Patterns of exposure to infectious diseases and social contacts in early life and risk of brain tumours in children and adolescents: an International Case-Control Study (CEFALO)

BACKGROUND Infectious diseases and social contacts in early life have been proposed to modulate brain tumour risk during late childhood and adolescence. METHODS CEFALO is an interview-based case-control study in Denmark, Norway, Sweden and Switzerland, including children and adolescents aged 7-19 years with primary intracranial brain tumours diagnosed between 2004 and 2008 and matched population controls. RESULTS The study included 352 cases (participation rate: 83%) and 646 controls (71%). There was no association with various measures of social contacts: daycare attendance, number of childhours at daycare, attending baby groups, birth order or living with other children. Cases of glioma and embryonal tumours had more frequent sick days with infections in the first 6 years of life compared with controls. In 7-19 year olds with 4+ monthly sick day, the respective odds ratios were 2.93 (95% confidence interval: 1.57-5.50) and 4.21 (95% confidence interval: 1.24-14.30). INTERPRETATION There was little support for the hypothesis that social contacts influence childhood and adolescent brain tumour risk. The association between reported sick days due to infections and risk of glioma and embryonal tumour may reflect involvement of immune functions, recall bias or inverse causality and deserve further attention.

Social Factors Associated with Readiness for Sexual Activity in Adolescents: A Population-Based Cohort Study

Various factors are associated with sexual activity in adolescence and it is important to identify those that promote healthy and adaptive romantic and sexual development. The objectives of this study were to describe rates of early sexual intercourse (before 16 years) and sexual readiness in adolescence and to assess the extent to which these were social patterned. We prospectively studied nearly 5,000 15-year-olds from the Avon Longitudinal Study of Parents and Children, a UK birth cohort. Between 2006 and 2008, female and male participants answered a computer assisted interview about romantic and sexual behaviors in the last year. Predictors of sexual intercourse and readiness for sexual intercourse were examined across a range of sociodemographic measures. Overall, 17.7 % (95 % CI 16.7 %, 18.9 %) of participants reported having had sexual intercourse in the last year, with more girls than boys reporting sexual experience (risk ratio 1.30, 95 % CI 1.15, 1.47). Of these, one-third of both male and female were classed as unready because they were unwilling, lacking in autonomy, felt regret or had not used contraception. There was strong evidence of social patterning for sexual activity with higher rates for young people from poorer homes, with lower social class, and with younger, less educated mothers. In contrast, among 860 young people who had had sexual intercourse, there was no clear evidence of associations between social factors and sexual readiness. The lack of social patterning in sexual readiness supports the provision of comprehensive education to develop life skills for adolescents across all social groups.

Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey.

OBJECTIVE To estimate chlamydia prevalence among 16-29-year-olds attending general practice clinics in Australia. DESIGN, PARTICIPANTS AND SETTING A cross-sectional survey was conducted from May 2010 to December 2012. Sexually experienced 16-29-year-olds were recruited from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics (consecutive patients were invited to participate). Participants completed a questionnaire and were tested for chlamydia. MAIN OUTCOME MEASURE Chlamydia prevalence. RESULTS Of 4284 participants, 197 tested positive for chlamydia (4.6%; 95% CI, 3.9%-5.3%). Prevalence was similar in men (5.2% [65/1257]; 95% CI, 3.9%-6.4%) and women (4.4% [132/3027]; 95% CI, 3.5%-5.2%) (P = 0.25) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI) - 17.0% in men (8/47; 95% CI, 2.8%-31.2%); 9.5% in women (16/169; 95% CI, 5.1%-13.8%). Nearly three-quarters of cases (73.4% [130/177]) were diagnosed in asymptomatic patients attending for non-sexual health reasons, and 83.8% of all participants (3258/3890) had attended for non-sexual health reasons. Prevalence was slightly higher in participants from rural and regional areas (4.8% [179/3724]; 95% CI, 4.0%-5.6%) than those from metropolitan areas (3.1% [17/548]; 95% CI, 1.5%-4.7%) (P = 0.08). In multivariable analysis, increasing partner numbers in previous 12 months (adjusted odds ratio [AOR] for three or more partners, 5.11 [95% CI, 2.35-11.08]), chlamydia diagnosis in previous 12 months (AOR, 4.35 [95% CI, 1.52-12.41]) and inconsistent condom use with most recent partner (AOR, 2.90 [95% CI, 1.31-6.40]) were significantly associated with chlamydia in men. In women, increasing partner numbers in previous 12 months (AOR for two partners, 2.59 [95% CI, 1.59-4.23]; AOR for three or more partners, 3.58 [95% CI, 2.26-5.68]), chlamydia diagnosis in previous 12 months (AOR, 3.13 [95% CI, 1.62-6.06]) and age (AOR for 25-29-year-olds, 0.23 [95% CI, 0.12-0.44]) were associated with chlamydia. CONCLUSIONS Chlamydia prevalence is similar in young men and women attending general practice. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas.

Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study

BACKGROUND The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationship are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms. METHODS We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N = 12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness. RESULTS Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p's < 0.05). All social relationship domains except marital status were independently associated with depressive symptoms whereas only loneliness and unmet support were associated with depressive disorder. CONCLUSIONS Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being.

Measuring Consumer Satisfaction in Family Preservation Services: Identifying Instrument Domains

Measuring consumer satisfaction in the social services has become an important source of feedback for the improvement of service delivery. Consumer satisfaction has recently been incorporated into family preservation evaluation. This article reviews instruments used to measure consumer satisfaction in family preservation services and other related areas. Trends in current practice are examined and instrument dimensions are identified. Finally, some recommendations are made about the application of consumer satisfaction measurement in family preservation services.

Social Meets Molecular: Combining Phylogenetic and Latent Class Analyses to Understand HIV-1 Transmission in Switzerland

Switzerland has a complex human immunodeficiency virus (HIV) epidemic involving several populations. We examined transmission of HIV type 1 (HIV-1) in a national cohort study. Latent class analysis was used to identify socioeconomic and behavioral groups among 6,027 patients enrolled in the Swiss HIV Cohort Study between 2000 and 2011. Phylogenetic analysis of sequence data, available for 4,013 patients, was used to identify transmission clusters. Concordance between sociobehavioral groups and transmission clusters was assessed in correlation and multiple correspondence analyses. A total of 2,696 patients were infected with subtype B, 203 with subtype C, 196 with subtype A, and 733 with recombinant subtypes (mainly CRF02_AG and CRF01_AE). Latent class analysis identified 8 patient groups. Most transmission clusters of subtype B were shared between groups of gay men (groups 1-3) or between the heterosexual groups "heterosexual people of lower socioeconomic position" (group 4) and "injection drug users" (group 8). Clusters linking homosexual and heterosexual groups were associated with "older heterosexual and gay people on welfare" (group 5). "Migrant women in heterosexual partnerships" (group 6) and "heterosexual migrants on welfare" (group 7) shared non-B clusters with groups 4 and 5. Combining approaches from social and molecular epidemiology can provide insights into HIV-1 transmission and inform the design of prevention strategies.

The strength of badenya ties: siblings and social security in old age – the case of urban Burkina Faso

In urban Burkina Faso, siblings play a decisive role in local social security. Badenya, the unity of children of the same mother, compensates in particular for the economic failure of an eldest son no longer in a position to fulfill his familial duties. Although the institution of badenya is strengthened as it increasingly comes into play to help a family avoid social marginalization, it is also overburdened, which makes its future uncertain. This article enhances the anthropological understanding of kinship by focusing on sibling relationships. Findings are based on interviews conducted between 2007 and 2010 with two generations in households in Bobo-Dioulasso and on participant-observation over the course of more than a dozen research stays since 1989.

Cultural capital and smoking in young adults: applying new indicators to explore social inequalities in health behaviour.

BACKGROUND Associations between social status and health behaviours are well documented, but the mechanisms involved are less understood. Cultural capital theory may contribute to a better understanding by expanding the scope of inequality indicators to include individuals' knowledge, skills, beliefs and material goods to examine how these indicators impact individuals' health lifestyles. We explore the structure and applicability of a set of cultural capital indicators in the empirical exploration of smoking behaviour among young male adults. METHODS We analysed data from the Swiss Federal Survey of Adolescents (CH-X) 2010-11 panel of young Swiss males (n = 10 736). A set of nine theoretically relevant variables (including incorporated, institutionalized and objectified cultural capital) were investigated using exploratory factor analysis. Regression models were run to observe the association between factor scores and smoking outcomes. Outcome measures consisted of daily smoking status and the number of cigarettes smoked by daily smokers. RESULTS Cultural capital indicators aggregated in a three-factor solution representing 'health values', 'education and knowledge' and 'family resources'. Each factor score predicted the smoking outcomes. In young males, scoring low on health values, education and knowledge and family resources was associated with a higher risk of being a daily smoker and of smoking more cigarettes daily. CONCLUSION Cultural capital measures that include, but go beyond, educational attainment can improve prediction models of smoking in young male adults. New measures of cultural capital may thus contribute to our understanding of the social status-based resources that individuals can use towards health behaviours.

The Social Geography of Education: Neighborhood, Class Composition, and the Educational Achievement of Elementary School Students in Zurich, Switzerland

Despite an impressive amount of research and policy intervention no robust pattern of neighborhood effects on educational attainment has previously been identified. Adequate theoretical modeling and the sensitivity of the results to the method of the study are the major challenges in this area of research. This paper elaborates the social mechanisms of neighborhood effects and applies various methodological approaches to test them. Using data from Switzerland, the research reported here has detected heterogeneous effects of neighborhood on elementary school students’ educational achievement in Zurich. Although modest in comparison with the effects of classroom composition, these effects appear to be mediated primarily through social integration into a local peer network and are differentiated according to students’ gender and their social origin.

Racing against Time: Varying Patterns of Social Mobilization in Serbia and Georgia

After the collapse of the Soviet Union and Yugoslavia, a number of actors started to engage in the power struggle for the opportunities to shape the new order in successive nation-states. In Serbia and Georgia historically hegemonic Orthodox Christian churches were among the firsts in the frontlines for political and economic power. More than a decade has passed since the so-called Coloured Revolutions in Georgia and Serbia, and the Orthodox churches still remain participants of an ongoing socio-political transition of these states. The revival of public role of religion appeared temporary in Serbia followed by a gradual decline of an influence of the Orthodox Church over political life and legal process. However, in Georgia the public and political role of religion increased rather than declined albeit changed shape. Examining the degree to which the two Orthodox churches can influence the political agenda in Serbia and Georgia, the paper attempts to understand how church-State relations work in practice. By bringing rich empirical data from the field (70 interviews with (arch)bishops, priests and religious clerics in Georgia and Serbia added to field observations), the paper reflects on the themes under which the two Orthodox churches mobilize public protest in Serbia and Georgia. The paper further looks at varying State responses and their broader implication for church-state problematique.

The American Myth of Markets in Social Policy: Ideological Roots of Inequality

The American Myth of Markets in Social Policy examines how implementing American tropes in policy design inadvertently frustrates policy goals. It investigates multiple market-oriented designs including funding for private organizations to deliver public services, funding for individuals to buy services, and policies incentivizing or mandating private actors to provide social policy. The author shows that these solutions often not only fail to achieve social goals, but, in fact, actively undermine them, for example saddling the poor with debt or encouraging discrimination. The book carefully details the mechanisms through which this occurs, for example a mismatch between program goals and either contract terms or individual preferences. The author examines several policies in depth, covering universal social insurance programs like healthcare and pensions, as well as smaller interventions like programs for the homeless. The author builds the argument using detailed empirical evidence as well as anecdote, keeping the book accessible and entertaining.

Managing social policy under federalism: The challenges of hybrid funding and program delivery

This paper discusses generally the question of the level of government that should be used to administer different social policies. The chapter focuses on the Medicaid program, looking at recent state-level changes in health insurance for the poor and long-term care policy. Particular attention will be paid to the question of how states have used their new freedoms to outsource public insurance to the private sector and on the consequent differences in outcomes across states. Notably, this paper will be drawn from my forthcoming book “The American Myth of Markets in Social Policy” (Palgrave, MacMillan, November, 2015).

Relações entre família, políticas de assistência social e vulnerabilidade social: um estudo a partir de entrevistas com mulheres usuárias do SUAS

A centralidade na família é uma das principais diretrizes adotadas pela Política Nacional de Assistência Social (PNAS) implementada por meio do Sistema Único de Assistência Social (SUAS). A noção de matricialidade sociofamiliar configura-se como base para a formulação de serviços específicos de abordagem familiar nos níveis de proteção social básica e especial, que visam o acompanhamento longitudinal de famílias em situação de vulnerabilidade social, definida neste contexto pela condição de desvantagem em decorrência da pobreza, da privação de renda e de acesso aos serviços e bens públicos, da fragilização de vínculos afetivos, relacionais e de pertencimento. Objetivou-se com esse estudo identificar como as mulheres usuárias do SUAS percebiam e definiam as vulnerabilidades do próprio núcleo familiar, assim como verificar se a concepção de vulnerabilidade social proposta pela PNAS é condizente com as problemáticas apresentadas pelas famílias usuárias do SUAS. A pesquisa qualitativa foi executada por meio de entrevistas de longa duração com temas advindos da observação participante realizada ao longo de três anos de acompanhamento de mulheres usuárias do SUAS por meio de abordagem grupal em serviço de Assistência Social do bairro do Butantã na cidade de São Paulo. Participaram do estudo oito mulheres, acima de 18 anos, usuárias do SUAS e residentes da zona oeste de São Paulo. As depoentes têm entre 35 e 51 anos de idade, estudaram entre a 5ª e a 8ª série do Ensino Fundamental II, cinco delas são migrantes, quatro vivem com os companheiros e filhos e quatro residem com os filhos em uma organização familiar monoparental, três são beneficiárias da Previdência Social, duas estão inseridas em trabalhos formais, duas em trabalhos informais e uma não trabalha. Todas relataram ter sofrido episódios de violência e violação de direitos, principalmente observados na dificuldade de acesso a serviços sociais básicos. Os depoimentos marcaram dificuldades experimentadas ao longo da vida das mulheres e a tônica dos relatos destacou as preocupações atreladas ao papel de mãe e à luta cotidiana que enfrentam para educar, orientar, sustentar e estar junto aos filhos, sobretudo daqueles que se encontram na fase da infância e da adolescência. À luz da noção de enraizamento, proposta por Simone Weil, foi possível identificar que as depoentes apresentam e enfrentam cotidianamente dificuldades ligadas ao desenraizamento urbano, elucidado especialmente na carência de participação comunitária e política. Nesse cenário, a condição de vulnerabilidade pela qual as famílias são definidas no âmbito da política de assistência social, revela certa ambiguidade, pois ao mesmo tempo em que permite oferecer a essas famílias alguma modalidade de apoio também as coloca numa posição estigmatizada de beneficiárias das políticas públicas. Com isso, considerou-se que apesar da concepção de vulnerabilidade proposta pela PNAS ser condizente com as problemáticas apresentadas pelas usuárias, verifica-se uma lacuna em relação à dimensão subjetiva da formação de cada grupo familiar e suas necessidades específicas a fim de apoiá-los para a promoção de uma mudança efetiva

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.