, mental health problems and multiple risk factors, as well as parent’s psychiatric diagnosis, was captured. We evaluated two groups of environmental risk factors (i.e. perinatal complications and social disadvantage) using a cumulative risk model. Results showed that higher serum levels of IL6 were associated with PMD (RR = 1.072, p = 0.001), perinatal complications (RR = 1.022, p = 0.013) and social disadvantage (RR = 1.024, p = 0.021). There was an interaction between PMD and social disadvantage (RR = 1.141, p = 0.021), as the effect of PMD on IL6 was significantly higher in children exposed to higher levels of social disadvantage. Moreover, there was a positive correlation between IL6 and mental health problems (RR = 1.099, p = 0.026), which was moderated by exposure to perinatal complications or social disadvantage (RR = 1.273, p = 0.015 and RR = 1.179, p = 0.048, respectively). In conclusions, there is evidence of a differential inflammatory activation in children with PMD and exposure to environmental risk factors, when compared to matched peers. Systemic inflammation may be involved in the pathway linking familial risk and mental health problems.

This study assessed whether the higher risk of victimization among criminally active and socially disadvantaged individuals is related to violent incidents including offenders with criminal backgrounds. The analysis is based on a Finnish general population sample ( N = 69,635) using a 7-year-follow-up of police-reported violent incidents that enabled the measurement of criminal background of the “outside-sample” opposite parties involved in the incidents. The association between socioeconomic/criminal background and victimization grew stronger by the intensity of the criminal background of the offender. The results indicate that the risk posed by prior offenders is disproportionally targeted toward criminally active and disadvantaged individuals.

Background People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes. Methods/design This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills – knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program. Discussion Outcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616000213448. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3034-9) contains supplementary material, which is available to authorized users.

Integrating physical activity into the curriculum has potential health and cognitive benefits in primary school children. The aim of this study was to investigate the effects of physically active academic lessons on cardiovascular fitness, muscular fitness and executive functions. In the current randomized controlled trial, 499 second and third graders within 12 primary schools (mean age = 8.1 +/- 0.7) were randomized to the intervention (n = 249) or control condition (n = 250). The physically active academic lessons were given for 2 consecutive school years, 22 weeks per year, three times a week, with a duration of 20-30 min per lesson. Multiple tests were administered before, between and after the intervention period, measuring cardiovascular fitness, muscular fitness and executive functions. Multilevel analysis accounted for the nested structure of the children within classes and schools. Results showed a larger improvement in speed-coordination (B = -0.70, P = 0.002) and a lower improvement in static strength (B = -0.92, P

In Australia and New Zealand, population groups who experience social disadvantage smoke at much higher rates than the general population. As there are limited data specific to these groups regarding the success of nicotine replacement therapy for smoking cessation, this commentary will provide an overview of the relevant international literature supplemented with observational data relevant to the policy contexts in Australia and New Zealand. [Paul C, Wolfenden L, Tzelepis F, Yoong S, Bowman J, Wye P, Sherwood E, Rose S, Wiggers J. Nicotine replacement therapy as a smoking cessation aid among disadvantaged smokers: What answers do we need? Drug Alcohol Rev 2016;35:785-789].

Up to 95% of women who use other substances also smoke tobacco during pregnancy. Challenging psychosocial circumstances and other barriers that contribute to high levels of tobacco dependence result in few quitting successfully. This case report describes the treatment of a highly tobacco dependent 34-year-old pregnant woman with a history of recent substance use, mental illness and trauma, enrolled in the Incentives to Quit Tobacco in Pregnancy program. Heavy smoking, both during the day and overnight, was reported. An extensive history of quit attempts, as well as a strong desire to cease tobacco use during pregnancy, was also noted. Treatment utilising extensive behavioural supports, including financial incentives for carbon monoxide verified abstinence and telephone-based counselling, in combination with nicotine replacement therapy (NRT), was offered to assist cessation. Excellent uptake and adherence to all aspects of treatment saw tobacco cessation achieved and maintained for 24 weeks while on the program. NRT used at doses well above those recommended for pregnancy was required to alleviate strong withdrawal symptoms and maintain abstinence. Daily monitoring of carbon monoxide, financial incentives for continued abstinence and regular phone support were critical to maintaining motivation and preventing relapse to smoking. Post-program relapse to smoking did occur, as is common, and highlights the need for longer-term intensive support for pregnant women with complex behavioural and social problems. Given the prevalence of tobacco smoking in such populations, long-term harm reduction treatment models using extensive behavioural support in combination with NRT should be considered for inclusion in current smoking cessation guidelines.

James Matheson, John Patterson, Laura Neilson CRC Taylor & Francis Group Ltd, 2020, PB, 364pp, £27.99, 978-1138499867 This book addresses a key ongoing cause of ill health, which as a GP impacts on my daily work at all levels — but is often implicit, and feels hard to address in any effective way. I went into general practice because I liked the idea of prevention, and being upstream of preventable damage. Forty years on, at the end of a period in the UK of disinvestment in public services and an emphasis on competitive markets, I continue to see many patients whose life chances and health are chronically disadvantaged …

Objective To explore perceptions of the impacts of dementia on people living with the condition and those close to them and examine the relationship between dementia, disadvantage and social exclusion. Methods Semi-structured in-depth interviews were conducted with 111 participants: people with dementia (n = 19), carers (n = 28), health-care professionals (n = 21), social workers (n = 23) and service professionals (n = 20). NVivo 11 was used to code descriptions and identify impact areas. Results Participants described social, psychological, carer, material, service-based and disparity impacts associated with the experience of dementia. Some of these impacts correspond to social exclusion associated with age, but some are distinctive to dementia. Discussion It is argued that dementia generates its own forms of social disadvantage and exclusion. This is in addition to being subject to structural risk factors. The implications of the active effects of dementia as a social phenomenon should give rise to new policy and practice priorities.

This study investigated the influence of illness on sexual risk behavior in adolescence and the transition to adulthood, both directly and through moderation of the impact of social disadvantage. We hypothesized positive effects for social disadvantages and illness on sexual risk behavior, consistent with the development of faster life history strategies among young people facing greater life adversity. Using the first two waves of the National Longitudinal Study of Adolescent Health, we developed a mixed effects multinomial logistic regression model predicting sexual risk behavior in three comparisons, risky nonmonogamous sex vs. 1) safer nonmonogamous sex, 2) monogamous sex, and 3) abstinence, by social characteristics, illness, interactions thereof, and control covariates. Multiple imputation was used to address a modest amount of missing data. Subjects reporting higher levels of illness had lower odds of having safer nonmonogamous sex (OR = 0.84, p < .001), monogamous sex (OR = 0.82, p < .001), and abstinence (OR = 0.74, p < .001) vs. risky nonmonogamous sex, relative to individuals in better health. Illness significantly moderated the sex (OR = 0.88, p < .01), race/ethnicity (e.g., OR = 1.21, p < .001), and childhood SES (OR = 0.94; p < .01) effects for the abstinent vs. risky nonmonogamous sex comparison. Substantive findings were generally robust across waves and in various sensitivity analyses. These findings offer general support for the predictions of life history theory. Illness and various social disadvantages are associated with increased sexual risk behavior in adolescence and the transition to adulthood. Analyses indicate that the buffering effects of several protective social statuses against sexual risk-taking are substantially eroded by illness.

Background and Aims: Scientific evidence regarding protective factors that contribute to healthy weight in childhood is limited and is particularly scarce in lower socio-economic populations in different ethnic groups. This study aimed to assess the prevalence of biological, behavioral and psychosocial factors for child overweight/obesity in Jewish and Arab population groups in Israel, and to compare their associations with child overweight/obesity in the two groups. Methods: Children aged 5–6 years were randomly selected from 20 Mother and Child Health clinics in towns and villages of lowest socio-economic ranking in Northern Israel. Children and mothers were invited for a special “One Stop Shop–Preparation for School” visit which included growth measurements. Questionnaires were distributed to mothers for self-report on biological, SES, psychological and lifestyle factors. Perinatal and early nutritional data were retrieved from clinic records. Multivariate analyses using logistic regression models predicting child overweight/obesity were conducted separately for Jewish (N = 371) and Arab (N = 575) children. Results: Overweight/obesity (BMI ≥85th centile) rates were higher in Jewish (25%) than Arab (19%) children. In both Jewish and Arab groups, respectively, maternal BMI (OR = 1.10 [95%CI = 1.04, 1.17]; OR = 1.08 [95%CI = 1.04, 1.13]), and child birthweight (OR = 1.33 [95%CI = 1.04, 1.71]; OR = 1.39 [95%CI = 1.11, 1.73]) were significant risk factors for overweight/obesity, and maternal self-efficacy regarding child's lifestyle was significantly protective (OR = 0.49 [95%CI = 0.28, 0.85]; OR = 0.54 [95%CI = 0.34, 0.85]). Additionally, four other maternal psychological and child behaviors were significantly associated with overweight/obesity in the Jewish group and two child lifestyle behavior factors in the Arab group. Moreover, significant interactions indicating moderation effects were found only in the Jewish group: maternal education and maternal age moderated the effect of maternal BMI on child overweight/obesity. No other moderation of risk factors was found. Discussion: In this study of children from low SES families, protective factors contributed to healthy child weight alongside risk factors for overweight/obesity. They differed between the population groups, and fewer variables explained overweight/obesity in Arab children. Although further expansion of these findings is required they point at the relevance of protective factors, maternal self-efficacy in particular, for understanding childhood obesity in specific ethnic contexts and for planning culturally adapted prevention programs in disadvantaged populations.

David Wastell and Susan White Policy Press, 2017, HB, 304 pp, £ 21.59, 978-1447322344 Science is one big story. Or, more accurately, it is lots of stories: conflicting, contested, merging, evolving — and sometimes ossifying, constraining, and distorting. Wittgenstein referred to the ‘railway tracks’ of science: the unspoken assumptions and shared ways of thinking within a scientific community, without which science cannot progress, and Thomas Kuhn talked of research paradigms: shared and evolving ways of conceptualising, theorising, empirically studying, and arguing about scientific topics. In their critique of an emerging new paradigm, David Wastell (a cognitive neuroscientist) and Sue White (a social scientist) offer an interdisciplinary text in two parts: ‘Getting to grips with the thought styles’ (an overview of the shared assumptions, practices, and methodologies on which modern neuroscience is based) and ‘Fixing real people’ (a critique of contemporary empirical findings and applications of neuroscience, especially in relation to social disadvantage). In Part 1, the authors explain that neuroscience asks questions like ‘Which part of the brain is responsible for which function?’ and ‘What happens when that part of the brain is damaged?’ A core assumption, which many neuroscientists share but these authors emphatically …

The article presents a social-psychological indicators of stress, coping mechanisms, rigidity and psychological component gestational dominant as risk factors predisposing to deviations in the context of preparedness for motherhood, marked psychological characteristics of pregnant women main group.Material and methods. The study was conducted on the basis of obstetric clinics SSMU, prenatal maternity hospital number 4 and the Centre for Medical Prevention (Cabinet crisis pregnancy). Total was attended by 52 women aged 18 to 44 years, at different stages of pregnancy – from 5 to 39 weeks. Methodological apparatus consisted of a structured interview questionnaire “Medical and social data of the pregnant woman” methodology for determining the stress and social adaptation of Holmes and Rage (1967), a questionnaire of coping R. Lazarus and S. Folkman (WCQ, 1988), Tomsk questionnaire rigidity G.V. Zalewski (TORZ, 1987), test on pregnant I.V. Dobryakova (1996). Data processing was carried out using statistical methods Spearman rank correlation coefficient, nonparametric Mann–Whitney U and Kruskal–Wallis H and φ * – Fisher's angular transformation.Results. Significant psychological factors that may influence the formation of readiness for motherhood among women of the main group can be considered an unplanned pregnancy (65%), and also its not gelendost (35%).Studies of stress resistance was detected in pregnant women from the main group low stress levels (88%), and only 12% have a high degree. Most of the women from the сomparison group reverse the situation 64% have a high degree of stress, this suggests that the presence of previously state miscarriage is for this group of stress.On the formation of readiness for motherhood affects not only the presence of stressful situations, butalso how the woman in their lives. Using U-test Mann–Whitney, were statistically significant differences were observed among the main group and сomparison group in the following coping strategies: selfcontrol (p ≤ 0.0014), the search for social support (p ≤ 0.0015), accepting responsibility (p ≤ 0.04), and planning solutions to the problems (p ≤ 0.00016). These differences are considered as one of the risk factors for deviant motherhood main group.In contrast to the сomparison group, where 62% of pregnant women with the optimal type PKGD, main group optimal type PKGD observed only in 38% of the respondents, which indicates that the risk of deviations in the structure of psychological readiness.Conclusion. Risk factors such as social disadvantage, the planned abandonment of a child, the tendency to rigid behavior, inefficient use of coping strategies and low level of optimal psychological component gestational dominant testify about the possible psychological unpreparedness for the upcoming event to become a mother and as a consequence to the development of deviant motherhood.