Successful ageing in an area of deprivation: Part 1—A qualitative exploration of the role of life experiences in good health in old age

Objectives: To determine the life histories and current circumstances of healthy and unhealthy older people who share an ecology marked by relative deprivation and generally poor health. Study design: In-depth interview study with a qualitative analysis. Methods: Matched pairs of healthy and unhealthy ‘agers’ were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. Study participants consisted of 22 pairs (44 individuals), aged 72–89 years, matched for sex, age and deprivation category, and currently resident in the West of Scotland. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Detailed life histories were obtained which focused on family, residence, employment, leisure and health. This information was supplemented by more focused data on ‘critical incidents’, financial situation and position in social hierarchies. Results: Data provided rich insights into life histories and current circumstances but no differences were found between healthy and unhealthy agers. Conclusions: It is important to understand what differentiates individuals who have lived in circumstances characterized by relative deprivation and poor health, yet have aged healthily. This study collected rich and detailed qualitative data. Yet, no important differences were detected between healthy and unhealthy agers. This is an important negative result as it suggests that the phenomenon of healthy ageing and the factors that promote healthy ageing over a lifetime are so complex that they will require even more detailed studies to disentangle

Who in Europe works beyond the state pension age and under which conditions? Results from SHARE

There is much research about those who exit the labour market prematurely, however, comparatively little is known about people working longer and about their employment and working conditions. In this paper, we describe the employment and working conditions of men and women working between 65 and 80 years, and compare them with previous conditions of those retired in the same age group. Analyses are based on wave 4 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with information collected between 2009 and 2011 from 17,625 older men and women across 16 European countries. Besides socio-demographic and health-related factors (physical and mental health), the focus lies on employment conditions (e.g. employment status, occupational position and working hours) and on stressful working conditions, measured in terms of low control at work and effort-reward imbalance. In case of retired people, information on working conditions refer to the last job before retirement. Following descriptive analyses, we then conduct multivariable analyses and investigate how working conditions and poor health are related to labour market participation (i.e. random intercept models accounting for country affiliation and adjusted for potential confounders). Results illustrate that people working between the ages of 65 and 80 are more likely to be self-employed (either with or without employees) and work in advantaged occupational positions. Furthermore, findings reveal that psychosocial working conditions are generally better than the conditions retired respondents had in their last job. Finally, in contrast to those who work, health tends to be worse among retired people. In conclusion, findings deliver empirical evidence that paid employment beyond age 65 is more common among self-employed workers throughout Europe, in advantaged occupations and under-favourable psychosocial circumstances, and that this group of workers are in considerably good mental and physical health. This highlights that policies aimed at increasing the state pension age beyond the age of 65 years put pressure on specific disadvantaged groups of men and women

Genomic surveillance reveals low prevalence of livestock-associated methicillin-resistant Staphylococcus aureus in the East of England

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is an emerging problem in many parts of the world. LA-MRSA has been isolated previously from animals and humans in the United Kingdom (UK), but the prevalence is unknown. The aim of this study was to determine the prevalence and to describe the molecular epidemiology of LA-MRSA isolated in the East of England (broadly Cambridge and the surrounding area). We accessed whole genome sequence data for 2,283 MRSA isolates from 1,465 people identified during a 12-month prospective study between 2012 and 2013 conducted in the East of England, United Kingdom. This laboratory serves four hospitals and 75 general practices. We screened the collection for multilocus sequence types (STs) and for host specific resistance and virulence factors previously associated with LA-MRSA. We identified 13 putative LA-MRSA isolates from 12 individuals, giving an estimated prevalence of 0.82% (95% CI 0.47% to 1.43%). Twelve isolates were mecC-MRSA (ten CC130, one ST425 and one ST1943) and single isolate was ST398. Our data demonstrate a low burden of LA-MRSA in the East of England, but the detection of mecC-MRSA and ST398 indicates the need for vigilance. Genomic surveillance provides a mechanism to detect and track the emergence and spread of MRSA clones of human importance.Supported by grants from the UKCRC Translational Infection Research (TIR) Initiative, and the Medical Research Council (Grant Number G1000803) with contributions to the Grant from the Biotechnology and Biological Sciences Research Council, the National Institute for Health Research on behalf of the Department of Health, and the Chief Scientist Ofce of the Scottish Government Health Directorate (to Prof. Peacock); a Hospital Infection Society Major Research Grant, and by Wellcome Trust grant number 098051 awarded to the Wellcome Trust Sanger Institute. Tis work was supported by the Wellcome Trust 201344/Z/16/Z. M.E.T. is a Clinician Scientist Fellow, supported by the Academy of Medical Sciences and the Health Foundation, and by the NIHR Cambridge Biomedical Research Centre

Longitudinal genomic surveillance of MRSA in the UK reveals transmission patterns in hospitals and the community

Genome sequencing has provided snapshots of the transmission of methicillin-resistant Staphylococcus aureus (MRSA) during suspected outbreaks in isolated hospital wards. Scale-up to populations is now required to establish the full potential of this technology for surveillance. We prospectively identified all individuals over a 12-month period who had at least one MRSA-positive sample processed by a routine diagnostic microbiology laboratory in the East of England, which received samples from three hospitals and 75 general practitioner (GP) practices. We sequenced at least 1 MRSA isolate from 1465 individuals (2282 MRSA isolates) and recorded epidemiological data. An integrated epidemiological and phylogenetic analysis revealed 173 transmission clusters containing between 2 and 44 cases and involving 598 people (40.8%). Of these, 118 clusters (371 people) involved hospital contacts alone, 27 clusters (72 people) involved community contacts alone, and 28 clusters (157 people) had both types of contact. Community- and hospital-associated MRSA lineages were equally capable of transmission in the community, with instances of spread in households, long-term care facilities, and GP practices. Our study provides a comprehensive picture of MRSA transmission in a sampled population of 1465 people and suggests the need to review existing infection control policy and practice.This work was supported by grants from the UK Clinical Research Collaboration Translational Infection Research Initiative and the Medical Research Council (grant no. G1000803) with contributions to the grant from the Biotechnology and Biological Sciences Research Council, the National Institute for Health Research (NIHR) on behalf of the Department of Health, and the Chief Scientist Office of the Scottish Government Health Directorate (to S.J.P.); by a Hospital Infection Society Major Research Grant; by Wellcome Trust grant no. 098051 awarded to the Wellcome Trust Sanger Institute; and by Wellcome Trust 201344/Z/16/Z awarded to F.C. M.S.T. is a Wellcome Trust Clinical PhD fellow. M.E.T. is a Clinician Scientist Fellow, supported by the Academy of Medical Sciences and the Health Foundation and by the NIHR Cambridge Biomedical Research Centr

Characterization of Single-Mode Vertical Cavity Surface-Emitting Lasers

A high-quality single-mode beam is desirable for the efficient use of lasers as light sources for optical data communications and interconnects, however there is little data which characterizes operating ranges and near-field beam qualities of Vertical Cavity Surface Emitting Lasers (VCSELs), which has resulted in a lack of analysis of these devices. Measures of beam quality include beam-quality factor (M2 ), Side-Mode-Suppression-Ratio (SMSR) and RMS linewidth. M2 is a measurement of how closely the beam is to an ideal Gaussian. SMSR is the difference, in dB, between the amplitude of the primary peak and the amplitude of the next highest peak of the output spectrum, with single-mode operation defined by a SMSR \u3e 30 dB. RMS linewidth is a second moment calculation involving the power spectral density, where smaller RMS linewidth indicates higher beam quality. Utilizing a novel vertical M2 setup in which on-wafer VCSEL M2 can be measured, a study was conducted on the relation between M2 , SMSR and RMS linewidth, for various oxide-confined VCSELs of varying aperture sizes and Photonic Crystal (PhC) VCSELs of varying aperture sizes and photonic crystal configurations. First, the operating range of the VCSEL was determined utilizing a Semiconductor Parameter Analyzer to obtain the LIV characteristics. Along with this measurement, spectral data was collected using an Optical Spectrum Analyzer at several key operating points, which allowed the RMS linewidths and SMSRs of the devices to be calculated at these points. The novel beam-profiler setup was used to measure the device’s M2 . Initial results show a strong correlation between the measures of beam quality, with increasing SMSR, corresponding to M2 values closer to 1, and single-mode operation characterized by a M2 of less than 1.5. A strong correlation between RMS linewidth and M2 was also seen, with increasing RMS linewidths corresponding to an increase in M2

Characterization of Single-Mode Vertical Cavity Surface-Emitting Lasers

A high-quality single-mode beam is desirable for the efficient use of lasers as light sources for optical data communications and interconnects, however there is little data which characterizes operating ranges and near-field beam qualities of Vertical Cavity Surface Emitting Lasers (VCSELs), which has resulted in a lack of analysis of these devices. Measures of beam quality include beam-quality factor (M2 ), Side-Mode-Suppression-Ratio (SMSR) and RMS linewidth. M2 is a measurement of how closely the beam is to an ideal Gaussian. SMSR is the difference, in dB, between the amplitude of the primary peak and the amplitude of the next highest peak of the output spectrum, with single-mode operation defined by a SMSR \u3e 30 dB. RMS linewidth is a second moment calculation involving the power spectral density, where smaller RMS linewidth indicates higher beam quality. Utilizing a novel vertical M2 setup in which on-wafer VCSEL M2 can be measured, a study was conducted on the relation between M2 , SMSR and RMS linewidth, for various oxide-confined VCSELs of varying aperture sizes and Photonic Crystal (PhC) VCSELs of varying aperture sizes and photonic crystal configurations. First, the operating range of the VCSEL was determined utilizing a Semiconductor Parameter Analyzer to obtain the LIV characteristics. Along with this measurement, spectral data was collected using an Optical Spectrum Analyzer at several key operating points, which allowed the RMS linewidths and SMSRs of the devices to be calculated at these points. The novel beam-profiler setup was used to measure the device’s M2 . Initial results show a strong correlation between the measures of beam quality, with increasing SMSR, corresponding to M2 values closer to 1, and single-mode operation characterized by a M2 of less than 1.5. A strong correlation between RMS linewidth and M2 was also seen, with increasing RMS linewidths corresponding to an increase in M2

Investigation of a Cluster of Sequence Type 22 MethicillinResistant Staphylococcus aureus Transmission in a Community Setting

BACKGROUND: Whole-genome sequencing (WGS) has typically been used to confirm or refute hospital/ward outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) identified through routine practice. However, appropriately targeted WGS strategies that identify routinely ‘undetectable’ transmission remains the ultimate aim. METHODS: WGS of MRSA isolates sent to a regional microbiological laboratory was performed as part of a 12-month prospective observational study. Phylogenetic analyses identified a genetically-related cluster of E-MRSA15 isolated from patients registered to the same General Practice (GP) surgery. This led to an investigation to identify epidemiological links, find additional cases and determine potential for on-going transmission. RESULTS: We identified 15 MRSA-positive individuals with 27 highly-related MRSA isolates who were linked to the GP surgery, two of whom died with MRSA bacteremia. Of the 13 cases who were further investigated, 11 had attended a leg ulcer/podiatry clinic. Cases lacked epidemiological links to hospitals, suggesting that transmission occurred elsewhere. Environmental and staff screening at the GP surgery did not identify an on-going source of infection. CONCLUSIONS: Surveillance in the United Kingdom shows that the proportion of MRSA bacteremias apportioned to hospitals is decreasing, suggesting the need for greater focus on the detection of MRSA outbreaks and transmission in the community. This case study confirms that the typically nosocomial lineage (E-MRSA15) can transmit within community settings. Our study exemplifies the continued importance of WGS in detecting outbreaks including those which may be missed by routine practice, and suggests that universal WGS of bacteremia isolates may help detect outbreaks in low-surveillance settings.This work was supported by grants from the UK Clinical Research Collaboration Translational Infection Research Initiative, and the Medical Research Council (Grant Number G1000803) with contributions to the Grant from the Biotechnology and Biological Sciences Research Council, the National Institute for Health Research on behalf of the Department of Health, and the Chief Scientist Office of the Scottish Government Health Directorate (to Prof. Peacock); by a Healthcare Infection Society Major Research Grant (to Prof. Peacock), and by Wellcome Trust grant number 098051 awarded to the Wellcome Trust Sanger Institute. MST was a Wellcome Trust Clinical PhD Fellow. FC was supported by the Wellcome Trust (201344/Z/16/Z). These sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The public health investigation was supported by Public Health England

The role of childhood social position in adult type 2 diabetes: Evidence from the English Longitudinal Study of Ageing

Copyright @ 2014 Pikhartova et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This article has been made available through the Brunel Open Access Publishing Fund.Background: Socioeconomic circumstances in childhood and early adulthood may influence the later onset of chronic disease, although such research is limited for type 2 diabetes and its risk factors at the different stages of life. The main aim of the present study is to examine the role of childhood social position and later inflammatory markers and health behaviours in developing type 2 diabetes at older ages using a pathway analytic approach. Methods. Data on childhood and adult life circumstances of 2,994 men and 4,021 women from English Longitudinal Study of Ageing (ELSA) were used to evaluate their association with diabetes at age 50 years and more. The cases of diabetes were based on having increased blood levels of glycated haemoglobin and/or self-reported medication for diabetes and/or being diagnosed with type 2 diabetes. Father's job when ELSA participants were aged 14 years was used as the measure of childhood social position. Current social characteristics, health behaviours and inflammatory biomarkers were used as potential mediators in the statistical analysis to assess direct and indirect effects of childhood circumstances on diabetes in later life. Results: 12.6 per cent of participants were classified as having diabetes. A disadvantaged social position in childhood, as measured by father's manual occupation, was associated at conventional levels of statistical significance with an increased risk of type 2 diabetes in adulthood, both directly and indirectly through inflammation, adulthood social position and a risk score constructed from adult health behaviours including tobacco smoking and limited physical activity. The direct effect of childhood social position was reduced by mediation analysis (standardised coefficient decreased from 0.089 to 0.043) but remained statistically significant (p = 0.035). All three indirect pathways made a statistically significantly contribution to the overall effect of childhood social position on adulthood type 2 diabetes. Conclusions: Childhood social position influences adult diabetes directly and indirectly through inflammatory markers, adulthood social position and adult health behaviours. © 2014Pikhartova et al.; licensee BioMed Central Ltd.Economic and Social Research Council-funded International Centre for Life Course Studies in Society and Health (RES-596-28-0001)

Adverse childhood experiences and premature all-cause mortality

Events causing stress responses during sensitive periods of rapid neurological development in childhood may be early determinants of all-cause premature mortality. Using a British birth cohort study of individuals born in 1958, the relationship between adverse childhood experiences (ACE) and mortality ≤50 year was examined for men (n = 7,816) and women (n = 7,405) separately. ACE were measured using prospectively collected reports from parents and the school: no adversities (70 %); one adversity (22 %), two or more adversities (8 %). A Cox regression model was carried out controlling for early life variables and for characteristics at 23 years. In men the risk of death was 57 % higher among those who had experienced 2+ ACE compared to those with none (HR 1.57, 95 % CI 1.13, 2.18, p = 0.007). In women, a graded relationship was observed between ACE and mortality, the risk increasing as ACE accumulated. Women with one ACE had a 66 % increased risk of death (HR 1.66, 95 % CI 1.19, 2.33, p = 0.003) and those with ≥2 ACE had an 80 % increased risk (HR 1.80, 95 % CI 1.10, 2.95, p = 0.020) versus those with no ACE. Given the small impact of adult life style factors on the association between ACE and premature mortality, biological embedding during sensitive periods in early development is a plausible explanatory mechanism

Research findings from the Memories of Nursing oral history project.

Capturing the stories of nurses who practised in the past offers the opportunity to reflect on the changes in practice over time to determine lessons for the future. This article shares some of the memories of a group of 16 nurses who were interviewed in Bournemouth, UK, between 2009 and 2016. Thematic analysis of the interview transcripts identified a number of themes, three of which are presented: defining moments, hygiene and hierarchy. The similarities and differences between their experiences and contemporary nursing practice are discussed to highlight how it may be timely to think back in order to take practice forward positively in the future