Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors : a prospective cohort study with 17-years of follow up

Background The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. Methods The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). Results A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. Conclusions Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.

'Pretend I was Mummy': Children's Production of Authority and Subordinance in Their Pretend Play Interaction During Disputes

Purpose – This chapter examines an episode of pretend play amongst a group of young girls in an elementary school in Australia, highlighting how they interact within the membership categorization device ‘family’ to manage their social and power relationships. Approach – Using conversation analysis and membership categorization analysis, an episode of video-recorded interaction that occurs amongst a group of four young girls is analyzed. Findings – As disputes arise amongst the girls, the mother category is produced as authoritative through authoritative actions by the girl in the category of mother, and displays of subordination on the part of the other children, in the categories of sister, dog and cat. Value of paper – Examining play as a social practice provides insight into the social worlds of children. The analysis shows how the children draw upon and co-construct family-style relationships in a pretend play context, in ways that enable them to build and organize peer interaction. Authority is highlighted as a joint accomplishment that is part of the social and moral order continuously being negotiated by the children. The authority of the mother category is produced and oriented to as a means of managing the disputes within the pretend frame of play.

‘The health-location connection’: using GIS and social media on smartphones to track engagement with the Local urban environment for work, recreation, and physical activity

A technologically innovative study was undertaken across two suburbs in Brisbane, Australia, to assess socioeconomic differences in women's use of the local environment for work, recreation, and physical activity. Mothers from high and low socioeconomic suburbs were instructed to continue with usual daily routines, and to use mobile phone applications (Facebook Places, Twitter, and Foursquare) on their mobile phones to ‘check-in’ at each location and destination they reached during a one-week period. These smartphone applications are able to track travel logistics via built-in geographical information systems (GIS), which record participants’ points of latitude and longitude at each destination they reach. Location data were downloaded to Google Earth and excel for analysis. Women provided additional qualitative data via text regarding the reasons and social contexts of their travel. We analysed 2183 ‘check-ins’ for 54 women in this pilot study to gain quantitative, qualitative, and spatial data on human-environment interactions. Data was gathered on distances travelled, mode of transport, reason for travel, social context of travel, and categorised in terms of physical activity type – walking, running, sports, gym, cycling, or playing in the park. We found that the women in both suburbs had similar daily routines with the exception of physical activity. We identified 15% of ‘check-ins’ in the lower socioeconomic group as qualifying for the physical activity category, compared with 23% in the higher socioeconomic group. This was explained by more daily walking for transport (1.7kms to 0.2kms) and less car travel each week (28.km to 48.4kms) in the higher socioeconomic suburb. We ascertained insights regarding the socio-cultural influences on these differences via additional qualitative data. We discuss the benefits and limitations of using new technologies and Google Earth with implications for informing future physical and social aspects of urban design, and health promotion in socioeconomically diverse cities.

Masturbation and the media

This paper explores the important role the media play in informing young people about masturbation. A pilot study of focus groups with twenty-two young Australians, aged between 14-16 explored what they know about sex and sexuality, and where they have found that knowledge. This paper reports on their knowledge about masturbation. Although researchers agree that masturbation can be a positive part of healthy sexual development, most young people reported that they received very little positive information about it from their parents or in formal sex education in school. These young people’s discussions around this topic were largely ambivalent, but also highly complex due to the varying levels and types of information that they receive. In this context the media play a vital role in providing information about masturbation through books and magazines for young women, and television comedies for young men.

Speaking truth to power : sexism, outrage and the public consciousness

Alan Jones's now infamous comment that women are destroying the joint' sparked a flurry of observations and interpretations in the national and international media and in the blogosphere about the motivations and meanings of such a statement. The overriding tone of this commentary was outrage - how dare an influential figure like Jones state with such blatant and provocative hostility that women are at best unsuitable for leadership and at worst, damaging our public and private institutions? The answers, as we have seen, are likely to be complex, but an alternative question could also be posed. Why the outrage? Public male figures have, throughout history, made derogatory, demeaning and sexist remarks about women, and the material effects of gender inequality continue to be felt- consider the gender pay gap and glass ceiling phenomenon for starters. So why did this particular comment ignite such widespread indignation and anger?

Young women's drinking experiences in public drinking venues

Alcohol-related mortality and morbidity represents a substantial financial burden to communities across the world. In Australia, conservative estimates place the societal cost (2004-2005) for alcohol abuse at approximately 15.3 billion dollar annually (Collins & Lapsley, 2008). Research has found that adolescence and young adulthood is a peak period for heavy episodic alcohol consumption, with over a third of all people aged 14-19 years having been at risk for acute alcohol-related harm at least once in the prior 12 months (Australian Institute of Health and Welfare [AIHW], (2008). While excessive alcohol consumption has, for a long time, been seen as a male problem; there has been a gradual shift towards a social acceptance of female drinking which has resulted in a diminishing gap in drinking quantity and style between men and women (Roche & Deehan, 2002). There is substantial evidence that women are at higher risk than men for detrimental physical, medical, social and psychological effects of at-risk alcohol consumption (Epstein, et al., 2007). Research outlining the epidemiology of women���s substance use emphasises the need for further examination into influences that may be gender specific and culturally defined (Matheson, 2008; Measham & Ostergaard, 2009). As such, there is a need to utilise female perspectives in examining alcohol consumption and alcohol related problems in order to reflect a more balanced and competent version of drinking in today’s culture (Allamani, 2008). Currently a number of reasons are offered to explain the observed trends including reduction in traditional sanctions and social norms against women drinking, financial emancipation, cultural shift and targeted advertising to name a few. However, there is yet comparatively little research examining drinking by young women in order to understand this ‘new’ drinking pattern. Most research into alcohol use and subsequent intervention and prevention campaigns have been based on male perceptions and constructs of drinking. While such approaches have provided important information regarding the quantity and frequency of alcohol consumption by women, they do not address the important question of why. To understand the why, research needs to explore the difference between males and females in the meaning of the behaviour and the place that drinking holds to them.

Feminist ethics and menopause : autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners’ accounts of menopause and treatment in Australia, women's ‘choice’, ‘informed decision-making’ and ‘empowerment’ were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of ‘informed decision-making’ in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an ‘ethic of autonomy’ and an ‘offer of choice’ in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Under-reporting of road crashes in Pakistan and the role of fate

Objective: Comprehensive, accurate information about road crashes and related trauma is a prerequisite for identification and control of risk factors as well as for identifying faults within the broader road safety system. Quality data and appropriate crash investigation are critical in reducing the road toll that is rapidly growing in much of the developing world, including Pakistan. This qualitative research explored the involvement of social and cultural factors (in particular, fatalism) in risky road use in Pakistan. The findings highlight a significant issue, previously unreported in the road safety literature, namely, the link between fatalistic beliefs and inaccurate reporting of road crashes. Method: Thirty interviews (one-to one) were conducted by the first author with police officers, drivers, policy makers and religious orators in three Pakistani cities. Findings: Evidence emerged of a strong link between fatalism and the under-reporting of road crashes. In many cases, crashes and related road trauma appear to go unreported because a crash is considered to be one’s fate and, therefore, beyond personal control. Fate was also implicated in the practice of reconciliation between parties after a crash without police involvement and the seeking and granting of pardon for a road death. Conclusions: These issues represent additional factors that can contribute to under-reporting of crashes and associated trauma. Together, they highlight complications involved in establishing the true cost of road trauma in a country such as Pakistan and the difficulties faced when attempting to promote scientifically-based road safety information to counteract faith-based beliefs.

Arguing the Autopsy : mutual suspicion, jurisdictional confusion and the socially marginal

Vulnerable and marginalised populations are not only over-represented in the criminal justice system, but also in civil jurisdictions like the coronial system. Moreover, many of the personnel who deal with criminal matters, especially in rural and regional areas, are also those who manage the coronial death investigation. This movement back and forth between civil and criminal jurisdictions is difficult for the both professional personnel and the families, but especially for those families who may also have had dealings with these personnel in the criminal justice system, or who present as suspicious due to larger historical and global issues. While coronial legislation now allows families to raise cultural and religious concerns about the process, particularly to do with the autopsy of their loved one, this also requires them to identify themselves to police at the initial stage of the death investigation. This paper, part of a larger body of work on autopsy decision making, discusses the ways in which this information is gathered by police, how it is communicated through the system, the ways in which families are supported through the process, and the difficulties that ensue.

Investigative Essentials for Journalists in Multicultural and Diverse Communities

This chapter describes how investigative journalism can uncover news that often goes unreported about personalities, problems, ways of life and pressing issues in ethnic and religious sub-communities. While investigative journalism is traditionally understood as reporting that exposes corrupt, inefficient, incompetent or other inappropriate conduct in politics and business circles, investigative reporters do far more than that. They also map human activities, landmarks, patterns and changes in the landscape, and connections across the whole of society. This type of investigative journalism can improve reporting of ethnic and religious sub-communities via identification, deep observation and analysis of trends, events, and issues that would otherwise remain hidden or obscured. The chapter includes details of techniques that investigative journalists can employ to identify interesting topics, find sources of information, analyse data and issues, and report compelling stories.

“Yarning” as a method for community-based health research with indigenous women : the indigenous women's wellness research program

This project explores yarning as a methodology for understanding health and wellness from an indigenous woman's perspective. Previous research exploring indigenous Australian women's perspectives have used traditional Western methodologies and have often been felt by the women themselves to be inappropriate and ineffective in gathering information and promoting discussion. This research arose from the indigenous women themselves, and resulted in the exploration of using yarning as a methodology. Yarning is a conversational process that involves the sharing of stories and the development of knowledge. It prioritizes indigenous ways of communicating, in that it is culturally prescribed, cooperative, and respectful. The authors identify different types of yarning that are relevant throughout their research, and explain two types of yarning—family yarning and cross-cultural yarning—which have not been previously identified in research literature. This project found that yarning as a research method is appropriate for community-based health research with indigenous Australian women. This may be an important finding for health professionals and researchers to consider when working and researching with indigenous women from other countries.

Convergence in the gender wage gap in Australia over the 1980s : identifying the role of counteracting forces via the Juhn, Murphy and Pierce decomposition

The paper utilises the Juhn Murphy and Pierce (1991) decomposition to shed light on the pattern of slow male-female wage convergance in Australia over the 1980s. The analysis allows one to distinguish between the role of wage structure and genderspecific effects. The central question addressed is whether rising wage inequality counteracted the forces of increased female investment in labour market skills, i.e. education and experience. The conclusion is that in contrast to the US and the UK, Australian women do not appear to have been swimming against a tide of adverse wage structure changes.

The Cairns abortion trial : deviance, stigma and the spoiled identity

In 2010 a couple in Cairns were charged, and later found not guilty, of illegally obtaining a medical abortion through the use of medication imported from overseas. The court case reignited the contentious debate surrounding the illegality and social acceptance of abortion in Queensland, Australia. Based on a critical discourse analysis of 150 online news media articles covering the Cairns trial, this paper argues that the media shapes perceptions of deviance and stigma in relation to abortion through the use of language. In this case, the Cairns couple were positioned as deviant for pursuing abortion on the basis that they were rejecting the social norm of motherhood. This paper identifies three key themes evident in the articles analysed which contribute to shaping the construction of deviance – the humanising of the foetus, the stereotyping of the traditional female role of mother, and the demonising of women who choose abortion. This paper argues that the use of specific language in media coverage of abortion has the power to disrespect and invalidate the experiences, rights, and health of women who choose to terminate pregnancies.

Genetic polymorphisms in DPF3 associated with risk of breast cancer and lymph node metastases

Background Several studies have identified rare genetic variations responsible for many cases of familial breast cancer but their contribution to total breast cancer incidence is relatively small. More common genetic variations with low penetrance have been postulated to account for a higher proportion of the population risk of breast cancer. Methods and Results In an effort to identify genes that influence non-familial breast cancer risk, we tested over 25,000 single nucleotide polymorphisms (SNPs) located within approximately 14,000 genes in a large-scale case-control study in 254 German women with breast cancer and 268 age-matched women without malignant disease. We identified a marker on chromosome 14q24.3-q31.1 that was marginally associated with breast cancer status (OR = 1.5, P = 0.07). Genotypes for this SNP were also significantly associated with indicators of breast cancer severity, including presence of lymph node metastases ( P = 0.006) and earlier age of onset ( P = 0.01). The association with breast cancer status was replicated in two independent samples (OR = 1.35, P = 0.05). High-density association fine mapping showed that the association spanned about 80 kb of the zinc-finger gene DPF3 (also known as CERD4 ). One SNP in intron 1 was found to be more strongly associated with breast cancer status in all three sample collections (OR = 1.6, P = 0.003) as well as with increased lymph node metastases ( P = 0.01) and tumor size ( P = 0.01). Conclusion Polymorphisms in the 5' region of DPF3 were associated with increased risk of breast cancer development, lymph node metastases, age of onset, and tumor size in women of European ancestry. This large-scale association study suggests that genetic variation in DPF3 contributes to breast cancer susceptibility and severity.

The clinical effectiveness of interventions to assist perioperative temperature management for women undergoing Cesarean Section : a systematic review

Background Women undergoing Cesarean Section (CS) are vulnerable to the adverse effects associated with perioperative core temperature drop, in part due to the tendency for CS to be performed under neuraxial anesthesia, blood and fluid loss, and vasodilation. Inadvertent perioperative hypothermia (IPH) is a common condition that affects patients undergoing surgery of all specialties and is detrimental to all age groups, including neonates. Previous systematic reviews on IPH prevention largely focus on either adult or all ages populations, and have mainly overlooked pregnant or CS patients as a distinct group. Not all recommendations made by systematic reviews targeting all adult patients may be transferable to CS patients. Alternative, effective methods for preventing or managing hypothermia in this group would be valuable. Objectives To synthesize the best available evidence in relation to preventing and/or treating hypothermia in mothers after CS surgery. Types of participants Adult patients over the age of 18 years, of any ethnic background, with or without co-morbidities, undergoing any mode of anesthesia for any type of CS (emergency or planned) at healthcare facilities who have received interventions to limit or manage perioperative core heat loss were included. Types of intervention(s) Active or passive warming methods versus usual care or placebo, that aim to limit or manage core heat loss as applied to women undergoing CS were included. Types of studies Randomized controlled trials (RCTs) that met the inclusion criteria, with reduction of perioperative hypothermia a primary or secondary outcome were considered. Types of outcomes Primary outcome: maternal core temperature measured during the preoperative, intraoperative and postoperative phases of care Secondary outcomes: newborn core temperature at birth, umbilical pH obtained immediately after birth, Apgar scores, length of Post Anesthetic Care Unit (PACU) stay, maternal thermal comfort. Search strategy A comprehensive search was undertaken of the following databases from their inception until May 2012: ProQuest, Web of Science, Scopus, Dissertation and Theses PQDT (via ProQuest), Current Contents, CENTRAL, Mednar, OpenGrey, Clinical Trials. There were no language restrictions. Methodological quality Retrieved papers were assessed for methodological quality by two independent reviewers prior to inclusion using JBI software. Disagreements were resolved via consultation with the third reviewer. An assessment of quality of the included papers was also made in relation to five key quality factors. Data collection Two independent reviewers extracted data from the included papers using a previously piloted customized data extraction tool. Results 12 studies with a combined total of 719 participants were included. Three broad intervention groups were identified; intravenous (IV) fluid warming, warming devices, leg wrapping. IV fluid warming, whether administered intraoperatively or preoperatively, was found to be effective at maintaining maternal (but not neonatal) temperature and preventing shivering, but does not improve thermal comfort. The effectiveness of IV fluid warming on Apgar scores and umbilical pH remains unclear. Warming devices, including forced air warming and under body carbon polymer mattresses, were effective at preventing hypothermia and reduced shivering, however were most effective if applied preoperatively. The effectiveness of warming devices to improve thermal comfort remains unclear. Preoperative forced air warming appears to aid maintenance of neonatal temperature, while intraoperative forced air warming does not. Forced air warming was not effective at improving Apgar scores and the effects for umbilical pH remain unclear. Conclusions Intravenous fluid warming, by any method, improves maternal temperature and reduces shivering for women undergoing CS. Preoperative body warming devices also improve maternal temperature, in addition to reducing shivering.