Social determinants and the decline of cardiovascular diseases: lJnderstanding the links

This article reviews the historical declines in cardiovascular mortality and provides an overview of the contribution of social and economic factors to disease change. We document the magnitude of declines in cardiovascular diseases and the major role of changes in conventional risk factors, and we review the contributions of social determinants to changes in disease rates. We conclude by arguing that understanding patterns and trends of social inequalities in cardiovascular disease and its risk factors requires consideration of the specific intersections of health and social exposures acting across the life course in different settings, in both time and place.Sam Harper, John Lynch and George Davey Smit

Socioeconomic status is associated with symptom severity and sickness absence in people with infectious intestinal disease in the UK

BACKGROUND: The burden of infectious intestinal disease (IID) in the UK is substantial. Negative consequences including sickness absence are common, but little is known about the social patterning of these outcomes, or the extent to which they relate to disease severity. METHODS: We performed a cross-sectional analysis using IID cases identified from a large population-based survey, to explore the association between socioeconomic status (SES) and symptom severity and sickness absence; and to assess the role of symptom severity on the relationship between SES and absence. Regression modelling was used to investigate these associations, whilst controlling for potential confounders such as age, sex and ethnicity. RESULTS: Among 1164 cases, those of lower SES versus high had twice the odds of experiencing severe symptoms (OR 2.2, 95%CI;1.66-2.87). Lower SES was associated with higher odds of sickness absence (OR 1.8, 95%CI;1.26-2.69), however this association was attenuated after adjusting for symptom severity (OR 1.4, 95%CI;0.92-2.07). CONCLUSIONS: In a large sample of IID cases, those of low SES versus high were more likely to report severe symptoms, and sickness absence; with greater severity largely explaining the higher absence. Public health interventions are needed to address the unequal consequences of IID identified

Facing others in pain : why context matters

Judging pain in another is challenging, largely because pain is a subjective phenomenon to which observers have no direct access. Despite this ambiguity, inferences often are made that can drive important clinical decisions, such as estimating another’s pain intensity, with significant implications for patient treatment and outcomes. This chapter focuses upon the influence of the context upon observer cognitive, emotional, and behavioral responses toward others in pain. In doing so, we consider context in its broadest form: characteristics of the patient/person in pain, the observer, and the situation, as well as elements of the reported pain experience, itself. Despite the increased understanding of and appreciation for the role of context in observer judgments, knowledge of how context, judgment, and treatment outcomes interact remains sketchy and in need of translational research. Such research is needed if we are to build our current base of knowledge and translate that knowledge into improved approaches to the assessment and treatment of patients in pain