Individual factors and perceived community characteristics in relation to mental health and mental well-being

Background
It has been argued that though correlated with mental health, mental well-being is a distinct entity. Despite the wealth of literature on mental health, less is known about mental well-being. Mental health is something experienced by individuals, whereas mental well-being can be assessed at the population level. Accordingly it is important to differentiate the individual and population level factors (environmental and social) that could be associated with mental health and well-being, and as people living in deprived areas have a higher prevalence of poor mental health, these relationships should be compared across different levels of neighbourhood deprivation.

Methods
A cross-sectional representative random sample of 1,209 adults from 62 Super Output Areas (SOAs) in Belfast, Northern Ireland (Feb 2010 – Jan 2011) were recruited in the PARC Study. Interview-administered questionnaires recorded data on socio-demographic characteristics, health-related behaviours, individual social capital, self-rated health, mental health (SF-8) and mental well-being (WEMWBS). Multi-variable linear regression analyses, with inclusion of clustering by SOAs, were used to explore the associations between individual and perceived community characteristics and mental health and mental well-being, and to investigate how these associations differed by the level of neighbourhood deprivation.

Results
Thirty-eight and 30 % of variability in the measures of mental well-being and mental health, respectively, could be explained by individual factors and the perceived community characteristics. In the total sample and stratified by neighbourhood deprivation, age, marital status and self-rated health were associated with both mental health and well-being, with the ‘social connections’ and local area satisfaction elements of social capital also emerging as explanatory variables. An increase of +1 in EQ-5D-3 L was associated with +1SD of the population mean in both mental health and well-being. Similarly, a change from ‘very dissatisfied’ to ‘very satisfied’ for local area satisfaction would result in +8.75 for mental well-being, but only in the more affluent of areas.

Conclusions
Self-rated health was associated with both mental health and mental well-being. Of the individual social capital explanatory variables, ‘social connections’ was more important for mental well-being. Although similarities in the explanatory variables of mental health and mental well-being exist, socio-ecological interventions designed to improve them may not have equivalent impacts in rich and poor neighbourhoods.

Socio-demographic correlates of physical activity of European adults: A cross-sectional study from the European Social Survey

ABSTRACT - Background: From a public health perspective, the study of socio-demographic factors related to physical activity is important in order to identify subgroups for intervention programs. Purpose: This study also aimed to identify the prevalence and the socio-demographic correlates related with the achievement of recommended physical activity levels. Methods: Using data from the European Social Survey round 6, physical activity and socio-demographic characteristics were collected from 39278 European adults (18271 men, 21006 women), aged 18-64 years, from 28 countries in 2012. Meeting physical activity guidelines was assessed using World Health Organization criteria. Results: 64.50% (63.36% men, 66.49% women) attained physical activity recommended levels. The likelihood of attaining physical activity recommendations was higher in age group of 55-64 years (men: OR=1.22, p<0.05; women: OR=1.66, p<0.001), among those who had completed high school (men: OR=1.28, p<0.01; women: OR=1.26, p<0.05), among those who lived in rural areas (men: OR=1.20, p<0.001; women: OR=1.10, p<0.05), and among those who had 3 or more people living at home (men: OR=1.40, p<0.001; women: OR=1.43, p<0.001). On the other hand, attaining physical activity recommendations was negatively associated with being unemployed (men: OR=0.70, p<0.001; women: OR=0.87, p<0.05), being a student (men: OR=0.56, p<0.001; women: OR=0.64, p<0.01), being a retired person (men: OR=0.86, p<0.05) and with having a higher household income (OR=0.80, p<0.001; women: OR=0.81, p<0.01). Conclusion: This research helped clarify that, as the promotion of physical activity is critical to sustain health and prevent disease, socio-demographic factors are important to consider when planning the increase of physical activity.

Enfermedad neonatal temprana por Streptococcus Agalactiae en un unidad de recién nacidos, factores de riesgo maternofetales asocaidos a severidad y mortalidad

la colonización materna por estreptococo del grupo B (SGB) en países en desarrollo es de 4-20%, 50% de sus hijos nacen colonizados y el 1-2% desarrollan enfermedad invasiva con alto riesgo de morbimortalidad y secuelas. La incidencia de infección es diez veces más alta en menores de 1500gramos. Objetivo: determinar los factores de riesgo maternofetales asociados a enfermedad severa y mortalidad neonatal por Streptococcus agalactidae en una unidad de recién nacidos. Materiales y Métodos: se realizó un estudio observacional analítico de cohorte histórica durante un periodo de 2 años. Se tomaron 11 (once) recién nacidos con cuadro clínico de enfermedad invasiva por SGB, con confirmación en ocho (8) casos con hemocultivos, un (1) caso con cultivo de líquido cefalorraquídeo y dos (2) con ambos. Quince (15) controles que correspondían a las madres colonizadas con recién nacidos asintomáticos y con cultivos negativos. Las características demográficas de los dos (2) grupos no mostraron diferencias significativas. Se calcularon frecuencias absolutas y relativas y se buscaron asociaciones mediante el cálculo del estadístico Chi2, se aceptaron valores de p < 0.05, bajo el programa SPSS 15.0 para Windows. Resultados: los factores maternos predictivos para enfermedad por SGB incluyeron, fiebre periparto mayor a 37.5 grados centígrados (p <0.05), corioamnionitis y ruptura de membranas mayor a 18 horas (p<0.05). Los factores de riesgo neonatal incluyeron prematurez (<37 semanas) y bajo peso al nacer(<2500 gramos) (p<0.05). La severidad de la enfermedad se valoró por la presencia de neumonía, meningitis o hemorragia pulmonar. Se encontró una mortalidad de 5(45%). Conclusiones: se encontró relación estadísticamente significativa entre la corioaminionitis materna, la ruptura de membranas mayor a 18 horas, la prematurez y el peso bajo al nacer con la severidad de la enfermedad y la mortalidad. La incidencia estimada de infección neonatal en la unidad de recién nacidos fue de 1,8 casos/1000 nacidos vivos y la de colonización materna fue de 4,3 casos/ 1000 maternas. Se deben realizar más estudios en el país para establecer la incidencia real de enfermedad neonatal por SGB y hacer investigación sobre la costoefectividad de las medidas de prevención.

Evaluación características operativas: ecografía 2D y Doppler color para diagnóstico de acretismo placentario, clínica universitaria colombia, bogotá.

La placenta ácreta es la implantación anómala de la placenta en la pared uterina. Se presenta en 0.9% de todos los embarazos; actualmente es una de las causas más importantes de morbimortalidad materna. Ecografía 2D y Doppler placentario son métodos diagnósticos de primera y segunda línea. Objetivo: Evaluar la utilidad diagnóstica de ecográfica 2D y Doppler color Placentario para diagnóstico de acretismo placentario en gestantes con factores de riesgo comparándolos con diagnóstico clínico e histopatológico; y determinar incidencia de acretismo placentario en población asistente a Clínica Universitaria Colombia. Metodología: Estudio de evaluación de tecnología diagnóstica. Entre Agosto a Noviembre de 2010 se incluyeron 53 gestantes entre 24 y 40 semanas de gestación con factores de riesgo para acretismo placentario. El desempeño diagnóstico de las pruebas se determinará por sensibilidad, especificidad, valores predictivos positivo y negativo. Las características demográficas de las pacientes y resultados neonatales se analizaron mediante proporción, media y rango. Resultados: Se determinó incidencia de acretismo placentario en 4,54% de las gestantes con presencia de factores de riesgo para esta patología. Los datos hasta el momento no nos permiten calcular valores de desempeño diagnóstico. Un caso termino en histerectomía por acretismo placentario. Conclusión: Con los datos preliminares registramos una incidencia de acretismo placentario de 1 en 22 pacientes. Revisión de literatura sustenta la necesidad de realización diagnostica prenatal que impacte en la morbimortalidad materna y fetal, haciendo necesario la evaluación diagnostica valida de herramientas como el Eco 2D y Doppler color en población a riesgo.

Evaluación características operativas : ecografía 2d y doppler color para diagnóstico de acretismo placentario, clínica universitaria Colombia, Bogotá

La placenta ácreta es la implantación anómala de la placenta en la pared uterina. Se presenta en 0.9% de todos los embarazos; actualmente es una de las causas más importantes de morbimortalidad materna. Ecografía 2D y Doppler placentario son métodos diagnósticos de primera y segunda línea. Objetivo: Evaluar la utilidad diagnóstica de ecográfica 2D y Doppler color Placentario para diagnóstico de acretismo placentario en gestantes con factores de riesgo comparándolos con diagnóstico clínico e histopatológico; y determinar incidencia de acretismo placentario en población asistente a Clínica Universitaria Colombia. Metodología: Estudio de evaluación de tecnología diagnóstica. Entre Agosto a octubre 2011 se incluyeron 137 gestantes entre 24 y 40 semanas de gestación con factores de riesgo para acretismo placentario. El desempeño diagnóstico de las pruebas se determinará por sensibilidad, especificidad, valores predictivos positivo y negativo. Las características demográficas de las pacientes y resultados neonatales se analizaron mediante proporción, media y rango. Resultados: En un grupo de 137 pacientes con factores de riesgo de acretismo placentario analizadas se obtuvo el dato de 119 en cuanto a la finalización del embarazo. Se observaron 4 casos con diagnóstico clínico e histopatológico de acretismo placentario, evidenciando una prevalencia del 2,9%. La ecografía 2D y Doppler en la detección de acretismo placentario con un nivel de confianza del 95%, presentaron sensibilidad del 100% (IC95% 87,5-100) y especificidad de 100% (IC95% 99,6-100). Conclusión: Con los datos analizados registramos una incidencia de acretismo placentario de 4 en 132 pacientes. Revisión de literatura sustenta la necesidad de realización diagnostica prenatal que impacte en la morbimortalidad materna y fetal, haciendo necesario la evaluación diagnostica valida de herramientas como el Eco 2D y Doppler color en población a riesgo.

Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community

Background: The paper reports the findings from a follow-up study of the factors that contribute to whether young people dropout or continue once-weekly psychotherapy at a voluntary sector psychotherapy service for young people aged 12 to 21 years. Method: The study uses data from an ongoing audit of the psychotherapy service that started in 1993; 882 young people were included in the study. Premature termination of treatment was defined as dropping out before the 21st session. Continuation in treatment was defined as remaining in therapy after 20 sessions. Measures and areas of interest used in the study include diagnostic measures, the Youth Self Report Form and Young Adult Self Report Form, demographic characteristics and treatment related information. Results: Young people who continued in treatment were more likely to be older, have anxieties about sexual and relationship issues and have higher scores on self-reported anxiety-depression. Young people who dropped out of treatment were more likely to be younger, have higher self-reported delinquency scores, have a diagnosis of hyperactivity-conduct disorder and be homeless. Conclusions: The study of treatment termination has demonstrated the value of service audit and has led to a significant change in clinical practice.

Attitudinal and demographic determinants of diet quality and implications for policy targeting

Background:  Poor diet quality is a major public health concern that has prompted governments to introduce a range of measures to promote healthy eating. For these measures to be effective, they should target segments of the population with messages relevant to their needs, aspirations and circumstances. The present study investigates the extent to which attitudes and constraints influence healthy eating, as well as how these vary by demographic characteristics of the UK population. It further considers how such information may be used in segmented diet and health policy messages. Methods:  A survey of 250 UK adults elicited information on conformity to dietary guidelines, attitudes towards healthy eating, constraints to healthy eating and demographic characteristics. Ordered logit regressions were estimated to determine the importance of attitudes and constraints in determining how closely respondents follow healthy eating guidelines. Further regressions explored the demographic characteristics associated with the attitudinal and constraint variables. Results:  People who attach high importance to their own health and appearance eat more healthily than those who do not. Risk-averse people and those able to resist temptation also eat more healthily. Shortage of time is considered an important barrier to healthy eating, although the cost of a healthy diet is not. These variables are associated with a number of demographic characteristics of the population; for example, young adults are more motivated to eat healthily by concerns over their appearance than their health. Conclusions:  The approach employed in the present study could be used to inform future healthy eating campaigns. For example, messages to encourage the young to eat more healthily could focus on the impact of diets on their appearance rather than health.

The relationship between entrepreneurial marketing and the characteristics of Thai hotels and their managers

Purpose – The purpose of this paper is to explore empirically whether there are meaningful relationships between key entrepreneurial marketing (EM) variables and the demographic characteristics of the organization and its manager. Design/methodology/approach – The data were gathered from a sample of 369 hotels from all regions of Thailand through the use of a postal survey. Several multiple regression models were used to test the relationships in the study. Interaction terms were added to some models to test the moderating effects of major demographic variables on various EM attributes. Findings – The study shows which types of hotels and which types of managers were associated with EM characteristics. The results indicate that demographic characteristics, such as age, size, location, experience, and gender, significantly explain sets of entrepreneurial marketing variables. It was found, for instance, that both a young hotel and a large hotel are positively associated with entrepreneurial marketing, while owner management is positively associated with market orientation and negatively associated with growth aspirations but has no significant relationship with entrepreneurial orientation. Originality/value – The paper provides a comprehensive overview of selected relationships between key EM dimensions in the existing literature. It is suggested that future research involves a more in-depth exploration of some of the relationships found in this study.

Customer characteristics, satisfaction, and repurchase intention

One area of services marketing which has remained relatively underdeveloped, is the nature of the relationship between customer satisfaction and loyalty, and the moderating influences on this relationship, despite the fact that loyalty is essential for service business survival (Reichheld, 1993). This paper reports research regarding the relationship between consumer satisfaction, repurchase intention, and demographic characteristics. A telephone survey was conducted of 500 city residents, focusing on their visitation of tourism special events. The study found support for the findings of some recent, non-Australian, non-services research studies, in that respondent demographics were found to moderate the relationship between satisfaction and repurchase behaviour (in this case, repurchase intention), in an Australian services context.

Multi-type maltreatment : relationships between familial characteristics, maltreatment and adjustment of children and adults

This thesis examines the nature, extent and impact of multiple forms of maltreatment (multi-type maltreatment) from within a developmental victimological framework. The interrelationships between sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence are assessed. The role of family variables in predicting maltreatment and the relative contribution of child maltreatment and family variables to adjustment are evaluated. Risk factors for multi-type maltreatment, and the relationship between multi-type maltreatment and adjustment are explored. The major theories of child development are reviewed. As well as exploring the relevance of developmental theories to understanding the impact of child maltreatment, factors influencing the emergence of child psychopathology are reviewed from a developmental psychopathology perspective. Ecological and developmental perspectives on how child maltreatment translates into the behavioural and emotional adjustment problems of children are integrated in the Child Maltreatment: Risk and Protection Model. After exploring some of the relevant conceptual issues, the literature on the prevalence and impact of each maltreatment type is reviewed, and the literature on multi-type maltreatment critiqued. Methodological and ethical concerns with the conduct of research in the field of child maltreatment using direct assessment of children led to the need for an instrument to assess parent perceptions of each of the types of abuse and neglect, as well as adult retrospective reports. Data are presented from two cross-sectional questionnaire-based studies using the Parent and Adult versions of the Family and Life Experiences Questionnaire which was designed to assess perceptions of children's experiences of sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence. Problems with the isolated focus of research on single forms of child maltreatment are addressed by the inclusion of each of these forms of child maltreatment within a single research design. Respondents for both studies were volunteers recruited from counselling agencies, medical, community health, child care and fitness centres and a first year psychology course. Parents (N=50) described their perceptions of primary school children's family characteristics, experiences of maltreatment and adjustment. Children's behavioural adjustment (internalising and externalising), sexual behaviours, emotions, self-esteem, gender identity, family adaptability and cohesion, parental traditionality, parental sexual punitiveness, interparental relationship satisfaction, and demographic characteristics are assessed in the study of Parents' perceptions. A large degree of overlap between the different types of abuse and neglect was found, with a high proportion of parents describing children's experiences of multiple forms of child maltreatment. Using both maltreatment and family characteristics to predict internalising behaviour problems, neglect and family cohesion were the only unique predictors. Family adaptability and cohesion were the only unique predictors of externalising behaviour problems. Physical and sexual abuse were not predicted from family characteristics; neglect was predicted, but no variables provided unique prediction. Unique predictors of psychological maltreatment were family cohesion, parental sexual punitiveness and divorce. Divorce was the only variable with significant unique prediction of the child witnessing family violence. Family background and family functioning were found to predict some forms of maltreatment, but to also be important factors mediating the adjustment of children, independent of maltreatment. The results are interpreted within an ecological framework, integrating risk factors for maltreatment with experiences of abuse and neglect and subsequent adjustment in childhood. Retrospective reports of adults' (N=175) own childhood family characteristics, experiences of maltreatment, and reports of their current adjustment are also studied. Included with the adult version of the FLEQ were the Trauma Symptom Checklist-40, Rosenberg's Self-esteem Scale, and the Family and Adaptability and Cohesion Evaluation Scale-II. Similar results were found in the in the Adult Study. As hypothesised, adult retrospective reports of the five different types of child maltreatment were found to be highly intercorrelated. Family characteristics predicted maltreatment and adjustment scores and discriminated between single and multi-type maltreatment. Maltreatment scores also predicted adult adjustment. As the number of maltreatment types increased, there was an increase in the number of adjustment problems reported. Alternate hypotheses regarding the possible operation of mediating and moderating processes in the relationships between family characteristics, maltreatment and the adjustment of adults were assessed. Finally, the results of these investigations are discussed and interpreted in the light of extant findings previously reviewed. Data from the two major empirical studies are used to demonstrate the overlap between different child maltreatment categories, and the extent and impact of multi-type maltreatment. The results show that children are vulnerable to more than one type of maltreatment. Individuals who experience a number of different forms of maltreatment had greater adjustment problems than those experiencing only one or two different types of abuse or neglect. Dysfunctional families place children at risk of child maltreatment. Negative family characteristics lead to adjustment problems in children and adults. The type of maltreatment having the most damaging effect on children was neglect, and in the long-term, sexual abuse. A multi-dimensional approach to prevention and intervention needs to be adopted, based on the co-morbidity of maltreatment types, and the likelihood of children experiencing further abuse or neglect of a different type. Dysfunctional family dynamics which place children at risk of multi-type maltreatment, and mediate the effects of maltreatment on adjustment, need to be specifically targeted with support and family intervention strategies. Risk-assessment measures used by Child Protection workers must include adequate knowledge of the inter-relationships between maltreatment types, and the particularly negative impact on adjustment of experiencing many forms of abuse or neglect. Suggestions for future clinical and research work in the area of child maltreatment are developed. The importance of assessing all forms of maltreatment when examining the relationships of maltreatment to adjustment is emphasised. It is recommended that prevention and intervention strategies acknowledge the interrelationships between maltreatment types.

Socio-economic and demographic variations in school lunch participation of French children aged 3-17 years

Objective: To assess school canteen attendance in a French nationally representative sample of children and to analyse its association with the socioeconomic and demographic characteristics of the children and their families.
Design: Data from the second French national cross-sectional food consumption survey (INCA2), performed in 2006–2007, were used. Information on usual weekly school canteen attendance was collected through a self-reported questionnaire, and demographic and socio-economic variables through a face-to-face questionnaire. The associations between school canteen attendance and the socio-economic and demographic variables were investigated by multivariate logistic regression analyses.
Setting: The INCA2 sample was representative of the children aged 3–17 years in France.
Subject: Analysis was performed on 1413 schoolchildren who completed the school canteen attendance questions.
Results: Some 65?6% of schoolchildren aged 3–17 years had school lunch at least once weekly. This rate of attendance was positively correlated with age. Whatever the school level, school canteen attendance was positively associated with the educational level of the caregiver/parent. In pre- and elementary-school children, enrolment at the school canteen was also higher when the caregiver/parent worked, or in single-parent families. In secondary-school children, school lunch participation decreased with children living in more densely populated areas and increased with the level of the household’s living standards.
Conclusions: School canteen attendance was positively associated with children’s socio-economic background. This could reduce the effectiveness of the forthcoming school meal composition regulations designed to improve the diet of children from deprived backgrounds, who are more likely to have unhealthy food habits.

Maternal correlates of preschool child eating behaviours and body mass index : a cross-sectional study

To the authors’ knowledge, this is the first study to evaluate maternal child feeding practices, maternal parenting characteristics and mother-child interactions as cross-sectional predictors of child eating and/or weight within the one sample. Maternal pressure for her child to eat was a significant positive correlate of fussiness and a negative correlate of enjoyment. Maternal parenting warmth was associated negatively with child BMIz, while mother-child dysfunctional interaction was associated positively with child BMIz. Our findings suggest that childhood obesity research may be better informed by evaluating not just what mothers do (feeding practices) but also how they parent (parenting behaviours and interactions with their child). Longitudinal studies are needed to identify causal influences of parenting on preschool child eating and weight.

Characteristics of utility cyclists in Queensland, Australia : an examination of the associations between individual, social and environmental factors and utility cycling

Background: Initiatives to promote utility cycling in countries like Australia and the US, which have low rates of utility cycling, may be more effective if they first target recreational cyclists. This study aimed to describe patterns of utility cycling and examine its correlates, among cyclists in Queensland, Australia.

Methods: An online survey was administered to adult members of a state-based cycling community and advocacy group (n=1813). The survey asked about demographic characteristics and cycling behavior, motivators and constraints. Utility cycling patterns were described, and logistic regression modeling was used to examine associations between utility cycling and other variables.

Results: Forty-seven percent of respondents reported utility cycling: most did so to commute (86%). Most journeys (83%) were >5 km. Being male, younger, employed full-time, or university-educated increased the likelihood of utility cycling (p<0.05). Perceiving cycling to be a cheap or a convenient form of transport were associated with utility cycling (p<0.05).

Conclusions: The moderate rate of utility cycling among recreational cyclists highlights a potential to promote utility cycling among this group. To increase utility cycling, strategies should target female and older recreational cyclists and focus on making cycling a cheap and convenient mode of transport.

Is demography destiny? Application of machine learning techniques to accurately predict population health outcomes from a minimal demographic dataset

For years, we have relied on population surveys to keep track of regional public health statistics, including the prevalence of non-communicable diseases. Because of the cost and limitations of such surveys, we often do not have the up-to-date data on health outcomes of a region. In this paper, we examined the feasibility of inferring regional health outcomes from socio-demographic data that are widely available and timely updated through national censuses and community surveys. Using data for 50 American states (excluding Washington DC) from 2007 to 2012, we constructed a machine-learning model to predict the prevalence of six non-communicable disease (NCD) outcomes (four NCDs and two major clinical risk factors), based on population socio-demographic characteristics from the American Community Survey. We found that regional prevalence estimates for non-communicable diseases can be reasonably predicted. The predictions were highly correlated with the observed data, in both the states included in the derivation model (median correlation 0.88) and those excluded from the development for use as a completely separated validation sample (median correlation 0.85), demonstrating that the model had sufficient external validity to make good predictions, based on demographics alone, for areas not included in the model development. This highlights both the utility of this sophisticated approach to model development, and the vital importance of simple socio-demographic characteristics as both indicators and determinants of chronic disease.