Debbi Stanistreet

Gender, health inequalities and welfare state regimes: a cross-national study of 13 European countries

Background: This study is the first to examine the relationship between gender and self-assessed health (SAH), and the extent to which this varies by socioeconomic position in different European welfare state regimes (Liberal, Corporatist, Social Democratic, Southern). Methods: The EUROTHINE harmonised data set (based on representative cross-sectional national health surveys conducted between 1998 and 2004) was used to analyse SAH differences by gender and socioeconomic position (educational rank) in different welfare states. The sample sizes ranged from 7124 (Germany) to 118 245 (Italy) and concerned the adult population (aged ⩾16 years). Results: Logistic regression analysis (adjusting for age) identified significant gender differences in SAH in nine European welfare states. In the UK (OR 0.88; 95% CI 0.78 to 0.99) and Finland (OR 0.85; 95% CI 0.77 to 0.95), men were significantly more likely to report “bad” or “very bad” health. In Denmark, Sweden, Norway, Holland, Italy, Spain and Portugal, a significantly higher proportion of women than men reported that their health was “bad” or “very bad”. The increased risk of poor SAH experienced by women from these countries ranged from a 23% increase in Denmark (OR 1.23; 95% CI 1.08 to 1.39) to more than a twofold increase in Portugal (OR 2.01; 95% CI 1.87 to 2.15). For some countries (Italy, Portugal, Sweden), women’s relatively worse SAH tended to be most prominent in the group with the highest level of education. Discussion: Women in the Social Democratic and Southern welfare states were more likely to report worse SAH than men. In the Corporatist countries, there were no gender differences in SAH. There was no consistent welfare state regime patterning for gender differences in SAH by socioeconomic position. These findings constitute a challenge to regime theory and comparative social epidemiology to engage more with issues of gender.

Enablers and barriers to large-scale uptake of improved solid fuel stoves: a systematic review.

Background: Globally, 2.8 billion people rely on household solid fuels. Reducing the resulting adverse health, environmental, and development consequences will involve transitioning through a mix of clean fuels and improved solid fuel stoves (IS) of demonstrable effectiveness. To date, achieving uptake of IS has presented significant challenges. Objectives: We performed a systematic review of factors that enable or limit large-scale uptake of IS in low- and middle-income countries. Methods: We conducted systematic searches through multidisciplinary databases, specialist websites, and consulting experts. The review drew on qualitative, quantitative, and case studies and used standardized methods for screening, data extraction, critical appraisal, and synthesis. We summarized our findings as “factors” relating to one of seven domains—fuel and technology characteristics; household and setting characteristics; knowledge and perceptions; finance, tax, and subsidy aspects; market development; regulation, legislation, and standards; programmatic and policy mechanisms—and also recorded issues that impacted equity. Results: We identified 31 factors influencing uptake from 57 studies conducted in Asia, Africa, and Latin America. All domains matter. Although factors such as offering technologies that meet household needs and save fuel, user training and support, effective financing, and facilitative government action appear to be critical, none guarantee success: All factors can be influential, depending on context. The nature of available evidence did not permit further prioritization. Conclusions: Achieving adoption and sustained use of IS at a large scale requires that all factors, spanning household/community and program/societal levels, be assessed and supported by policy. We propose a planning tool that would aid this process and suggest further research to incorporate an evaluation of effectiveness. Citation: Rehfuess EA, Puzzolo E, Stanistreet D, Pope D, Bruce NG. 2014. Enablers and barriers to large-scale uptake of improved solid fuel stoves: a systematic review. Environ Health Perspect 122:120–130; http://dx.doi.org/10.1289/ehp.1306639

General health mediates the relationship between loneliness, life satisfaction and depression. A study with Malaysian medical students.

ObjectiveTo examine the associations between life satisfaction, loneliness, general health and depression among 172 medical students in Malaysia.MethodParticipants completed a questionnaire battery, which included the 12-item General Health Questionnaire, Beck’s Depression Inventory, the Revised UCLA Loneliness Scale and the Satisfaction With Life Scale.ResultsLife satisfaction was negatively and significantly correlated with suicidal attitudes, loneliness and depression; and positively with health, which was negatively and significantly correlated with depression and loneliness. Self-concept was negatively correlated with loneliness and depression, depression was positively and significantly correlated with loneliness. Mediational analyses showed that the effects of loneliness and life dissatisfaction on depression were fully mediated by health.ConclusionEven though less satisfied, and particularly lonelier, individuals are more likely to report higher levels of depression, this is only the case because both higher loneliness and life dissatisfaction are associated with poorer health. These results are discussed in terms of their implications for the diagnosis and treatment of mental health disorders in developing nations.

Is patriarchy the source of men’s higher mortality?

Objective: To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries. Hypothesis: High levels of patriarchy in a society are associated with increased mortality among men. Design: Cross sectional ecological study design. Setting: 51 countries from four continents were represented in the data—America, Europe, Australasia, and Asia. No data were available for Africa. Results: A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson’s r = 0.699 and Spearman’s 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men. Conclusion: These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men’s higher mortality is a preventable social condition, which could be tackled through global social policy measures.

Accident or suicide? Predictors of Coroners' decisions in suicide and accident verdicts

Objective To examine the factors used by Coroners to distinguish between suicide and accidental death among young men in Merseyside and Cheshire. Design Retrospective epidemiological survey of deaths due to external causes. Data sources included Coroners Inquest, GP and hospital data. Logistic regression was carried out to determine the multiple effect of individual factors on defining Coroners verdict. Setting Merseyside and Cheshire, United Kingdom. Subjects Males aged 15–39 years who died from unnatural causes during 1995 in Merseyside and Cheshire. Main outcome measure Coroners verdict. Results An active mode of death was by far the strongest predictor of a suicide as opposed to an accident verdict. Other significant differentiating factors included expressed intent, behavioural change, deliberate self-harm and psychiatric contact. Conclusion The validity of using method of death as a predictor of intent is questionable. Evidence left by drug users who kill themselves may differ from that left by non-drug users and may need to be sought in less conventional ways. There may be a discrepancy between those factors deemed important by health professionals as indicators of suicide, such as deliberate self-harm, and those given most weight by the Coroner. It may be more pragmatic, in terms of public health policy development, to challenge the concept that self-destructive behaviour can be categorized as being either intentional or unintentional. There is some evidence suggesting that deaths due to suicide and accidents both result from elements of self-destructive behaviour and therefore, the practice of categorizing deaths as either suicides or accidents could be misleading.

Quantitative Methods for Health Research

Quantitative methods for health research , Quantitative methods for health research , کتابخانه دیجیتال جندی شاپور اهواز

'If Michael Owen drinks it, why can't I?' - 9 and 10 year olds' perceptions of physical activity and healthy eating

Objective To explore the perceptions of physical activity and healthy eating among children from two north west of England primary schools, with the ultimate aim of improving healthy lifestyle choices. Design A qualitative study in which each child participated in two focus groups. Setting Two primary schools in a deprived ward of Warrington, chosen to contrast with the focus of earlier research on relatively affluent communities. Method A sample of 32 9 and 10 year olds was randomly selected from two Year 5 classes. Four focus groups were held in total; two in each school. The first explored perceptions of physical activity and the second examined views on food and eating. Discussions were recorded, transcribed verbatim and findings emerged through a process of thematic analysis. Results Children reported being involved in a range of physical activities and recognized the health benefits associated with being active. Boys and girls differed in their attitude towards physical activity, with boys appearing competitive about sport while girls enjoyed a wider range of activities. Children were able to distinguish between healthy and unhealthy foods, but there was uncertainty over the healthiness of foods containing multiple ingredients (for example, salad in burgers). Children also identified the impact of the local environment, parents, school, the food industry and their peers on their diet and involvement in physical activity. Conclusions Children receive contradictory messages about food and diet, which they make sense of through their social interactions. The development of obesity prevention strategies and weight management programmes must take into account childrens perspectives. Children should be given the opportunity to contribute to the development of initiatives that are set up to prevent and treat obesity.

Clean fuels for resource-poor settings: A systematic review of barriers and enablers to adoption and sustained use

BACKGROUND Access to, and sustained adoption of, clean household fuels at scale remains an aspirational goal to achieve sufficient reductions in household air pollution (HAP) in order to impact on the substantial global health burden caused by reliance on solid fuels. AIM AND OBJECTIVES To systematically appraise the current evidence base to identify: (i) which factors enable or limit adoption and sustained use of clean fuels (namely liquefied petroleum gas (LPG), biogas, solar cooking and alcohol fuels) in low- and middle-income countries; (ii) lessons learnt concerning equitable scaling-up of programmes of cleaner cooking fuels in relation to poverty, urban-rural settings and gender. METHODS A mixed-methods systematic review was conducted using established review methodology and extensive searches of published and grey literature sources. Data extraction and quality appraisal of quantitative, qualitative and case studies meeting inclusion criteria were conducted using standardised methods with reliability checking. FINDINGS Forty-four studies from Africa, Asia and Latin America met the inclusion criteria (17 on biogas, 12 on LPG, 9 on solar, 6 on alcohol fuels). A broad range of inter-related enabling and limiting factors were identified for all four types of intervention, operating across seven pre-specified domains (i.e. fuel and technology characteristics, household and setting characteristics, knowledge and perceptions, financial, tax and subsidy aspects, market development, regulation, legislation and standards, and programme and policy mechanisms) and multiple levels (i.e. household, community, national). All domains matter and the majority of factors are common to all clean fuels interventions reviewed although some are fuel and technology-specific. All factors should therefore be taken into account and carefully assessed during planning and implementation of any small- and large-scale initiative aiming at promoting clean fuels for household cooking. CONCLUSIONS Despite limitations in quantity and quality of the evidence this systematic review provides a useful starting point for the design, delivery and evaluation of programmes to ensure more effective adoption and use of LPG, biogas, alcohol fuels and solar cooking. FUNDING This review was funded by the Department for International Development (DfID) of the United Kingdom. The authors would also like to thank the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) for their technical support.

Women with learning disabilities and access to cervical screening: retrospective cohort study using case control methods

BackgroundSeveral studies in the UK have suggested that women with learning disabilities may be less likely to receive cervical screening tests and a previous local study in had found that GPs considered screening unnecessary for women with learning disabilities. This study set out to ascertain whether women with learning disabilities are more likely to be ceased from a cervical screening programme than women without; and to examine the reasons given for ceasing women with learning disabilities. It was carried out in Bury, Heywood-and-Middleton and Rochdale.MethodsCarried out using retrospective cohort study methods, women with learning disabilities were identified by Read code; and their cervical screening records were compared with the Call-and-Recall records of women without learning disabilities in order to examine their screening histories. Analysis was carried out using case-control methods – 1:2 (women with learning disabilities: women without learning disabilities), calculating odds ratios.Results267 womens records were compared with the records of 534 women without learning disabilities. Women with learning disabilities had an odds ratio (OR) of 0.48 (Confidence Interval (CI) 0.38 – 0.58; X2: 72.227; p.value <.001) of receiving a cervical screening test; an OR of 2.05 (CI 1.88 – 2.22; X2: 24.236; p.value <.001) of being ceased from screening; and an OR of 0.14 (CI 0.001 – 0.28; X2: 286.341; p.value <0.001 of being a non-responder compared to age and practice-matched women without learning disabilities.ConclusionThe reasons given for ceasing and/or not screening suggest that merely being coded as having a learning disability is not the sole reason for these actions. There are training needs among smear takers regarding appropriate reasons not to screen and providing screening for women with learning disabilities.

Hegemonic masculinity, structural violence and health inequalities

There is persuasive evidence that the reduction of health inequalities can only be achieved by addressing their fundamental causes as opposed to the diseases through which they are expressed or the immediate precursors of those diseases. This explains both the persistence of health inequalities over time and the failure of policies which only target their immediate manifestations to have any lasting impact. Fundamental causes of health inequalities are thought to include: inequalities in power, money, prestige, knowledge and beneficial social connections. The aim of this discussion is to consider the impact of hegemonic masculinity in determining unequal social and political relations which are deleterious to the health of both men and women on a global scale.