Women?s health in mid-life: life course social roles and agencyas quality

Data from a prospective British birth cohort study showed that women who were childless, lone mothers or full-timehomemakers between the ages of 26 and 54 were more likely to report poor health at age 54 than women who occupiedmultiple roles between these ages. To explain this finding we developed and tested a theory of role quality based on theconcept of agency by drawing on Giddens? theory of structuration and Doyal and Gough?s theory of human needs.According to our theory, the patriarchal structuration (drawing on Giddens? term) of work and family roles provides bothlimitation and opportunity for the expression of agency. Doyal and Gough?s theory of human needs was then used toidentify the restriction of agency as a possible influence on health. This theory of role quality was operationalised using ameasure of work (paid and unpaid) quality at age 36 and a measure of work and family stress between ages 48 and 54. Therelatively poor subjective health in mid-life of lone mothers was explained by work and family stress and adult social class.In contrast, the poor health in mid-life of long-term homemakers and childless women was less easily explained.Homemaker?s excess risk of reporting poor health at age 54 remained strong and significant even after adjusting for rolequality and socioeconomic indicators, and childless women were at an increased risk of reporting poor health despite thesocial advantage inherent in attaining educational qualifications and occupying professional or managerial occupations.This study highlights the need to develop measures of role quality specifically designed to capture agency aspects of socialroles

Labour force transitions and changes in quality of life at age 50 to 55 years: evidence from a birth cohort study

In the context of an ageing population and longer working lives, the impact of increasing rates of early exit from the labour force on quality of life is a particularly current concern. However, relatively little is known about the impact on quality of life of later life labour force transitions and various forms of early exit from the labour force, compared to remaining in employment. This paper examines life course labour force trajectories and transitions in relation to change in quality of life prior to the State Pension Age. Life course data on early life circumstances, labour force trajectories and labour force transitions from 3,894 women and 3,528 men in the National Child Development Study (1958 British Birth Cohort) were examined in relation to change in quality of life, measured by a short-form version of CASP, between ages 50 and 55 years. Women and men differed in the types of labour force transition associated with positive change in quality of life, with men more frequent beneficiaries. For both men and women, labour force exit due to being sick or disabled was associated with a negative change in quality of life, whereas joining the labour force was associated with a positive change in quality of life. Moving into retirement was associated with a positive change in men’s quality of life, but not women’s. Moving from full-time to part-time employment was associated with a positive change in women’s quality of life, but not men’s. The findings that stand out for their policy relevance are: the threat to the quality of life of both women and men from early labour force exit due to limiting longstanding illness; and, women are less likely to experience beneficial labour force exit in the later years of their working life, but are more likely to benefit from a reduction in working hours

Fit for work? Health, employability and challenges for the UK welfare reform agenda

This article introduces a special issue of Policy Studies entitled “Fit for work? Health, employability and challenges for the UK welfare reform agenda”. Growing from a shared concern over the need to expand the evidence base around the processes that led to large numbers of people claiming disability benefits in the UK, it brings together contributions from leading labour market and social policy researchers providing evidence and commentary on major reforms to Incapacity Benefit (IB) in the UK. This special issue address three key questions: what are the main causes of the long-term rise in the number of people claiming IBs; what will reduce the number of claimants; and what is likely to deliver policy effectively and efficiently? This introduction first explains and examines the challenges to reforms to IB in the UK, and then, in conclusion, highlights the answers to the previous three questions – first, labour market restructuring and marginalisation have driven the rise in numbers claiming IBs. Second, economic regeneration in the Britain’s less prosperous areas coupled with intensive and sustained supply-side support measures will bring numbers down. Third, delivery need to be flexible and tailored to individual needs and needs to be able to access local and expert knowledge in a range of organisations, including Job Centre Plus, the NHS as well as the private and voluntary sectors

'Men give in to chips and beer too easily': How working-class men make sense of gender differences in health

This article, based on qualitative research with working-class men, explores men's perceptions and experiences regarding gender differences in health. It demonstrates how men put forward a range of behavioural/cultural, materialist/structural and psychosocial factors, which were believed to differently impact men's health compared to women. A common theme underpinning their explanations was the ways in which men and women were located within two distinct gender categories. These characterisations were used to explain why health-damaging beliefs and behaviours were more prevalent among men and also why men were better suited for certain kinds of jobs, albeit with potential costs to their health. Men also believed that women were protected from the damaging physical and emotional impact of manual employment because of their primary role within the home and because they were less emotionally robust, which required men to shield women from the stresses they experienced. However, men's emotional withdrawal can also be viewed as another example of how men use whatever resources are available to achieve and maintain dominance over women. Finally, the article demonstrates how a gender- and class-based approach can capture the impact of men's health-related practices alongside the broader cultural and structural influences on men's health

Estimating the changing nature of Scotland's health inequalities using a multivariate spatiotemporal model

Health inequalities are the unfair and avoidable differences in people's health between different social groups. These inequalities have a huge influence on people's lives, particularly those who live at the poorer end of the socio‐economic spectrum, as they result in prolonged ill health and shorter lives. Most studies estimate health inequalities for a single disease, but this will give an incomplete picture of the overall inequality in population health. Here we propose a novel multivariate spatiotemporal model for quantifying health inequalities in Scotland across multiple diseases, which will enable us to understand better how these inequalities vary across disease and have changed over time. In developing this model we are interested in estimating health inequalities between Scotland's 14 regional health boards, who are responsible for the protection and improvement of their population's health. The methodology is applied to hospital admissions data for cerebrovascular disease, coronary heart disease and respiratory disease, which are three of the leading causes of death, from 2003 to 2012 across Scotland

Increased expression of a microRNA correlates with anthelmintic resistance in parasitic nematodes

Resistance to anthelmintic drugs is a major problem in the global fight against parasitic nematodes infecting humans and animals. While previous studies have identified mutations in drug target genes in resistant parasites, changes in the expression levels of both targets and transporters have also been reported. The mechanisms underlying these changes in gene expression are unresolved. Here, we take a novel approach to this problem by investigating the role of small regulatory RNAs in drug resistant strains of the important parasite Haemonchus contortus. microRNAs (miRNAs) are small (22 nt) non-coding RNAs that regulate gene expression by binding predominantly to the 3′ UTR of mRNAs. Changes in miRNA expression have been implicated in drug resistance in a variety of tumor cells. In this study, we focused on two geographically distinct ivermectin resistant strains of H. contortus and two lines generated by multiple rounds of backcrossing between susceptible and resistant parents, with ivermectin selection. All four resistant strains showed significantly increased expression of a single miRNA, hco-miR-9551, compared to the susceptible strain. This same miRNA is also upregulated in a multi-drug-resistant strain of the related nematode Teladorsagia circumcincta. hco-miR-9551 is enriched in female worms, is likely to be located on the X chromosome and is restricted to clade V parasitic nematodes. Genes containing predicted binding sites for hco-miR-9551 were identified computationally and refined based on differential expression in a transcriptomic dataset prepared from the same drug resistant and susceptible strains. This analysis identified three putative target mRNAs, one of which, a CHAC domain containing protein, is located in a region of the H. contortus genome introgressed from the resistant parent. hco-miR-9551 was shown to interact with the 3′ UTR of this gene by dual luciferase assay. This study is the first to suggest a role for miRNAs and the genes they regulate in drug resistant parasitic nematodes. miR-9551 also has potential as a biomarker of resistance in different nematode species

Multiple indices of diffusion identifies white matter damage in mild cognitive impairment and Alzheimer's disease

The study of multiple indices of diffusion, including axial (DA), radial (DR) and mean diffusion (MD), as well as fractional anisotropy (FA), enables WM damage in Alzheimer's disease (AD) to be assessed in detail. Here, tract-based spatial statistics (TBSS) were performed on scans of 40 healthy elders, 19 non-amnestic MCI (MCIna) subjects, 14 amnestic MCI (MCIa) subjects and 9 AD patients. Significantly higher DA was found in MCIna subjects compared to healthy elders in the right posterior cingulum/precuneus. Significantly higher DA was also found in MCIa subjects compared to healthy elders in the left prefrontal cortex, particularly in the forceps minor and uncinate fasciculus. In the MCIa versus MCIna comparison, significantly higher DA was found in large areas of the left prefrontal cortex. For AD patients, the overlap of FA and DR changes and the overlap of FA and MD changes were seen in temporal, parietal and frontal lobes, as well as the corpus callosum and fornix. Analysis of differences between the AD versus MCIna, and AD versus MCIa contrasts, highlighted regions that are increasingly compromised in more severe disease stages. Microstructural damage independent of gross tissue loss was widespread in later disease stages. Our findings suggest a scheme where WM damage begins in the core memory network of the temporal lobe, cingulum and prefrontal regions, and spreads beyond these regions in later stages. DA and MD indices were most sensitive at detecting early changes in MCIa

Assessment of the Influence of Demographic and Professional Characteristics on Health Care Providers' Pain Management Decisions Using Virtual Humans

Disparities in health care associated with patients’ gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists’ and physicians’ use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β-weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients’ pain intensity and unpleasantness and then rated their own likelihood of administering non-opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β-weights associated with VH age cues for all ratings (p0.69). These effects varied by provider race and gender. For pain intensity, professional differences were present only among non-white providers. White providers had greater β-weights than non-white providers for pain unpleasantness but only among men. Provider differences regarding the use of VH age cues in non-opioid analgesic administration were present among all providers except non-white males. These findings highlight the interaction of patient and provider factors in driving clinical decision making. Although profession was related to use of VH age cues in pain-related clinical judgments, this relationship was modified by providers’ personal characteristics. Additional research is needed to understand what aspects of professional training or practice may account for differences between physicians and dentists and what forms of continuing education may help to mitigate the disparities

Trends in mortality by labour market position around retirement ages in three European countries with different welfare regimes

<p>Objectives: In the face of economic downturn and increasing life expectancy, many industrial nations are adopting a policy of postponing the retirement age. However, questions still remain around the consequence of working longer into old age. We examine mortality by work status around retirement ages in countries with different welfare regimes; Finland (social democratic), Turin (Italy; conservative), and England and Wales (liberal).</p> <p>Methods: Death rates and rate ratios (RRs) (reference rates = ‘in-work’), 1970 s–2000 s, were estimated for those aged 45–64 years using the England and Wales longitudinal study, Turin longitudinal study, and the Finnish linked register study.</p> <p>Results: Mortality of the not-in-work was consistently higher than the in-work. Death rates for the not-in-work were lowest in Turin and highest in Finland. Rate ratios were smallest in Turin (RR men 1972–76 1.73; 2002–06 1.63; women 1.22; 1.68) and largest in Finland (RR men 1991–95 3.03; 2001–05 3.80; women 3.62; 4.11). Unlike RRs for men, RRs for women increased in every country (greatest in Finland).</p> <p>Conclusions: These findings signal that overall, employment in later life is associated with lower mortality, regardless of welfare regime.</p&gt