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This paper begins with a critical review of studies which have examined the effects of caring on health. Most are shown to suffer from defects in sampling and design, so that the evidence for detrimental effects is suggestive rather than conclusive. The substantive part of the paper then utilizes data on a cohort of 55-year-olds to compare the health of carers with the health of non-carers and to examine changes in caring and health over a 3-year period. The comparison yields no systematic evidence of the deleterious effects of caring on health; indeed, if there is a tendency in the accumulated data, it is in the opposite direction i.e. that carers report better health and functioning than non-carers. It is suggested that part of the explanation relates to selection and self-selection and the longitudinal data reveals high volatility in caring status, even over a short time period. The paper goes on to examine sub-groups of carers considered to be at greater risk. There is no evidence that their health is compromised but the authors acknowledge weaknesses in the data and argue for a specially designed study. The paper concludes with a discussion of the findings and their implications for research, policy and practice.

Although life event research has burgeoned in recent years, little attention has been paid to the prevalence of events among the elderly or their relationship to psychological well-being. This paper presents data from a three-wave longitudinal study of community elderly in Aberdeen. Negative life events were highly prevalent among both survivors [N=349) and non-survivors [N=108], but the relatively small differences between the groups indicate that attrition does not seriously affect longitudinal findings. Longitudinal analysis of survivors' data was performed using LISREL and yielded a model with a goodness of fit index of 0.918, demonstrating a close fit between the data and the model. The model parameters indicate that those in poor psychological state were more likely to report serious non-health events than health events, although the latter were more likely than the former to result in a decline in psychological well-being, even after prior psychological state was taken into account. While ...

While there has been increasing recognition of the general proposition that the elderly are not a homogenous population there have been few attempts to delineate the characteristics of sub‐groups varying on dimensions of well‐being, such as health and psychological state. This may be due to the difficulty researchers have encountered in finding a rational basis for differentiating elderly people. However, there are also conceptual and methodological reasons which have contributed towards the neglect of this topic.

Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference in resource use. Discussion and conclusions: The Managed Clinical Network made a difference to ways of working, particularly in breaching traditional boundaries and involving the public, and made modest changes in patient care. However, it required a two-year “set-up” period. Managed clinical networks are complex initiatives with an increasing profile in health care policy. This study suggests that they require energetic leadership and improvements are likely to be slow and incremental.

Rudolf Virchow's Report on the 1848 typhus epidemic is one of the neglected classics of ‘social medicine’— a term he did much to popularise. His analysis of the epidemic emphasised the economic, social and cultural factors involved in its aetiology and clearly identified the contradictory social forces that prevented any simple solution. Instead of recommending medical changes like more doctors or hospitals, he outlined a revolutionary programme of social reconstruction; including full employment, higher wages, the establishment of agricultural co-operatives, universal education and the disestablishment of the Catholic church. The present paper includes the first English translation of these long-term recommendations. It also locates Virchow's Report within the context of the Medical Reform Movement of 1848 and traces his influence on the subsequent development of social medicine. Parallels are drawn between Virchow's attempts to reform health care and current developments in the political economy of health.

This paper is concerned with the nature, usage and potential of the concept of lifestyle. It concentrates on usage in social gerontology and specifically on the way in which it has been used by three teams of American researchers. Its overall aim is to discover guidelines for establishing the lifestyle concept on a sounder methodological footing.The paper begins with a discussion of diversity within the elderly population and it identifies the need for a systematic conceptual scheme for describing the social life of the individual. It examines the relationship between lifestyle and social class and concludes that they represent complementary rather than competing approaches. The paper goes on to explore three definitions of life-style - as structure, content and meaning - and compares and contrasts these three alternative approaches. The difference between ‘nominal’ and ‘real’ definitions is discussed and the paper ends with a summary account of the way in which the concept has been operationalized in a continuing British study.

This article adopts a case study approach to examine the contribution of social science research to health policy. It concentrates exclusively on the recent Royal Commission on the National Health Service. After describing its background and modus operandi the paper goes on to assess the Report's utilization of social science research, both in its diagnosis and recommendations. This assessment suggests that while the Commissioners made relatively little use of research-based evidence in their diagnosis, their recommendations provide the basis for a substantial increase in the contribution of social sicentists, particularly in the field of health services evaluation.

In her recent discussion of women's incorporation into their husbands' employment Janet Finch produces a useful maxim for prospective wives

While all migration involves a sending a receiving and a migrating unit it is rare that equal attention is given to all three. Most migration studies have concentrated on the changing relationship between individual migrants or migrant groups and the receiving or host society. They are in fact studies of immigration; and as such they make an important contribution to our understanding of the processes of assimilation acculturation and since most migrations are rural-urban of urbanization itself. By contrast few studies have examined the changing relationship between the migrant and the sending or residual community and comparatively little is known about the overall effects of migration on the residual community. For sociologists part of this neglect is explained by the urbanindustrial orientation of the discipline. Both the European speculative and the American empirical traditions have been animated principally by urban and industrial themes. Therefore when sociologists have shown an interest in migration they have concentrated on the adjustment of migrants in urban and industrial settings. This concentration on immigration is particularly evident in American sociology where many sociologists are immigrants themselves and the society as a whole has subscribed to a melting pot ideology. (excerpt)

This paper identifies the local health system as an area for sociological observation and analysis. Within the local system professional, managerial and lay groupings are described, and their influence on resource allocation assessed. It is suggested that ultimate claims to membership of the Health Board rest on three different principles—patronage, worker syndicalism and the popular vote— and that this gives rise to three potential interest groups. The reconstruction of a controversy in the local system reveals the ways in which these different groups formulate and pursue their interests both within and out of the formal structure. Professional-lay and managerial-professional conflicts provide the central themes, and the paper is ultimately concerned with the question, who defines health needs?

This paper examines the distribution of personal resources - financial, social, health and psychological - between age cohorts, sex groups and social classes in a random sample of community elderly. As expected, the young elderly, males and those from middle-class backgrounds have a disproportionate share of three out of four of these resources, but for social support the balance of advantage is reversed. When age, sex and class are combined to yield eight subgroups, younger working-class males consistently rank high on all resources and older working-class females consistently rank low. Older middle-class females rank low on all resources other than on close friends.

An investigation was conducted in the Aberdeen area on wives of oil men working either off-shore or on-shore. No differences were found in measures of general health; but ‘off-shore wives' were shown to experience mood and behavioural changes, linked to the pattern of swiftly recurring partings and reunions. While a majority of such wives appeared to tolerate or even thrive on their style of life, 10% had reactions sufficiently pronounced to deserve the label of Intermittent Husband Syndrome or ‘caseness'. Many others would have benefited from more effective preventive and support services.

This article uses cluster analysis to identify different patterns of personal resources within a random sample of the well, elderly population. Ten such patterns or natural groupings are identified and their implications for coping and successful aging are discussed. It is apparent that there are a number of ways both of aging well and aging badly, and that these patterns cannot be predicted solely on the basis of structural data. The article poses a number of questions on the performance of cluster members over time and draws attention to the importance of longitudinal data.

A number of studies have now shown a markedly higher prevalence of multiple sclerosis (MS) in northern Scotland.1 The prevalence rates appear particularly high in the islands, with Orkney having the highest rate reported anywhere in the world.2 3 Our specific task in this paper is to consider the possible effect of differential migration upon prevalence. The hypothesis is that part or all of the difference in prevalence may be the result of differences in migration, and the possibility that persons with MS are less likely to migrate, and that those who do are most likely to return after onset of the disease. Bradford Hill's4 pioneering study of the effect of migration on mortality rates produced the earliest clear evidence for our migration hypothesis. Additional and more recent evidence has come from those studies which have used height as an index of health status; most of these show that migrants are invariably taller than residents.5 The best British data are those collected by Martin,6 the Scottish Council for Research in Education,7 and Illsley, Finlayson, and Thompson.8 The latter are of particular interest because Aberdeen is the main destination for migrants from Orkney and Shetland. The authors demonstrated that migrants into the city were taller and had lower prematurity and perinatal death rates than Aberdeen women, and that the superiority was most marked among the more distant in-migrants. In the absence of studies of MS which provide a direct test of the migration hypothesis, this paper proceeds on the assumption that persons with MS migrate differently from the remaining section of the population. Assuming that those with MS are less likely to migrate, and that those who do are more likely to return, can we account for the observed prevalence rates? Before examining the special situations of Orkney and Shetland, we consider a number of factors which might plausibly affect prevalence rates.

It is ironic that one of the unintended consequences of attempts to improve the circumstances and status of the elderly has been the tendency to describe them in an undifferentiated fashion. Ironic — but understandable: because the more those over a certain age are described as a group with shared experiences and deprivations, the more they are likely to obtain material improvements. While there can be no doubt that by comparison with younger age groups the elderly share a number of deprivations, this must not blind us to substantial differences between the elderly themselves. This chapter is concerned with the internal social differentiation of the distribution of personal resources — social, material, and mental and physical health — between age cohorts, sex groups and social classes. This is followed by a more focused examination of the distribution of these resources between a number of commonly identified risk groups — for example, those who live alone, the childless, recent movers. It ends with a more speculative examination of differentiation through the identification of lifestyle clusters.

Rudolf Virchow's Report on the 1848 typhus epidemic is one of the neglected classics of “social medicine”—a term he did much to popularize. His analysis of the epidemic emphasized the economic, social, and cultural factors involved in its etiology, and clearly identified the contradictory social forces that prevented any simple solution. Instead of recommending medical changes (i.e., more doctors or hospitals), he outlined a revolutionary program of social reconstruction; including full employment, higher wages, the establishment of agricultural cooperatives, universal education, and the disestablishment of the Catholic Church. This article includes the first English translation of these long-term recommendations. It also locates Virchow's Report within the context of the Medical Reform Movement of 1848 and traces his influence on the subsequent development of social medicine. Parallels are drawn between Virchow's attempts to reform health care and current developments in the political economy of health.

As the preventive approach gains ground in the care of the elderly there is increasing interest in screening or case-finding. Given the impracticability of visiting all those over a certain age, most GPs and health visitors concentrate on those considered to be at greatest risk of medical and social deterioration. This paper draws on data from a random sample of the elderly population of Aberdeen to examine the nature and extent of ‘risk’ experienced by those falling into a number of conventionally defined risk groups. It shows that few of these groups are comprehensively disadvantaged and most are inefficient for selective case-finding. An alternative approach based on answers to a carefully selected set of screening questions is shown to be more efficient, and suggestions are offered for further improvements.

An earlier generation of sociologists would have looked at the oil industry in the context of a body of work concerned with ‘extreme occupations’. Much of that material was predicated upon the notion of a radical separation of home and work, apparently visible in the lives of fishermen (Tunstall, 1962), lorry drivers (Hollowell, 1968), miners (Dennis, Henriques and Slaughter, 1969) and others. This separation allowed the work-place to become the focus of attention, reducing family, kinship and community to the level of dependent variables. As we have already seen (pp. 12–19) such a distinction often serves to mask the complex interrelationships between work and family and is likely to obscure important gender differences with shape experiences in the two arenas. A growing body of writing has therefore begun to examine the work/family nexus and the concept of incorporation (Callan and Ardener, 1984) has been especially helpful in revealing the variety of ways in which women may be co-opted as unpaid collaborators in their husbands’ paid employment. Whilst occupations such as the ministry, general practice or those in which the worker is self-employed provide obvious examples of this phenomenon (Finch, 1983), some of the very jobs which were once classified as ‘extreme’ in character also merit attention.

This paper examines the psycho-social effects on wives of their husbands' intermittent absence on off-shore oil rigs. It is based on data gathered from a random sample of wives living in the Aberdeen area, and it proceeds in three stages. The analysis begins with a comparison between wives whose husbands work on- and off-shore, it goes on to examine differential reaction to husband absence in the off-shore group and concludes with an attempt to estimate prevalence of the 'intermittent husband syndrome'. All the available evidence suggests that the psycho-social effects of intermittent husband absence have been exaggerated. The mental and physical health of wives of men working off-shore was similar in most respects to the health of wives whose husbands work on-shore. Within the sample of wives whose husbands worked off-shore those most affected by intermittent husband absence were 'Novices' (newly married wives with preschool children and no previous experience of husband absence), those with outside employment and those experiencing irregular absences. But even among such groups with fairly pronounced mood and behaviour changes there was little evidence of raised levels of morbidity. When defined in terms of specified levels of reactivity, marital conflict and morbidity prevalence of the 'intermittent husband syndrome' was found to be around 10%.