Birthweight, postnatal growth and cognitive function in a national UK birth cohort

BACKGROUND: Birthweight is associated with cognition and educational attainment across the full birthweight range in the normal population, independently of social background. However, the extent to which birthweight reflects fetal growth, or is a marker of subsequent size, with respect to this association, is not clear. We therefore investigated the independent effects of birthweight and postnatal height adjusted for postnatal weight on cognitive function and educational attainment while controlling for family background. METHODS: Using the British 1946 birth cohort we investigated the association between cognitive function at various ages and birthweight, height adjusted for weight in childhood and adulthood, and educational attainment, controlling for sex, father's social class, maternal education, birth order, and maternal age. RESULTS: Birthweight was positively associated with cognition up to age 26, and with the likelihood of obtaining advanced educational qualifications. Height was positively associated with cognition at all ages, and also with educational attainment. Weight was not associated with cognition at ages 8 and 15, but was negatively associated with verbal ability at age 26, with verbal memory at age 43, and with educational attainment. These effects were independent of each other, and of family background. Conditional analyses suggested the positive effect of height growth on cognition at two intervals, one in early childhood, and the other in late adolescence. In addition, weight gain after age 15 was negatively associated with cognition at 26. CONCLUSION: Birthweight and postnatal growth are independently associated with cognition.     

Contextual social capital as a risk factor for poor self-rated health: a multilevel analysis

In this study, we critically examine whether contextual social capital (CSC) is associated with self-rated health, with an emphasis on the problem of confounding. We also examine different components of CSC and their association with self-rated health. Finally, we look at differences in susceptibility between different socio-demographic groups. We use the cross-sectional base line study of the Stockholm Public Health Cohort, conducted in 2002. A postal questionnaire was answered by 31,182 randomly selected citizens, 18-84 years old, in Stockholm County. We used four measures of social capital: horizontal (civic trust and participation), vertical (political trust and participation), cognitive (civic and political trust) and structural (civic and political participation). CSC was measured at parish level from aggregated individual data, and multilevel regression procedures were employed. We show a twofold greater risk of poor self-rated health in areas with very low CSC compared with areas with very high CSC. Adjustments for individual socio-demographic factors, contextual economic factors and individual social capital lowered the excess risk. Simultaneous adjustment for all three forms of confounding further weakened the association and rendered it insignificant. Cognitive and structural social capital show relatively similar associations with self-rated health, while horizontal CSC seems to be more strongly related to self-rated health than vertical CSC. In conclusion, whether there is none or a moderate association between CSC and self-rated health, depends on the extent to which individual social capital is seen as a mediator or confounder. The association with self-rated health is similar independent of the measure of CSC used. It is also similar in different socio-demographic groups.     

Understanding the relationship between cognition and death: a within cohort examination of cognitive measures and mortality

Despite several studies demonstrating an independent and inverse association between cognition and mortality, the nature of this association still remains unclear. To examine the association of cognition and mortality after accounting for sociodemographic, health and lifestyle factors and to explore both test and population characteristics influencing this relationship. In a population based cohort of 8585 men and women aged 48–92 years, who had cognitive assessments in 2006–2011 and were followed up till 2016 for mortality, we examined the relationship between individual cognitive tests as well as a global cognition score to compare their ability in predicting mortality and whether these differed by population characteristics. Risk of death was estimated using Cox proportional hazard regression models including sociodemographic, lifestyle and health variables, and self-reported comorbidities, as covariates in the models. Poor cognitive performance (bottom quartile of combined cognition score) was associated with higher risk of mortality, Hazard Ratio?=?1.32 (95% Confidence Interval 1.09, 1.60); individual cognitive tests varied in their mortality associations and also performed differently in middle-age and older age groups. Poor cognitive performance is independently associated with higher mortality. This association is observed for global cognition and for specific cognitive abilities. Associations vary depending on the cognitive test (and domain) as well as population characteristics, namely age and education.     

Sociodemographic Determinants of Leisure Participation Among Elderly in Malaysia

Leisure participation has been proven to be beneficial and has a positive link to successful ageing. This study aims to explore the sociodemographic determinants of leisure participation among the Malaysian elderly. A cross-sectional study was conducted among persons aged 60 years and above, purposively selected from eight health clinics in the state of Selangor. Leisure participation was measured using a validated Leisure Participation Questionnaire specific for Malaysian elderly, consisting of 25 activities, categorized into 4 categories, namely recreational (physical), cognitive, social and productive. Frequency of such participation was measured on a 6-point scale. Its association with sociodemographic variables was examined using inferential and regression analysis. 268 participants were involved in this study (response rate = 100%). The most common daily leisure activities were having conversations while relaxing (78.7%), watching television (74.6%) and reading (63.4%). The least frequently done leisure activities were from the recreational and cognitive categories. The activities were weakly correlated to each other, reflecting the lack of diversity of leisure activities among respondents. Education was the main predictor for leisure participation among elderly, with higher educational level is associated with high RAS (B = 1.020, P < 0.05), CAS (B = 1.580, P < 0.05) and SAS (B = 1.276, P < 0.05). Education level, marital status and locality were important determinants of leisure participation among elderly, with education being the main predictor. Further studies exploring the effective method of educating the ageing society are recommended.     

Factors associated with IADL independence: implications for OT practice

Background: Globally, the population is aging. Instrumental activities of daily living (IADL) are an important component of independent function and impact the ability of older adults to age in place. Therefore, factors associated with IADL independence warrant further study.

Objective: To explore the association of age, depressive symptoms and leisure participation with IADL independence, and the relative importance of these three factors in predicting IADL independence.

Methods: A cross-sectional design using an existing data set was employed. Older adults age 60 and older (n?=?98) who resided in senior housing or their own home/apartment were included in the study. A hierarchical multiple regression analysis was employed.

Results: The second model predicting IADL independence using age, depressive symptoms and level of leisure participation was significant (F_(3,96)?=?15.57, p?R² adjusted?=?18.00%). Age was the strongest of the three predictors, accounting for 11.40% of the variance in IADL independence. Depressive symptoms and participation in leisure activities were also significant predictors, their unique contributions being 7.30 and 4.30%, respectively.

Conclusion and significance: Age, depressive symptoms and leisure participation are all significant predictors of IADL independence among older adults. Therefore, according to our preliminary findings, leisure participation and non-pharmacological interventions for depressive symptoms warrant attention in practice in relation to IADL independence.     

Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002

BACKGROUND: A good understanding of the association between obesity and socioeconomic status (SES) has many important public health and policies implications, particularly for the prevention and management of obesity. OBJECTIVE: The objective was to examine secular trends in the relations between overweight (body mass index > or = 95th percentile) and SES. DESIGN: We examined secular trends in the relation between overweight and SES using nationally representative data collected in the National Health and Nutrition Examination Surveys (NHANES) between 1971 and 2002 for 30 417 US children aged 2-18 y. Poverty income ratio tertiles at each survey were used to indicate low, middle, and high SES. RESULTS: Considerable race, sex, and age differences were observed in the association between overweight and SES. A reverse association only existed in white girls; African American children with a high SES were at increased risk. Socioeconomic disparities in overweight have changed over time, with an overall trend of weakening. Compared with the medium-SES group, the adjusted odds ratios and 95% CIs were 0.79 (0.47, 1.33), 1.08 (0.73, 1.61), 1.24 (0.73, 2.09), and 1.04 (0.82, 1.33) in NHANES I, II, and III and in the 1999-2002 NHANES for the low-SES group and 0.66 (0.43, 1.00), 0.60 (0.35, 1.03), 0.42 (0.23, 0.76), and 0.99 (0.68, 1.43) for the high-SES group, respectively. Between 1988-1994 and 1999-2002, the ratio in the prevalence of overweight between adolescent boys with a low or high SES decreased from 2.5 to 1.1 and from 3.1 to 1.6 in girls. Consistently across almost all SES groups, the prevalence of overweight was much higher in blacks than in whites. CONCLUSIONS: Complex patterns in the association between SES and overweight exist. Efforts solely targeting reductions in income disparities probably cannot effectively reduce racial disparities in obesity.     

Inequalities in health in intensive care patients

In order to study the possible association between socioeconomic status (SES) and critical care mortality, we examined a cohort of 847 patients over 14 years of age, as they were consecutively admitted to three general intensive care units (ICUs). The patients with low SES (social classes IV and V according to the British Registrar General's classification) were older (62.0 v 58.5 years old, p less than 0.0001) and showed a higher ICU mortality (odds ratio (OR) = 1.61, p = 0.0204) and severity of illness on admission (mean Simplified Acute Physiology Score [SAPS] 9.9 vs 8.7, p = 0.0002) than patients with high SES (social classes I-III). The initial severity of illness differential was detected both in patients admitted from the emergency area and in patients admitted from the general hospitalization ward, suggesting the existence of some kind of preselection procedure related to the SES of the patient. The stepwise logistic regression analysis identified as independent predictive variables of ICU mortality therapeutic effort (measured with the Therapeutic Intervention Scoring System [TISS]), SAPS score, age and hospital, but not SES. The TISS/SAPS ratio according to origin of patients (emergency/general wards) was comparable in the high and low SES. We conclude that there is an inverse relationship between SES and ICU mortality. The mortality excess in the low SES patients is largely accounted for by the covariates of the low SES (especially their high age and severity of illness on admission). There is no evidence of a different relative therapeutic effort according to the SES.     

The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations

Objectives: To assess the association between leisure time physical activity and musculoskeletal morbidity, as well as possible interactions with physical activity at work. Methods: A literature search was performed to collect all studies on musculoskeletal disorders in which physical activity was involved as a variable. Next, an analysis was made of questionnaire data on a group of 2,030 workers in various occupations, on self-reported physical activity in leisure time and at work, musculoskeletal symptoms (from low back, neck-shoulder and lower extremity) and sick leave due to these symptoms. A logistic regression analysis was carried out to estimate the association between musculoskeletal morbidity and four physical-activity indices (participation in sports and sedentary activities, active life style, sedentary life style), adjusted for age, gender, education and work load. Interaction of leisure activities with age and work load was tested too. Results: Available literature data (39 studies) showed inconsistent results. Most studies did not show any effects. Some studies indicated favourable effects of physical activity, both on low back and neck pain. Participation in some vigorous sports seemed associated with unfavourable effects. The empirical data showed no association between participation in sports and/or other physical activities in leisure time and musculoskeletal symptoms. Sedentary activity in leisure time was associated with higher prevalence rates of low back symptoms and sick leave due to low back symptoms. Conclusions: Stimulation of leisure time physical activity may constitute one of the means of reducing musculoskeletal morbidity in the working population, in particular in sedentary workers. Received: 4 October 1999 / Accepted: 25 April 2000     

Leisure time exercise and personal circumstances in the working age population: longitudinal analysis of the British household panel survey

OBJECTIVES: Investigate the impact of social, economic, and family circumstances on participation in weekly leisure time exercise. DESIGN: Longitudinal regression analysis of the British household panel survey. PARTICIPANTS: 9473 people (4521 men and 4952 women) giving 27,881 person years of responses across eight years and four survey waves. MAIN RESULTS: There was considerable variation among people in regular exercise participation over time. Having children was associated with a reduced likelihood of exercise for both men and women, although there were sex differences in this association according to the age of the youngest child. For both men and women working long hours was associated with a reduced likelihood of exercise, as was having a lower grade job. Retired men and women were more likely to exercise, as were those who attended a fee paying school. There was no strong independent association between household income and exercise. CONCLUSIONS: For most people, participation in leisure time exercise "comes and goes" rather than being something they always or never do. Those with time pressures from work or domestic life are less likely to participate in leisure time physical activity. There are important sex differences in the impact of having children, with women experiencing longer term detrimental effects. Working long hours reduces leisure time exercise participation. Opportunities for physical activity as part of our daily working routines should be increased.     

Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly

BACKGROUND: This study examines how changes in cognition over time are related to participation in social activities and the extent of social networks. METHODS: Data are drawn from a population-based, longitudinal study that began in 1989 among elderly Taiwanese. An over-dispersed Poisson model is used to regress the number of failed cognitive tasks (0-5) in 1996, 1999, and 2000 on prior measures of cognitive impairment, social activities, social networks, health status, and sociodemographic characteristics. The analysis sample comprises 2387 individuals, who contribute a total of 4603 observations across three survey intervals (1993-96, 1996-99, 1999-2000). RESULTS: After adjusting for prior cognitive impairment, baseline health status, and sociodemographic factors, respondents who participated in one or two social activities failed 13% fewer cognitive tasks (P < 0.01) than those with no social activities; those who engaged in three or more activities failed 33% fewer cognitive tasks (P < 0.001). In contrast, none of the social network measures was related to cognitive impairment. CONCLUSIONS: Despite a social structure where elderly persons often live with their children and social interaction is likely to be more family-centered than in western countries, data from Taiwan suggest that participation in social activities outside the family may have a bigger impact on cognitive function than social contacts with family or non-relatives.     

Lipid profile and socioeconomic status in healthy middle aged women in Sweden.

STUDY OBJECTIVE: To examine the relationship between socioeconomic status (SES) and full lipid profile in middle aged healthy women. PARTICIPANTS: These comprised 300 healthy Swedish women between 30 and 65 years who constitute the control group of the Stockholm female coronary risk study, a population based, case-control study of women with coronary heart disease (CHD). The age matched control group, drawn from the census register of greater Stockholm, was representative of healthy Swedish women aged 30-65 years. Five measures of SES were used; educational level, occupation, decision latitude at work, annual income, and size of house or apartment. MAIN RESULTS: Swedish women with low decision latitude at work, low income, low educational level, blue collar jobs, and who were living in small houses or apartments had an unhealthy lipid profile, suggesting an increased risk of CHD. Part of this social gradient in lipids was explained by an unhealthy lifestyle, but the lipid gradients associated with decision latitude at work and annual income were independent of these factors. Decision latitude, educational level, and annual income had the strongest associations with lipid profile. These associations were independent of age, menopausal status, smoking, sedentary lifestyle, alcohol consumption, obesity, excess abdominal fat, and unhealthy dietary habits. Of the lipid variables, low high density lipoprotein cholesterol (HDL) levels were most consistently associated with low SES. CONCLUSIONS: Decision latitude at work was the strongest SES predictor of HDL levels in healthy middle aged Swedish women, after simultaneous adjustment for other SES measures, age, and all lifestyle factors in the multivariable regression model.     

Social representations of the participation of third age groups in leisure activities

The objective of this research is to study the social representations concerning the participation of third age groups in leisure activities. Thirteen individual interviews were accomplished with the co-operation of men and women over sixty-years-old in a Third Age Coexistence Center. The discourses were analyzed starting from the technique of content analysis, followed by discussion based on the Theory of Social Representations. The "marks of old age", such as, solitude, disease and lack of activity, are the reasons elderly people take part in this kind of leisure activities in the Third Age Coexistence Center. They belong to the "Third Age family" and find medicine and therapeutic assistance for the "signs of old age". The participation in leisure activities represents the "exit from rock-bottom", and brings meaning to the life of elders as well as a sense of rebirth.     

Associations of self-rated health with different forms of leisure activities among ageing people

Summary Objectives:  This study examined associations between self-rated health and specific forms of leisure activities – i. e. singing in a choir, art painting, playing music; art exhibitions, theatre, movies, concerts; religious events; studying and self-development; voluntary work – and investigated how confounding factors contribute to these associations among ageing people in Finland. Methods:  A postal survey was conducted in 2002 among men and women born in 1926–30, 1936–40 and 1946–50. The final 2,815 participants represented 66% of the original sample drawn, stratified by age, gender, and municipality. Logistic regression analyses were used to investigate associations between specific forms of leisure activities and self-rated health. Results:  Going to art exhibitions, theatre, movies, and concerts among women and studying and self-development among men were significantly positively related to self-rated health, even after adjusting for socioeconomic status (SES), other sociodemographic variables, obesity, and health behaviours. Among women, active participation in religious events and voluntary work were negatively associated with self-rated health. Conclusions:  The association of leisure activities and good self-rated health may differ for genders due to their nature or meaning. Partial support was found for the assumption that leisure activities go together with better self-rated health among ageing people. Submitted: 14 December 2006; Revised: 04 July 2007; Accepted: 02 April 2008     

Women's alcohol dependence and abuse: the relation to social network and leisure time

The aim of this study was to analyse the occurrence of alcohol dependence and abuse in relation to variables reflecting social network and leisure time, social class, education, occupation and family conditions. The study was based on the second wave of interviews performed within the longitudinal study of Women and Alcohol in G?teborg. In this present study we analysed 416 face-to-face interviews performed in 1995 96. Women with only one or no friends for support had higher rates of alcohol dependence and abuse than did women with more friends. Women with high rates of alcohol dependence or abuse did not take part in cultural events as much as women with low rates of alcohol dependence and abuse. Women with homemaking skills and gardening as leisure time interests had lower prevalences of alcohol dependence and abuse. In general, women with diagnoses of alcohol dependence and abuse in this population-based sample were not alone and without a social network. However, their pattern of activity differed slightly from those without such diagnoses. The association between women with alcohol dependence and abuse and leisure time activities is probably circular: a poor social network and low participation in social activities increase the risk of alcohol dependence and abuse, and alcohol dependence and abuse lead to low participation in social activities.     

Social determinants of psychological distress in a nationally-representative sample of South African adults

There is substantial evidence from developed countries that lower socioeconomic status (SES) is associated with increased occurrence of mental illness, and growing interest in the role of social support and social capital in mental health. However, there are few data on social determinants of mental health from low- and middle-income nations. We examined the association between psychological distress and SES, social support and bonding social capital in a nationally-representative sample of South African adults. As part of a national survey of mental health, a probability sample of 4,351 individuals was interviewed between 2002 and 2004. Non-specific psychological distress was measured using the Kessler K-10 scale. SES was assessed from an aggregate of household income, individual educational and employment status, and household material and financial resources. Social support, bonding social capital and traumatic life events were measured using multi-item scales. The mean age in the sample was 37 years and 76% of participants were black African. Measures of SES and social capital were inversely associated (p<0.001). Both recent and traumatic life events were more common among individuals with low levels of SES and social support. After adjusting for participant demographic characteristics and life events, high levels of psychological distress were most common among individuals with lower levels of SES and social capital. There was no independent association between levels of social support and psychological distress. The occurrence of recent life events appeared to partially mediate the association between SES and psychological distress (p=0.035) but not the association involving social capital (p=0.40). These data demonstrate persistent associations between levels of SES, social capital and psychological distress in South Africa. The increased frequency of recent life events appears to only partially explain higher levels of psychological distress among individuals of lower SES. Additional research is required to understand the temporality of this association as well as mechanisms through which SES and social capital influence mental health in low- and middle-income settings where high levels of poverty and trauma may contribute to excess burden of mental illness.     

Personal and environmental pathways to participation in young children with and without mild motor disabilities

Objective Participation in everyday activities has a positive influence upon health and well‐being and is considered as an outcome measure. According to recent models child participation is the product of the dynamic interaction between health states and both individual and environmental factors. Children with mild developmental disabilities often present decreased participation in everyday activities. The purpose of this study was to explore the extent to which individual and environmental factors explain the participation of young children, with and without mild motor disabilities. Methods The study population included 58 kindergarten children together with their parents (29 children with mild motor disabilities who were referred to occupational therapy and 29 children without motor disabilities). Both groups of children were matched for: age; gender; age of parents; and socio‐economic status (SES). We assessed participation using the Child Participation Questionnaire (intensity, diversity, independence, child enjoyment and parental satisfaction) and we assessed children's self‐efficacy and motor abilities for individual factors. Parental self‐efficacy and SES were collected by questionnaires. Results Participation diversity (number of activities) was predicted by child and mother self‐efficacy and by SES. Child independence and enjoyment as well as parental satisfaction were predicted by child motor ability but mainly by maternal self‐efficacy. Results suggest that the total explained variance is more than double when the environmental variables (parental self‐efficacy and SES) are inserted to the participation model. Conclusions Maternal self‐efficacy and SES serve as facilitators to increased participation and well‐being of children with mild motor disabilities.     

Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia

OBJECTIVE: To estimate variation between small areas in the levels of walking, cycling, jogging, and swimming and overall physical activity and the importance of area level socioeconomic disadvantage in predicting physical activity participation. METHODS: All census collector districts (CCDs) in the 20 innermost local government areas in metropolitan Melbourne, Australia, were identified and ranked by the percentage of low income households (<400 dollars/week) living in the CCD. Fifty CCDs were randomly selected from the least, middle, and most disadvantaged septiles of the ranked CCDs and 2349 residents (58.7% participation rate) participated in a cross sectional postal survey about physical activity. Multilevel logistic regression (adjusted for extrabinomial variation) was used to estimate area level variation in walking, cycling, jogging, and swimming and in overall physical activity participation, and the importance of area level socioeconomic disadvantage in predicting physical activity participation. RESULTS: There were significant variations between CCDs in all activities and in overall physical participation in age and sex adjusted models; however, after adjustment for individual SES (income, occupation, education) and area level socioeconomic disadvantage, significant differences remained only for walking (p = 0.004), cycling (p = 0.003), and swimming (p = 0.024). Living in the most socioeconomically disadvantaged areas was associated with a decreased likelihood of jogging and of having overall physical activity levels that were sufficiently active for health; these effects remained after adjustment for individual socioeconomic status (sufficiently active: OR 0.70, 95% CI 0.55 to 0.90 and jogging: OR = 0.69, 95% CI 0.51 to 0.94). CONCLUSION: These research findings support the need to focus on improving local environments to increase physical activity participation.     

Social inequalities in alcohol use and misuse in the german general population

This paper investigates social inequalities in drinking behaviour in a sample of the German general population aged 25 to 59 years. The prevalence of several indicators of alcohol use and misuse were examined by socio-economic status (SES). Odds ratios were calculated to examine the relative effect of socio-economic status on the various alcohol misuse indicators. Abstinence showed a clear negative gradient with social status. When age was controlled, no differences were found in the prevalence of hazardous drinking. In comparison with men of high SES, men of middle SES had increased odds of consuming five or more drinks per day at least weekly and of a positive score on the AUDIT hazardous use measure, while men of lower SES had higher odds for dependence symptoms. Women of middle SES had significantly lower odds for reporting items of the CAGE alcohol screening instrument and DSM-IV alcohol abuse criteria in comparison to women of high SES. Thus, women of lower and higher SES resemble each other in drinking behaviour. For men, no identifiable pattern was found. The lack of clear social inequalities among the consuming German general population may be due to the widespread integration of alcohol drinking in everyday life.     

A multilevel analysis of race, community disadvantage, and body mass index among adults in the US

This study examined the contributions of both individual socioeconomic status (SES) and community disadvantage in explaining the higher body mass index (BMI) of black adults in the US. Data from a national survey of adults (1986 American's Changing Lives Study) were combined with tract-level community data from the 1980 census. Results of multilevel regression analyses showed that black women had an age-adjusted BMI score three points higher than non-black women. Individual SES (income, education, assets) was negatively associated with BMI in women, but it only reduced the association between race and BMI from 2.99 to 2.50. Adding community socioeconomic disadvantage index further reduced the race coefficient slightly from 2.50 to 2.21. Nevertheless, living in communities with higher socioeconomic disadvantage was associated with higher BMI net of age, race, individual SES, smoking, physical activity, stress, and social support. Community income inequality (Gini) had an independent positive association with BMI, but did not substantially reduce racial differences among women. Community percent black was not associated with BMI. Results for men demonstrated no statistically significant racial differences in BMI, and no association between BMI and either individual SES or community disadvantage. Although individual SES and community socioeconomic disadvantage each partly explained the higher average BMI among black women, clear racial disparities persisted. Moreover, race, individual SES, community socioeconomic disadvantage, and individual health behaviors were each independent predictors of BMI among women. Unexplained within- and between-community variance in BMI remained among both women and men, with most unexplained variation due to within-community variance. Because our evidence for women suggests that the determinants of obesity are multiple and multilevel, attempts to address this growing social problem will similarly require a multi-faceted and multilevel approach.