Nonlinear Associations Between Working Hours and Overwork-Related Cerebrovascular and Cardiovascular Diseases (CCVD)

Long working hours are recognized as a risk factor for cerebrovascular and cardiovascular diseases (CCVD). We investigated the relationship between working hours and different CCVD severity outcomes—death, disability, and illness—across industries in Taiwan from 2006 to 2016. We applied a generalized additive mixed model to estimate the association between working hours and the rate of each severity outcome, adjusted for salary, unemployment rate, time, and a random intercept. Industry-average working hours were significantly associated with each outcome level of overwork-related CCVD, especially when monthly working hours increased from 169 (relative risk [RR] = 1.46, 95% confidence interval [CI] 1.002–2.12) to 187 (RR = 5.73, 95% CI 3.61–9.08). Although RR trends declined after monthly working hours exceeded 187, excess risks remained statistically significant. Each 1-hour increase in working hours had a stronger effect on the RR increase in death and disability than on illness. Variations in CCVD risks existed across industries, with the highest risk in transportation and information. Reducing working hours is essential to preventing overwork-related CCVD, especially the more severe outcomes. We recommend further research to address possible underreporting of less severe cases, and to explore actions to narrow the gaps in risk across industries

Are Maternal Social Networks and Perceptions of Trust Associated with Suspected Autism Spectrum Disorder in Offspring? A Population-Based Study in Japan

Objective: To investigate the associations of maternal social networks and perceptions of trust with the prevalence of suspected autism spectrum disorders in 18-month-old offspring in Japan. Methods: Questionnaires included measurements of maternal social networks (number of relatives or friends they could call upon for assistance), maternal perceptions of trust, mutual assistance (i.e. individual measures of “cognitive social capital”), and social participation (i.e. individual measures of “structural social capital”) as well as the Modified Checklist for Autism in Toddlers to detect suspected autism spectrum disorder (ASD). These tools were mailed to all families with 18-month-old toddlers in Chiba, a city near Tokyo (N = 6061; response rate: 64%). The association between social capital or social network indicators and suspected ASD were analyzed, adjusted for covariates by logistic regression analysis. Results: Low maternal social trust was found to be significantly positively associated with suspected ASD in toddlers compared with high maternal social trust (adjusted odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.38 to 2.40); mutual aid was also significantly positively related (low vs. high: OR, 1.82, 95% CI: 1.38 to 2.40). However, maternal community participation showed U-shape association with suspected ASD of offspring. Maternal social network showed consistent inverse associations with suspected ASD of offspring, regardless of the type of social connection (e.g., relatives, neighbors, or friends living outside of their neighborhood). Conclusions: Mothers' cognitive social capital and social networks, but not structural social capital, might be associated with suspected ASD in offspring

Mortality among Lifelong Nonsmokers Exposed to Secondhand Smoke at Home: Cohort Data and Sensitivity Analyses

Evidence is growing that secondhand smoke can cause death from several diseases. The association between household exposure to secondhand smoke and disease-specific mortality was examined in two New Zealand cohorts of lifelong nonsmokers (‘‘never smokers’’) aged 45–77 years. Individual census records from 1981 and 1996 were anonymously and probabilistically linked with mortality records from the 3 years that followed each census. Age- and ethnicity-standardized mortality rates were compared for never smokers with and without home exposure to secondhand smoke (based on the reported smoking behavior of other household members). Relative risk estimates adjusted for age, ethnicity, marital status, and socioeconomic position showed a significantly greater mortality risk for never smokers living in households with smokers, with excess mortality attributed to tobacco-related diseases, particularly ischemic heart disease and cerebrovascular disease, but not lung cancer. Adjusted relative risk estimates for all cardiovascular diseases were 1.19 (95 % confidence interval: 1.04, 1.38) for men and 1.01 (95 % confidence interval: 0.88, 1.16) for women from the 1981–1984 cohort, and 1.25 (95 % confidence interval: 1.06, 1.47) for men and 1.35 (95 % confidence interval: 1.11, 1.64) for women from the 1996–1999 cohort. Passive smokers also had nonsignificantly increased mortality from respiratory disease. Sensitivity analyses in-dicate that these findings are not due to misclassification bias. cohort studies; mortality; myocardial ischemia; neoplasms; New Zealand; respiratory tract diseases; tobacc

Less comprehensive social policies may contribute to lower life expectancies and worse health in the U.S. compared to other high-income countries

Americans lead shorter and less healthy lives than people in other high-income countries. Is this US health disadvantage specific to some US populations, diseases, or particular age groups? And what explains these variations in the length and quality of life between Americans and other high-income countries? Mauricio Avendano and Ichiro Kawachi review the evidence and find the American health disadvantage begins at birth and extends across the life-course, and it is particularly marked for American women and for regions in the US South and Midwest. They propose explanations that include differences in health care, individual behaviors, socioeconomic inequalities, and the physical and the built environment. However, crucial differences in social policy between the US and other high income countries may also underlie an important part of the US’ health disadvantage

Do residents of food deserts express different food buying preferences compared to residents of food oases? A mixed-methods analysis

Background: Many people lack access to food stores that provide healthful food. Neighborhoods with poor supermarket access have been characterized as “food deserts” (as contrast with “food oases”). This study explored factors influencing food buying practices among residents of food deserts versus food oases in the city of Boston, USA. Methods: We used the mixed-methods approach of concept mapping, which allows participants to identify, list, and organize their perceptions according to importance. Resulting maps visually illustrate priority areas. Results: Sixty-seven low-income adults completed the concept mapping process that identified 163 unique statements (e.g. relating to affordability, taste, and convenience) that influence food buying practices. Multivariate statistical techniques grouped the 163 statements into 8 clusters or concepts. Results showed that average cluster ratings and rankings were similar between residents of food deserts and food oases. Conclusions: The implication of this study pertains to the importance of community resources and emergency food assistance programs that have served to minimize the burden associated with hunger and poor food access among low-income, urban populations

Distance From Home to the Nearest Tobacco Outlet May Not Reflect the True Accessibility Reply

Non peer reviewe

Social Capital and Health: A Review of Prospective Multilevel Studies

Background: This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital. Methods: We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome. Results: We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia. Conclusions: Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health

Social participation and mental health: moderating effects of gender, social role and rurality

Background: Previous studies have reported that older people’s social participation has positive effects on their health. However, some studies showed that the impacts of social participation on health differ by gender. We sought to examine whether the effects of social participation on mental health differ for men and women in a Japanese population. We also examined the moderating influence of social position within the organization as well as urban/rural locality. Methods: We used two waves of the Aichi Gerontological Evaluation Study’s longitudinal survey, which targeted residents with aged 65 years or over (n = 2,728) in a central part of Japan. The first wave survey was conducted in 2003, and the second wave in 2006. Depressive symptoms of the study participants were assessed using the short version of the Geriatric Depression Scale (GDS-15). A multilevel logistic regression model was used with individual-level as level 1 and the school district-level as level 2. Results: We found that higher social participation and performing key roles in the organization had protective effects on depressive symptoms for women. However, there were no main effects of these variables for the mental health of men. We found an interaction between social participation, organizational position, and rural residence among men only. That is, men who occupied leadership positions in organizations reported better mental health, but only in rural areas. Conclusions: Our findings support the notion that increasing the opportunities for social participation improves older people’s heath, especially for women. However, in the rural Japanese context, offering men meaningful roles within organizations may be important

Mortality From Myocardial Infarction After the Death of a Sibling: A Nationwide Follow‐up Study From Sweden

Background: Death of a sibling represents a stressful life event and could be a potential trigger of myocardial infarction (MI). We studied the association between loss of an adult sibling and mortality from MI up to 18 years after bereavement. Methods and Results: We conducted a follow‐up study for Swedes aged 40 to 69 years between 1981 and 2002, based on register data covering the total population (N=1 617 010). Sibling deaths could be observed from 1981 and on. An increased mortality rate from MI was found among women (1.25 CI 1.02 to 1.54) and men (1.15 CI 1.03 to 1.28) who had experienced death of an adult sibling. An elevated rate some years after bereavement was found among both women (during the fourth to sixth half‐years after the death) and men (during the second to sixth half‐years after the death), whereas limited support for a short‐term elevation in the rate was found (during the first few months since bereavement). External causes of sibling death were associated with increased MI mortality among women (1.54 CI 1.07 to 2.22), whereas nonexternal causes showed associations in men (1.23 CI 1.09 to 1.38). However, further analyses showed that if the sibling also died from MI, associations were primarily found among both women (1.62 CI 1.00 to 2.61) and men (1.98 CI 1.59 to 2.48). Conclusions: Our study provided the first large‐scale evidence for mortality from MI associated with the death of a sibling at an adult age. The fact that findings suggested associations primarily between concordant causes of death (both died of MI) could indicate genetic resemblance or shared risk factors during childhood. Future studies on bereavement should carefully deal with the possibility of residual confounding

Pediatricians’ Practice Location Choice—Evaluating the Effect of Japan’s 2004 Postgraduate Training Program on the Spatial Distribution of Pediatricians

Objectives: To explore determinants of change in pediatrician supply in Japan, and examine impacts of a 2004 reform of postgraduate medical education on pediatricians’ practice location choice. Methods: Data were compiled from secondary data sources. The dependent variable was the change in the number of pediatricians at the municipality (“secondary tier of medical care” [STM]) level. To analyze the determinants of pediatrician location choices, we considered the following predictors: initial ratio of pediatricians per 1000 children under five years of age (pediatrician density) and under-5 mortality as measures of local area need, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Basic comparisons of pediatrician coverage in the top and bottom 10% of STMs were conducted to assess inequality in pediatrician supply. Results: Increased supply was inversely associated with baseline pediatrician density both in the pre-period and post-period. Estimated impact of pediatrician density declined over time (P = 0.026), while opposite trends were observed for measures of residential quality. More specifically, urban centers and the SES composite index were positively associated with pediatrician supply for the post-period, but no such associations were found for the pre-period. Inequality in pediatrician distribution increased substantially after the reform, with the best-served 10% of communities benefitting from five times the pediatrician coverage compared to the least-served 10%. Conclusions: Residential quality increasingly became a function of location preference rather than public health needs after the reform. New placement schemes should be developed to achieve more equity in access to pediatric care