Objectively measured physical capability levels and mortality: systematic review and meta-analysis

Objective: To do a quantitative systematic review, including published and unpublished data, examining the associations between individual objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality in community dwelling populations. Design: Systematic review and meta-analysis. Data sources: Relevant studies published by May 2009 identified through literature searches using Embase (from 1980) and Medline (from 1950) and manual searching of reference lists; unpublished results were obtained from study investigators. Study selection: Eligible observational studies were those done in community dwelling people of any age that examined the association of at least one of the specified measures of physical capability (grip strength, walking speed, chair rises, or standing balance) with mortality. Data synthesis: Effect estimates obtained were pooled by using random effects meta-analysis models with heterogeneity between studies investigated. Results: Although heterogeneity was detected, consistent evidence was found of associations between all four measures of physical capability and mortality; those people who performed less well in these tests were found to be at higher risk of all cause mortality. For example, the summary hazard ratio for mortality comparing the weakest with the strongest quarter of grip strength (14 studies, 53 476 participants) was 1.67 (95% confidence interval 1.45 to 1.93) after adjustment for age, sex, and body size (I2=84.0%, 95% confidence interval 74% to 90%; P from Q statistic <0.001). The summary hazard ratio for mortality comparing the slowest with the fastest quarter of walking speed (five studies, 14 692 participants) was 2.87 (2.22 to 3.72) (I2=25.2%, 0% to 70%; P=0.25) after similar adjustments. Whereas studies of the associations of walking speed, chair rising, and standing balance with mortality have only been done in older populations (average age over 70 years), the association of grip strength with mortality was also found in younger populations (five studies had an average age under 60 years). Conclusions: Objective measures of physical capability are predictors of all cause mortality in older community dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death. With Contributions from Dr P.A. Bath, University of Sheffiel

Racial Discrimination in Life Insurance

We examine the historical and statistical relationship between race and life insurance. Life insurance can play a central role in households’ financial security. Race has played an important and changing role in the provision of life insurance in the U.S. from slave insurance before the Civil War, to “Scientific Racism” continuing into the 20th century, to policies that do not explicitly mention race in recent decades. In empirical work using new data, we confirm earlier work showing that Black individuals have higher life insurance coverage rates than white individuals, controlling for observable characteristics. We find no difference in the likelihood of purchasing coverage—for Black individuals versus white individuals—in states with strong versus weak anti-discrimination laws. We also find that the presence of strong anti-discrimination laws tends to reduce overall life insurance coverage – by about 3 percentage points. We present some evidence that this finding is due to a generally stronger regulatory stance in the state rather than the specific impact of the anti-discrimination life insurance law. This analysis bears on the presence of discrimination in the current life insurance industry as well as related issues like the financial status of minority households

Cognitive function in childhood and lifetime cognitive change in relation to mental wellbeing in four cohorts of older people

Background: poorer cognitive ability in youth is a risk factor for later mental health problems but it is largely unknown whether cognitive ability, in youth or in later life, is predictive of mental wellbeing. The purpose of this study was to investigate whether cognitive ability at age 11 years, cognitive ability in later life, or lifetime cognitive change are associated with mental wellbeing in older people.Methods: we used data on 8191 men and women aged 50 to 87 years from four cohorts in the HALCyon collaborative research programme into healthy ageing: the Aberdeen Birth Cohort 1936, the Lothian Birth Cohort 1921, the National Child Development Survey, and the MRC National Survey for Health and Development. We used linear regression to examine associations between cognitive ability at age 11, cognitive ability in later life, and lifetime change in cognitive ability and mean score on the Warwick Edinburgh Mental Wellbeing Scale and meta-analysis to obtain an overall estimate of the effect of each.Results: people whose cognitive ability at age 11 was a standard deviation above the mean scored 0.53 points higher on the mental wellbeing scale (95% confidence interval 0.36, 0.71). The equivalent value for cognitive ability in later life was 0.89 points (0.72, 1.07). A standard deviation improvement in cognitive ability in later life relative to childhood ability was associated with 0.66 points (0.39, 0.93) advantage in wellbeing score. These effect sizes equate to around 0.1 of a standard deviation in mental wellbeing score. Adjustment for potential confounding and mediating variables, primarily the personality trait neuroticism, substantially attenuated these associations.Conclusion: associations between cognitive ability in childhood or lifetime cognitive change and mental wellbeing in older people are slight and may be confounded by personality trait difference

British Council School Programmes in Scotland: an Impact Study: Final Report

This report evaluates the impact of British Council programmes in Scottish schools, particularly their contribution to closing the attainment gap for students from different socioeconomic backgrounds. British Council Scotland works with approximately a third of all schools in Scotland through programmes, including Erasmus+, Connecting Classrooms, e-Twinning, and Modern Language Assistants, that enrich curriculum, pedagogy and professional development with a global outlook. Despite a variety of definitions and treatments, there is growing attention to global citizenship education and sustainability education as important curricular goals across nations and systems.The research reported herein sought to document the impact of BC programmes in Scottish schools, and its contribution to the Attainment Challenge’s focus on achieving both excellence and equity. It used a mixed methods approach of quantitative data analysis (using open national data and individual pupil data) in combination with qualitative case studies of differently positioned schools and interviews with senior staff in key stakeholder agencies

Australia’s Grains Farm Biosecurity Program – a national initiative in plant biosecurity awareness, education and best management practice.: Presentation

Sound biosecurity systems contribute to achieving sustainable agricultural and environmental systems, reducing the threat of introducing unwanted pests and supporting food safety and product integrity. Within Australia, the Grains Farm Biosecurity Program (GFBP) is a national initiative to assist in the development and implementation of improved biosecurity practice within its grain industry. Initiated in 2007, the extension focused program contributes to the industry’s risk mitigation activities, supports continued market access and promotes a partnership approach involving governments, industry and community. The program is funded through grower levies in partnership with state government agencies and Plant Health Australia. Using a variety of community engagement strategies, the GFBP has developed a wide range of tools to improve the management of and preparedness for, biosecurity risks in the Australian grains industry at the farm and industry level by highlighting risk pathways and activities throughout the supply chain and encouraging adoption of practices and strategies to mitigate risks. The GFPB also promotes and conducts surveillance for high priority pests especially in on-farm storage. Evaluations indicate an increased awareness of biosecurity risks, industry capacity and voluntary adoption of biosecurity best practices throughout the sector. The GFBP focus on biosecurity best practice through industry engagement has seen it contribute to safeguarding and maintaining Australia’s export reputation, with the program recently winning a national biosecurity award.Sound biosecurity systems contribute to achieving sustainable agricultural and environmental systems, reducing the threat of introducing unwanted pests and supporting food safety and product integrity. Within Australia, the Grains Farm Biosecurity Program (GFBP) is a national initiative to assist in the development and implementation of improved biosecurity practice within its grain industry. Initiated in 2007, the extension focused program contributes to the industry’s risk mitigation activities, supports continued market access and promotes a partnership approach involving governments, industry and community. The program is funded through grower levies in partnership with state government agencies and Plant Health Australia. Using a variety of community engagement strategies, the GFBP has developed a wide range of tools to improve the management of and preparedness for, biosecurity risks in the Australian grains industry at the farm and industry level by highlighting risk pathways and activities throughout the supply chain and encouraging adoption of practices and strategies to mitigate risks. The GFPB also promotes and conducts surveillance for high priority pests especially in on-farm storage. Evaluations indicate an increased awareness of biosecurity risks, industry capacity and voluntary adoption of biosecurity best practices throughout the sector. The GFBP focus on biosecurity best practice through industry engagement has seen it contribute to safeguarding and maintaining Australia’s export reputation, with the program recently winning a national biosecurity award

Right-wing political orientation, national identification and the acceptance of immigrants and minorities

This paper examines the intriguing possibility that higher national identification commonly found among political conservatives can make them more, rather than less, accepting towards immigrants and minorities. This possibility is based on the theoretical reasoning that national attachment, net of national narcissism, provides a secure and stable sense of national belonging that forms a basis for a more open attitude towards outgroups. In two studies using three nationally representative samples from Germany and Netherlands (N = 4440), we show that stronger political conservatism predicts more positive outgroup attitudes and higher tolerance through stronger national attachment, specifically when partialling out national narcissism. These findings indicate that higher national identification from politically more conservative individuals can provide a confident basis for positive outgroup attitudes

The risk of infection by African swine fever virus in European swine through boar movement and legal trade of pigs and pig meat

African swine fever (ASF) is currently spreading westwards throughout Europe and eastwards into China, with cases occurring in both wild boar and domestic pigs. A generic risk assessment framework is used to determine the probability of first infection with ASF virus (ASFV) at a fine spatial scale across European Union Member States. The framework aims to assist risk managers across Europe with their ASF surveillance and intervention activities. Performing the risk assessment at a fine spatial scale allows for hot-spot surveillance, which can aid risk managers by directing surveillance or intervention resources at those areas or pathways deemed most at risk, and hence enables prioritization of limited resources. We use 2018 cases of ASF to estimate prevalence of the disease in both wild boar and pig populations and compute the risk of initial infection for 2019 at a 100 km2 cell resolution via three potential pathways: legal trade in live pigs, natural movement of wild boar, and legal trade in pig meat products. We consider the number of pigs, boar and amount of pig meat entering our area of interest, the prevalence of the disease in the origin country, the probability of exposure of susceptible pigs or boar in the area of interest to introduced infected pigs, boar, or meat from an infected pig, and the probability of transmission to susceptible animals. We provide maps across Europe indicating regions at highest risk of initial infection. Results indicate that the risk of ASF in 2019 was predominantly focused on those regions which already had numerous cases in 2018 (Poland, Lithuania, Hungary, Romania, and Latvia). The riskiest pathway for ASFV transmission to pigs was the movement of wild boar for Eastern European countries and legal trade of pigs for Western European countries. New infections are more likely to occur in wild boar rather than pigs, for both the pig meat and wild boar movement pathways. Our results provide an opportunity to focus surveillance activities and thus increase our ability to detect ASF introductions earlier, a necessary requirement if we are to successfully control the spread of this devastating disease for the pig industry

Effectiveness of combining feedback about lung age or exhaled carbon monoxide levels with Very Brief Advice (VBA) and support for smoking cessation in primary care compared to giving VBA and support alone – protocol for a randomized controlled trial within the Breathe Well research program

INTRODUCTION: In 2015, smoking prevalence in Republic of Macedonia was 36% in men and 21% in women We aim to assess the effectiveness and cost-effectiveness of two methods of motivating smokers to quit smoking compared with very brief advice (VBA) alone. Тo date, there are no studies investigating smoking cessation treatment in Republic of Macedonia. METHODS/DESIGN: RCT with process evaluation and cost-effectiveness analysis within 31 general practices in Republic of Macedonia recruiting smokers currently smoking &gt;10 cigarettes per day, aged &gt;35 years, attending primary care practices for any reason, regardless of motivation to quit smoking. Respondents will be randomized into one of three groups: (1) VBA and assessment and communication of lung age; (2) VBA and additional assessment and communication of exhaled carbon monoxide (CO) levels; or (3) control group – VBA. All participants who attempt to quit smoking will be offered behavioral support based on the UK standard program for smoking cessation. Primary outcome: Proportion of smokers who are quit at 4 weeks (7-day point prevalence, confirmed by salivary cotinine level). Secondary outcomes: Proportion who have attempted to quit smoking or have quit smoking, a proportion that has reduced the number of cigarettes and motivation to quit smoking; cost-effectiveness analysis calculating cost per quality-adjusted life year. We will evaluate the fidelity to the intervention and will explore patients’ and GPs’ experience and the acceptability of the study intervention by interview. DISCUSSION: The study will evaluate the effectiveness of combining feedback about lung age or exhaled CO levels with VBA and support for smoking cessation in primary care compared to giving VBA and support alone. It will explore how willing primary care physicians are to perform such interventions and the acceptability and effectiveness of such interventions to patients in Republic of Macedonia. TRIAL REGISTRATION: The study is registered on the ISRCTN registry (ISRCTN54228638)

Clinical and budget impacts of changes in oral anticoagulation prescribing for atrial fibrillation

OBJECTIVE: To assess temporal clinical and budget impacts of changes in atrial fibrillation (AF)-related prescribing in England. METHODS: Data on AF prevalence, AF-related stroke incidence and prescribing for all National Health Service general practices, hospitals and registered patients with hospitalised AF-related stroke in England were obtained from national databases. Stroke care costs were based on published data. We compared changes in oral anticoagulation prescribing (warfarin or direct oral anticoagulants (DOACs)), incidence of hospitalised AF-related stroke, and associated overall and per-patient costs in the periods January 2011-June 2014 and July 2014-December 2017. RESULTS: Between 2011-2014 and 2014-2017, recipients of oral anticoagulation for AF increased by 86.5% from 1 381 170 to 2 575 669. The number of patients prescribed warfarin grew by 16.1% from 1 313 544 to 1 525 674 and those taking DOACs by 1452.7% from 67 626 to 1 049 995. Prescribed items increased by 5.9% for warfarin (95% CI 2.9% to 8.9%) but by 2004.8% for DOACs (95% CI 1848.8% to 2160.7%). Oral anticoagulation prescription cost rose overall by 781.2%, from £87 313 310 to £769 444 028, (£733,466,204 with warfarin monitoring) and per patient by 50.7%, from £293 to £442, giving an incremental cost of £149. Nevertheless, as AF-related stroke incidence fell by 11.3% (95% CI -11.5% to -11.1%) from 86 467 in 2011-2014 to 76 730 in 2014-2017 with adjustment for AF prevalence, the overall per-patient cost reduced from £1129 to £840, giving an incremental per-patient saving of £289. CONCLUSIONS: Despite nearly one million additional DOAC prescriptions and substantial associated spending in the latter part of this study, the decline in AF-related stroke led to incremental savings at the national level

Towards a sociology of risk work: a narrative review and synthesis

In this article, we define the concept of “risk work,” which aims to make visible working practices to assess or manage risk, in order to subject these practices to sociological critique. This article reviews and synthesizes existing published literature to identify components of risk work: (a) translating risk into different contexts, (b) minimizing risks in practice, and (c) caring in the context of risk. We argue that these three components of risk work raise important tensions for workers that have been inadequately explored in the literature to date. We propose that future research should additionally focus on practitioner subjectivity and identity in risk work. In addition, we argue that comparative research—across type of risk and different contexts—and methodological and theoretical diversity would enhance this emerging field of research