How does socio economic position link to health behaviour? Sociological pathways and perspectives for health promotion

Socio economic inequalities in adult health behaviour are consistently observed. Despite a well-documented pattern, social determinants of variations in health behaviour have not been sufficiently clarified. This article therefore presents sociological pathways to explain the existing inequalities in health behaviour. At a micro level, control beliefs have been part of several behavioural theories. We suggest that these beliefs might bridge the gap between sociology and psychology by emphasising their roots in fundamental socio-economic environments. At a meso level, social networks and support have not been explicitly considered as behavioural determinants. This contribution states that these social factors influence health behaviour while being unequally distributed across society. At a macro level, characteristics of the neighbourhood environment influence health behaviour of its residents above and beyond their individual background. Providing further opportunity for policy makers, it is shown that peer and school context equalise inequalities in risky behaviour in adolescence. As a conclusion, factors such as control expectations, social networks, neighbourhood characteristics, and school context should be included as strategies to improve health behaviour in socially disadvantaged people.

AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients

Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial) coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1) modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2) modeling geographic coverage according to the availability of services; (3) projecting the coverage of a scaling-up of an existing network; (4) providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation) that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on geographic coverage. Conclusion By incorporating the demand (population) and the supply (capacities of heath care centers), AccessMod provides a unifying tool to efficiently assess the geographic coverage of a network of health care facilities. This tool should be of particular interest to developing countries that have a relatively good geographic information on population distribution, terrain, and health facility locations.

Personality, risky health behavior, and perceived susceptibility to health risks

We examined the relations between personality (Five-Factor Model), risky health behaviours, and perceptions of susceptibility to health risks among 683 university students. The hypothesis was that personality would affect perceptions of susceptibility to health risks in two ways: directly, irrespective of risky health behaviours, and indirectly, through the effects of personality on risky health behaviours. The students were surveyed about smoking, being drunk, drunk driving, risky sexual behaviour, and perceptions of susceptibility to related health risks. In path-analytical models we found the expected direct and indirect effects. The personality dimensions of Agreeableness and Conscientiousness had negative direct effects on perceptions of susceptibility as well as negative indirect effects through risky health behaviours. Neuroticism was the only personality dimension to show positive direct effects on perceptions of susceptibility as well as negative indirect effects.

Taxonomy, phylogeny and molecular epidemiology of Echinococcus multilocularis: From fundamental knowledge to health ecology.

Alveolar echinococcosis, caused by the tapeworm Echinococcus multilocularis, is one of the most severe parasitic diseases in humans and represents one of the 17 neglected diseases prioritised by the World Health Organisation (WHO) in 2012. Considering the major medical and veterinary importance of this parasite, the phylogeny of the genus Echinococcus is of considerable importance; yet, despite numerous efforts with both mitochondrial and nuclear data, it has remained unresolved. The genus is clearly complex, and this is one of the reasons for the incomplete understanding of its taxonomy. Although taxonomic studies have recognised E. multilocularis as a separate entity from the Echinococcus granulosus complex and other members of the genus, it would be premature to draw firm conclusions about the taxonomy of the genus before the phylogeny of the whole genus is fully resolved. The recent sequencing of E. multilocularis and E. granulosus genomes opens new possibilities for performing in-depth phylogenetic analyses. In addition, whole genome data provide the possibility of inferring phylogenies based on a large number of functional genes, i.e. genes that trace the evolutionary history of adaptation in E. multilocularis and other members of the genus. Moreover, genomic data open new avenues for studying the molecular epidemiology of E. multilocularis: genotyping studies with larger panels of genetic markers allow the genetic diversity and spatial dynamics of parasites to be evaluated with greater precision. There is an urgent need for international coordination of genotyping of E. multilocularis isolates from animals and human patients. This could be fundamental for a better understanding of the transmission of alveolar echinococcosis and for designing efficient healthcare strategies.

[Health literacy : An introduction to the concept and its measurement].

Over the last 20 years, health literacy (German: Gesundheitskompetenz/health competency) has become a popular concept in research and health policy. Initially defined as an individual's ability to understand medical information, the definition has quickly expanded to describe individual-based resources for actions or conduct relevant to health, in different socio-cultural or clinical contexts. Today, researchers and practice experts can draw on a wide variety of definitions and measurements. This article provides an overview of the definitions, briefly introduces the "structure and agency" approach as an example of theorizing health literacy, and shows different types of operationalization. The article presents the strengths and shortcomings of the available concepts and measures and provides starting points for future research in public health and health promotion.

Supply sensitive services in Swiss ambulatory care: an analysis of basic health insurance records for 2003-2007

Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation') whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated.

Strategies to prevent neuronal damage in paediatric bacterial meningitis

PURPOSE OF REVIEW: The mortality of bacterial meningitis can reach 30%, and up to 50% of survivors suffer from persisting neurological deficits as a consequence of the disease. The incidence of neurological sequelae of bacterial meningitis has not improved over the last decade. Adjunctive therapeutic options are limited, and ongoing research into the pathophysiology of brain damage in bacterial meningitis aims at providing the scientific basis for future development of more efficient adjunctive options. RECENT FINDINGS: In a population with good access to health care, dexamethasone given before or at the time of initiation of antibiotic therapy acts beneficially in paediatric pneumococcal meningitis, but not in meningococcal meningitis. In experimental animal models, brain-derived neurotrophic factor protected against brain injury and improved hearing while melatonin, which has antioxidant properties among other effects, reduced neuronal death. Transgene technology can be used to provide new insights into the pathophysiology of the disease and to identify potential therapeutic targets. SUMMARY: Although dexamethasone improves outcome of bacterial meningitis under defined circumstances, the morbidity of bacterial meningitis still remains unacceptably high. Experimental models may help to identify new therapeutic strategies to further improve the neurological outcome in young children suffering from bacterial meningitis.

Environmental justice and health practices: understanding how health inequities arise at the local level

While empirical evidence continues to show that people living in low socio-economic status neighbourhoods are less likely to engage in health-enhancing behaviour, our understanding of why this is so remains less than clear. We suggest that two changes could take place to move from description to understanding in this field; (i) a move away from the established concept of individual health behaviour to a contextualised understanding of health practices; and (ii) a switch from focusing on health inequalities in outcomes to health inequities in conditions. We apply Pierre Bourdieu's theory on capital interaction but find it insufficient with regard to the role of agency for structural change. We therefore introduce Amartya Sen's capability approach as a useful link between capital interaction theory and action to reduce social inequities in health-related practices. Sen's capability theory also elucidates the importance of discussing unequal chances in terms of inequity, rather than inequality, in order to underscore the moral nature of inequalities. We draw on the discussion in social geography on environmental injustice, which also underscores the moral nature of the spatial distribution of opportunities. The article ends by applying this approach to the 'Interdisciplinary study of inequalities in smoking' framework.

Challenge stressors: longitudinal effects on self attitudes, work attitudes, and health.

Recent research suggests that some stressors (i.e. hindrance stressors) have mainly negative consequences, whereas others (i.e. challenge stressors) can simultaneously have positive and negative consequences (e.g., LePine et al., 2005). Although a number of studies have dealt with potential outcomes of challenge stressors, some criteria have received only limited attention (e.g., positive self-attitudes; cf. Widmer et al., 2012), and some have been neglected altogether (i.e., physical health outcomes). Furthermore, while sophisticated methods – such as meta-analyses (e.g., LePine et al., 2005), diary studies (Ohly & Fritz, 2010), and multi-source analyses (Wallace et al., 2009) – have been applied to the framework, there are no longitudinal studies. We report results from a longitudinal study containing three waves, with two time-lags of one month each (N = 393). We analyzed relationships between challenge stressors and work attitudes (e.g. job satisfaction), self attitudes (e.g. self-esteem), and health indicators (e.g. sleep quality) using cross-lagged SEM. We expected positive effects of challenge stressors to appear only when their negative variance is controlled (e.g. by including hindrance stressors as a suppressor variable; cf. Cavanaugh et al., 2000). As the positive aspects of challenge stressors relate to self-affirming experiences, we also expected positive effects to be especially strong for self attitudes. Regarding work attitudes, the only significant paths found were from work attitudes to challenge stressors over both time lags. Regarding health, there was a significant cross-sectional association at time 1, which was negative, as expected. Longitudinally, a positive path from challenge stressors to health for both time lags was found only when hindrances stressors were controlled, confirming the expected suppressor effect. Hindrance stressors had a negative effect on health. For self-attitudes, there was a positive cross-sectional association at time one. In addition, a positive effect on self attitudes was found longitudinally for both time lags, but only when hindrance stressors were controlled. Additional analyses showed that the positive longitudinal effect on health was mediated by self attitudes. Although the lack of associations with work attitudes was surprising, our results indicate that challenge stressors contain aspects that provide an opportunity to develop self-esteem through demanding work situations, thereby contributing to personal growth and thriving at the workplace. They also confirm the ambiguous nature of challenge stressors, as, with one exception, positive effects were found only when hindrance stressors were controlled (cf. Widmer et al., 2012). Finally, our results confirm the importance of self-related attitudes in the stress process.

Capital interplays and the self-rated health of young men: results from a cross-sectional study in Switzerland.

INTRODUCTION We apply capital interplay theory to health inequalities in Switzerland by investigating the interconnected effects of parental cultural, economic and social capitals and personal educational stream on the self-rated health of young Swiss men who live with their parents. METHODS We apply logistic regression modelling to self-rated health in original cross-sectional survey data collected during mandatory conscription of Swiss male citizens in 2010 and 2011 (n = 23,975). RESULTS In comparison with sons whose parents completed mandatory schooling only, sons with parents who completed technical college or university were significantly more likely to report very good or excellent self-rated health. Parental economic capital was an important mediating factor in this regard. Number of books in the home (parental cultural capital), family economic circumstances (parental economic capital) and parental ties to influential people (parental social capital) were also independently associated with the self-rated health of the sons. Although sons in the highest educational stream tended to report better health than those in the lowest, we found little evidence for a health-producing intergenerational transmission of capitals via the education stream of the sons. Finally, the positive association between personal education and self-rated health was stronger among sons with relatively poorly educated parents and stronger among sons with parents who were relatively low in social capital. CONCLUSIONS Our study provides empirical support for the role of capital interplays, social processes in which capitals interpenetrate or co-constitute one another, in the intergenerational production of the health of young men in Switzerland.

Looking too Old? How First Impressions of Older-looking Candidates Contribute to Unfavorable Selection Decisions

Building on theories of impression formation based on faces, this research investigates the impact of job candidates’ facial age appearance on hiring as well as the underlying mechanism. In an experiment, participants decided whether to hire a fictitious candidate aged 50 years, 30 years or without age information. The candidate’s age was signaled either via chronological information (varied by date of birth) or via facial age appearance (varied by a photograph on the résumé). Findings showed that candidates with older-appearing faces—but not chronologically older candidates—triggered impressions of low health and fitness, compared to younger-appearing candidates. These impressions reduced perceptions of person-job fit, which lowered hiring probabilities for older-appearing candidates. These findings provide the first evidence that trait impressions from faces are a determinant of age discrimination in personnel selection. They call for an extension of current models of age discrimination by integrating the effects of face-based trait impressions, particularly with respect to health and fitness.