The politics of social policy: welfare expansion in Brazil, China, India and South Africa in comparative perspective

This introductory essay reviews the scholarship on the politics of social policy, and shows the contribution of the special issue to explaining expanded welfare commitments in Brazil, China, India and South Africa in the twenty-first century. Much literature on welfare expansion in lower- and middle-income contexts views it primarily as a policy corrective to the economic dislocations produced by global economic integration. This special issue focuses on the political factors that are critical to understanding the shape social policies have taken and their effectiveness in ameliorating poverty and inequality

The influence of training and athletic performance on the neural and mechanical determinants of muscular rate of force development

Neuromuscular explosive strength (defined as rate of force development; RFD) is considered important during explosive functional human movements; however this association has been poorly documented. It is also unclear how different variants of strength training may influence RFD and its neuromuscular determinants. Furthermore, RFD has typically been measured in isometric situations, but how it is influenced by the types of contraction (isometric, concentric, eccentric) is unknown. This thesis compared neuromuscular function in explosive power athletes (athletes) and untrained controls, and assessed the relationship between RFD in isometric squats with sprint and jump performance. The athletes achieved a greater RFD normalised to maximum strength (+74%) during the initial phase of explosive contractions, due to greater agonist activation (+71%) in this time. Furthermore, there were strong correlations (r2 = 0.39) between normalised RFD in the initial phase of explosive squats and sprint performance, and between later phase absolute explosive force and jump height (r2 = 0.37), confirming an association between explosive athletic performance and RFD. This thesis also assessed the differential effects of short-term (4 weeks) training for maximum vs. explosive strength, and whilst the former increased maximum strength (+20%) it had no effect on RFD. In contrast explosive strength training improved explosive force production over short (first 50 ms; +70%) and long (>50 ms; +15%) time periods, due to improved agonist activation (+65%) and maximum strength (+11%), respectively. Explosive strength training therefore appears to have greater functional benefits than maximum strength training. Finally, the influence of contraction type on RFD was assessed, and the results provided unique evidence that explosive concentric contractions are 60% more effective at utilising the available force capacity of the muscle, that was explained by superior agonist activation. This work provides a comprehensive analysis of the association between athletic performance and RFD, the differential effects of maximum vs. explosive strength training, and the influence of contraction type on the capacity for RFD

Ethnicity-specific obesity cut-points in the development of Type 2 diabetes - a prospective study including three ethnic groups in the United Kingdom

Aims: Conventional definitions of obesity, e.g. body mass index (BMI) ≥ 30 kg/m2 or waist circumference cut-points of 102 cm (men) and 88 cm (women), may underestimate metabolic risk in non-Europeans. We prospectively identified equivalent ethnicity-specific obesity cut-points for the estimation of diabetes risk in British South Asians, African-Caribbeans and Europeans. Methods: We studied a population-based cohort from London, UK (1356 Europeans, 842 South Asians, 335 African-Caribbeans) who were aged 40–69 years at baseline (1988–1991), when they underwent anthropometry, fasting and post-load (75 g oral glucose tolerance test) blood tests. Incident Type 2 diabetes was identified from primary care records, participant recall and/or follow-up biochemistry. Ethnicity-specific obesity cut-points in association with diabetes incidence were estimated using negative binomial regression. Results: Diabetes incidence rates (per 1000 person years) at a median follow-up of 19 years were 20.8 (95% CI: 18.4, 23.6) and 12.0 (8.3, 17.2) in South Asian men and women, 16.5 (12.7, 21.4) and 17.5 (13.0, 23.7) in African-Caribbean men and women, and 7.4 (6.3, 8.7), and 7.2 (5.3, 9.8) in European men and women. For incidence rates equivalent to those at a BMI of 30 kg/m2 in European men and women, age- and sex-adjusted cut-points were: South Asians, 25.2 (23.4, 26.6) kg/m2; and African-Caribbeans, 27.2 (25.2, 28.6) kg/m2. For South Asian and African-Caribbean men, respectively, waist circumference cut-points of 90.4 (85.0, 94.5) and 90.6 (85.0, 94.5) cm were equivalent to a value of 102 cm in European men. Waist circumference cut-points of 84.0 (74.0, 90.0) cm in South Asian women and 81.2 (71.4, 87.4) cm in African-Caribbean women were equivalent to a value of 88 cm in European women. Conclusions: In prospective analyses, British South Asians and African-Caribbeans had equivalent diabetes incidence rates at substantially lower obesity levels than the conventional European cut-points

Ethnic Differences in Disability Prevalence and Their Determinants Studied over a 20-Year Period: A Cohort Study.

BACKGROUND: To compare disability prevalence rates in the major ethnic groups in the UK and understand the risk factors contributing to differences identified. It was hypothesised that Indian Asian and African Caribbean people would experience higher rates of disability compared with Europeans. METHODS: Data was collected from 888 European, 636 Indian Asian and 265 African Caribbean men and women, aged 58-88 years at 20-year follow-up of community-based cohort study, based in West London. Disability was measured using a performance-based locomotor function test and self-reported questionnaires on functional limitation, and instrumental (IADL) and basic activities of daily living (ADL). RESULTS: The mean (SD) age of participants at follow-up was 69.6 (6.2) years. Compared with Europeans, Indian Asian people were significantly more likely to experience all of the disability outcomes than Europeans; this persisted after adjustment for socioeconomic, behavioural, adiposity and chronic disease risk factors measured at baseline (locomotor dysfunction: adjusted odds ratio (OR) 2.20, 95% CI 1.56-3.11; functional limitation: OR 2.77, 2.01-3.81; IADL impairment: OR 3.12, 2.20-4.41; ADL impairment: OR 1.58, 1.11-2.24). In contrast, a modest excess risk of disability was observed in African Caribbeans, which was abolished after adjustment (e.g. locomotor dysfunction: OR 1.37, 0.90-1.91); indeed a reduced risk of ADL impairment appeared after multivariable adjustment (OR from 0.99, 0.68-1.45 to 0.59, 0.38-0.93), compared with Europeans. CONCLUSIONS: Substantially elevated risk of disability was observed among Indian Asian participants, unexplained by known factors. A greater understanding of determinants of disability and normative functional beliefs of healthy aging is required in this population to inform intervention efforts to prevent disability

The Effects of Long-Term Muscle Disuse on Neuromuscular Function in Unilateral Transtibial Amputees

The purpose of this study was to determine: (1) whether individuals with unilateral transtibial amputations (ITTAs), who habitually disuse the quadriceps muscles of their amputated limb, provide an effective model for assessing the effects of long-term muscle disuse; and (2) the effects of such disuse on quadriceps muscle strength and neuromuscular function in this population. Nine ITTAs and nine controls performed isometric voluntary knee extensions in both limbs to assess maximal voluntary torque (MVT) and rate of torque development (RTD). The interpolated twitch technique and EMG normalised to maximal M-wave assessed neural activation, involuntary (twitch and octet) contractions assessed intrinsic contractile properties, and ultrasound images of the vastus lateralis assessed muscle architecture. Clinical gait analysis was used to measure knee kinetic data during walking at an habitual speed. ITTAs displayed 54-60% lower peak knee extensor moments during walking in the amputated than intact/control limbs, but the intact and control limbs were comparable for loading during walking and muscle strength variables, suggesting the intact limb provides a suitable internal control for comparison to the disused amputated limb. MVT and RTD were ~60% and ~75% lower, respectively, in the amputated than intact/control limbs. The differences in MVT appeared associated with ~40% and ~43% lower muscle thickness and neural activation, respectively, whilst the differences in RTD appeared associated with the decline in MVT coupled with slowing of the intrinsic contractile properties. These results indicate considerable changes in strength and neuromuscular function with long-term disuse, that could not be predicted from short-term disuse studies. This is the peer reviewed version of the following article: The Effects of Long-Term Muscle Disuse on Neuromuscular Function in Unilateral Transtibial Amputees, which has been published in final form at Experimental Physiology. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Version

Ethnic Differences in Associations Between Blood Pressure and Stroke in South Asian and European Men.

It is unknown whether associations between blood pressure (BP) and stroke vary between Europeans and South Asians, despite higher stroke rates in the latter. We report findings from a UK cohort study of 1375 European and 1074 South Asian men, not receiving antihypertensive medication, aged 40 to 69 years at baseline (1988-1991). Assessment included BP, blood tests, anthropometry, and questionnaires. Incident stroke was established at 20 years from death certification, hospital and primary care records, and participant report. South Asians had higher systolic BP, diastolic BP, and mean arterial pressure than Europeans, and similar pulse pressure. Associations between systolic BP or diastolic BP and stroke were stronger in South Asians than Europeans, after adjustment for age, smoking status, waist/hip ratio, total/high-density lipoprotein-cholesterol ratio, diabetes mellitus, fasting glucose, physical activity, and heart rate (systolic BP: Europeans [odds ratio, 1.22; 95% confidence interval, 0.98-1.51], South Asians [1.56; 1.24-1.95]; ethnic difference P=0.04; diastolic BP: Europeans [0.90; 0.71-1.13], South Asians [1.68; 1.32-2.15]; P<0.001). Hemodynamic correlates of stroke risk differed by ethnicity: in combined models, mean arterial pressure but not pulse pressure was detrimentally associated with stroke in South Asians, whereas the converse was true for Europeans. The combination of hyperglycemia and hypertension appeared particularly detrimental for South Asians. There are marked ethnic differences in associations between BP parameters and stroke. Undue focus on systolic BP for risk prediction, and current age and treatment thresholds may be inappropriate for individuals of South Asian ancestry

Reassessing Ethnic Differences in Mean BMI and Changes Between 2007 and 2013 in English Children.

OBJECTIVE: National body fatness (BF) data for English South Asian and Black children use BMI, which provides inaccurate ethnic comparisons. BF levels and time trends in the English National Child Measurement Programme (NCMP) between 2007 and 2013 were assessed by using ethnic-specific adjusted BMI (aBMI) for South Asian and Black children. METHODS: Analyses were based on 3,195,323 children aged 4 to 5 years and 2,962,673 children aged 10 to 11 years. aBMI values for South Asian and Black children (relating to BF as in White children) were derived independently. Mean aBMI levels and 5-year aBMI changes were obtained by using linear regression. RESULTS: In the 2007-2008 NCMP, mean aBMIs in 10- to 11-year-old children (boys, girls) were higher in South Asian children (20.1, 19.9 kg/m2 ) and Black girls, but not in Black boys (18.4, 19.2 kg/m2 ) when compared with White children (18.6, 19.0 kg/m2 ; all P < 0.001). Mean 5-year changes (boys, girls) were higher in South Asian children (0.16, 0.32 kg/m2 per 5 y; both P < 0.001) and Black boys but not girls (0.13, 0.15 kg/m2 per 5 y; P = 0.01, P = 0.41) compared with White children (0.02, 0.11 kg/m2 per 5 y). Ethnic differences at 4 to 5 years were similar. Unadjusted BMI showed similar 5-year changes but different mean BMI patterns. CONCLUSIONS: BF levels were higher in South Asian children than in other groups in 2007 and diverged from those in White children until 2013, a pattern not apparent from unadjusted BMI data