Social pathways to health_ On the mediating role of the social network in the relation between socio-economic position and health
مسیرهای اجتماعی برای سلامتی. بر نقش میانجیگری شبکه اجتماعی در رابطه بین موقعیت اجتماعی و اقتصادی و سلامت-2017
Good health is one of the key qualities of life, but opportunities to be and remain healthy are unequally distributed across socio-economic groups. The beneficial health effects of the social network are well known. However, research on the social network as potential mediator in the pathway from socio-economic position (SEP) to health is scarce, while there are good reasons to expect a socio-economical patterning of networks. We aim to contribute to our understanding of socio-economic inequalities in health by examining the mediating role of structural and functional characteristics of the social network in the SEP-health relationship. Data were from the second wave of the Norwegian study on the life course, aging and generation study (NorLAG) and comprised 4534 men and 4690 women aged between 40 and 81. We applied multiple mediation models to evaluate the relative importance of each network characteristic, and multiple group analysis to examine differences between middle-aged and older men and women. Our results indicated a clear socio-economical patterning of the social network for men and women. People with higher SEP had social networks that better protect against loneliness, which in turn lead to better health outcomes. The explained variance in health in older people by the social network and SEP was only half of the explained variance observed in middle-aged people, suggesting that other factors than SEP were more important for health when people age. We conclude that it is the function of the network, rather than the structure, that counts for health.
Keywords: Socio-economic position | Social networks | Multiple mediation | Older adults |Health inequalities
Genitourinary paraganglioma: Demographic, pathologic, and clinical characteristics in the surveillance, epidemiology, and end results database (2000–2012)
پاراژنگلیوم تناسلی: مشخصات دموگرافیک، پاتولوژیک و بالینی در نظارت، اپیدمیولوژی و پایگاه داده نتایج (2000-2012)-2017
Background: Extra-adrenal paragangliomas (PGLs) are infrequent, benign, and neuroendocrine tumors arising from chromafﬁn cells of the autonomic nervous system. Most PGLs are sporadic, but up to 32% are associated with inherited syndromes such as neuroﬁbromatosis type 1, von Hippel-Lindau disease, and familial PGL. Although most PGLs develop above the umbilicus, they have been reported in the genitourinary (GU) tract. Owing to the paucity of literature on the rates of GU PGL, the objective of our study is to describe the demographic, pathologic, and clinical characteristics of GU PGL, and compare them to non-GU sites of PGL using the surveillance, epidemiology, and end results (SEER) database.Methods: The SEER 18 database was used to identify all cases of PGL from 2000 to 2012. Demographic, pathologic, and clinical characteristics were described using chi-square and t-test for categorical and continuous variables, respectively. The Kaplan-Meier method was used to compare overall survival (OS) between GU and non-GU PGL. Statistical signiﬁcance was deﬁned as P o 0.05. All analyses were performed using excel and SAS/Stat version 9.4.Results: A total of 299 cases of PGL were retrieved from SEER, and 20 (6.7%) of the total PGL arose from the GU tract. The mean age at diagnosis was higher in non-GU than GU PGL (50.4 ± 17.2 vs. 40.8 ± 15.6, P ¼ 0.026). Furthermore, 75% of GU PGLs developed in the bladder, followed by the kidneys/renal pelvis, and spermatic cord (20%). Non-GU PGL developed most frequently within the endocrine system (43%). PGL, overall, was more common in men than in women, and it was more common in whites than all other races. Although 55.5% of GU PGLs were organ conﬁned, only 22.2% of non-GU PGLs were localized at diagnosis. All cases of PGL were treated with surgery. There were 2 cause-speciﬁc deaths in the GU PGL groups between 2000 and 2012. The 5-year OS was 93.3% for GU PGL vs. 65.5% in non-GU PGL (P ¼ 0.062).Conclusions: GU PGL remains rare with low incidence (6.7% of all PGL cases) in the US population between 2000 and 2012. Bladder PGL represents just 5% of all PGL. Moreover, GU PGL had better OS compared to PGL developing outside of the GU tract although the P-value only approached statistical signiﬁcance. The bladder represents the most common site of involvement, and surgery is the mainstay of treatment for GU PGL. Clearer prognostic factors, including tumor grade and stage, are needed to better elucidate PGL management in the future; thus, pooled studies from various institutions with detailed clinical information are needed to delineate these prognostic factors. r 2017 Elsevier Inc. All rights reserved.
Self-efficacy, stress, and locus of control: The psychology of earthquake risk perception in Bucharest, Romania
خودکارامدی ، استرس ، و مکان کنترل : روانشناسی درک خطر زلزله در بوخارست و رومانی-2017
This research explores the way three distinct psychological determinants shape seismic risk perceptions. We surveyed over 1300 persons in the city and measured the way locus of control, self-efficacy, and stress vulnerability relate to risk perception and various socio-demographic indicators. We found that self-efficacy varies with gender, whether people live in a house or a block of flats, and previous earthquake training. Stress has a spatial component to it as various areas of the city show different stress levels. Socio-demographics also leave their mark, as women, people over 50 years of age, and those with declared lower incomes, score higher in stress vulnerability. Locus of control varies with age and gender, with men and the young most confident in their ability to control events. Those who do worry also have more trust in various entities that might help, such as the Fire Department, Charities, or Government. Interestingly, both the extent to which people worry and their perceived earthquake preparedness correlate with all three psychological dimensions measured. Since these modifiable psychological dimensions shape operant behaviours, such as disaster related ones, we discuss avenues for their improvement and increased adaptability.
Keywords: Bucharest | Disaster risk reduction | Earthquake risk perception | Locus of control | Self-efficacy | Stress
General and emotion-specific alterations to cognitive control in women with a history of childhood abuse
تغییرات کلی و عاطفی خاص در کنترل شناختی در زنان با سابقه سوء استفاده از دوران کودکی-2017
Background: Although limited, the literature suggests alterations in activation of cognitive control regions in adults and adolescents with a history of childhood abuse. The current study examined whether such alterations are increased in the face of emotionally-distracting as compared to emotionally neutral information, and whe ther such alterations occur in brain regions that exert cognitive control in a more top-down sustained manner or a more bottom-up transient manner. Methods: Participants were young adult women (ages 23–30): one group with a history of childhood physical or sexual abuse (N = 15) and one with no trauma exposure (N = 17), as assessed through the Trauma History Questionnaire and a two-stage interview adapted from the National Crime Victims Survey. Participants un derwent fMRI scanning while completing hybrid block/event-related versions of a classic color-word and an emotional Stroop paradigm (threat and positive words). This paradigm allowed us to examine both sustained (activation persisting across blocks) and transient (event-specific activation) aspects of cognitive control. Results: Women with a history of childhood abuse demonstrated decreased recruitment of frontal-parietal re gions involved in cognitive control and enhanced recruitment of a ventral attention surveillance network during blocks of both versions of the Stroop task. Additionally, they had less suppression of brain regions involved in self-referential processes for threat blocks, but greater suppression of these regions for positive blocks. Severity of avoidance symptoms was associated with sustained activation in lateral prefrontal regions, whereas hyper arousal/re-experiencing symptoms were associated with sustained activity in temporal regions. No differential effects were observed for transient control. Conclusions: Results suggest exposure to childhood abuse is associated with blunted recruitment of brain regions supporting task-set maintenance but hypervigilance for task-irrelevant information, regardless of whether dis tractors are emotionally neutral or emotional. Exposure to childhood abuse is also associated with less sup pression of default mode brain regions associated with self-referential processing in the face of irrelevant threat information, but heightened ability to suppress similar processing for irrelevant positive information.
Keywords: Childhood abuse | Maltreatment | Trauma | fMRI | Inhibition | Cognitive control
Health marketing in an emerging market: The critical role of signaling theory in breast cancer awareness
بازاریابی بهداشتی در یک بازار در حال ظهور: نقش حیاتی نظریه سیگنالینگ در آگاهی سرطان پستان-2017
In India, breast cancer is the most commonly diagnosed type of cancer among women in cities and urban areas, yet women seek medical care extremely late due to lack of awareness about self-examination. This study explores the health marketing literature via signaling theory, to uncover the unique social, economic, cultural and in stitutional challenges and opportunities faced by health marketers and consumers in breast cancer awareness (BCA) in an emerging economy – India. An interpretive-inductive method, alongside a grounded theory ap proach via focus groups with medical professionals and interviews with women is employed. Findings reveal complex challenges at national, state and community levels which impact negatively on the reputation of Indias health sector. Social marketing strategies could be leveraged to raise BCA via community health activists. Propositions are suggested and a conceptual framework is developed to assist health marketers to manage BCA in an emerging economy.
Keywords: Health marketing | Breast cancer awareness | Signaling theory | India | Emerging economy
Clinically relevant potential drug-drug interactions among outpatients: A nationwide database study
تعاملات بالقوه دارو-دارو در میان بیماران سرپایی بالینی: یک مطالعه پایگاه داده در سراسر کشور-2017
Background: Adverse drug events due to drug-drug interactions (DDIs) represent a considerable public health burden, also in Slovenia. A better understanding of the most frequently occurring potential DDIs may enable safer pharmacotherapy and minimize drug-related problems. Objectives: The aim of this study was to evaluate the prevalence and predictors of potential DDIs among outpatients in Slovenia. Methods: An analysis of potential DDIs was performed using health claims data on prescription drugs from a nationwide database. The Lexi-Interact Module was used as the reference source of interactions. The influence of patient-specific predictors on the risk of potential clinically relevant DDIs was evaluated using logistic regression model. Results: The study population included 1,179,803 outpatients who received 15,811,979 prescriptions. The total number of potential DDI cases identified was 3,974,994, of which 15.6% were potentially clinically relevant. Altogether, 9.3% (N ¼ 191,213) of the total population in Slovenia is exposed to clinically relevant potential DDIs, and the proportion is higher among women and the elderly. After adjustment for cofactors, higher number of medications and older age are associated with higher odds of clinically relevant potential DDIs. The burden of DDIs is highest with drug combinations that increase risk of bleeding, enhance CNS depression or anticholinergic effects or cause cardiovascular complications. Conclusion: The current study revealed that 1 in 10 individuals in the total Slovenian population is exposed to clinically relevant potential DDIs yearly. Taking into account the literature based conservative estimate that approximately 1% of potential DDIs result in negative health outcomes, roughly 1800 in dividuals in Slovenia experience an adverse health outcome each year as a result of clinically relevant potential interactions alone.
Keywords: Potential drug-drug interactions | Outpatients | Database research | Health claims data | Drug related problems
Why is it a mans world, after all? Women on bank boards in India
پس چرا دنیای مرد، بعد از همه؟ زنان در هیئت مدیره بانک در هند-2017
Employing information on all publicly listed Indian banks covering the period 2003–2012, the study explores whether gender diversity impacts bank behaviour. The evidence suggests that the value addition to banks from the induction of women on their boards of directors is not compelling, although executive women directors enhance bank stability. Looking across ownership, the evidence suggests that gender diversity in state-owned banks enhances stability, but at the cost of lower profitability.
Keywords: Gender diversity | Banking | Ownership | India
Female tourism entrepreneurs in Bali, Indonesia
کارآفرینان گردشگری زن در بالی، اندونزی-2017
Bali is one of the most popular islands in Indonesia for tourism due to its beaches, nightlife and religious sites. Female tourism entrepreneurs are a growing segment of the hospitality industry in Bali due to their involvement in food stalls and small restaurants. This paper will focus on the strategic decisions of female Balinese tourism entrepreneurs by utilizing a purposeful sampling method in which in-depth interviews were carried out over a six-month period. Meaning units (MUs) were abstracted, which were compared and discussed with the interviewees until a basic agreement of terms could be made. Using in depth interviews and other supplemental evidence, this trend was examined in order to explore how women were influenced by environmental factors, in additional to their culture and heritage. The findings from this paper will help other tourism entrepreneurs how to develop their businesses using limited resources and financial capital but also provide suggestions about how female entrepreneurs can succeed in the globally competitive tourism industry.
Keywords: Bali Female entrepreneur | Hospitality | Indonesia | Small business | Tourism
Characteristics and social impact of the use of social media by Chinese Dama
خصوصیات و تاثیر اجتماعی استفاده از رسانه های اجتماعی توسط دیم چینی-2017
Against the backdrop of broader social changes, social media has developed rapidly in China, which has pushed the transition of the media environment from a traditional authority-dominated one to a modern media society. In particular, the use of social media by Chinese Dama can be perceived as an exemplar of media-driven social change. ‘Chinese Dama’ is a buzzword coined in tandem with the development of social media since 2013. This term represents a particular group of middle-aged Chinese women who reflect a dis tinctive social phenomenon in China. It is noteworthy that a growing number of Chinese Dama are learning to use social media and have established thousands of social media communities, exerting significant influence on the wider media and social environment. This study focuses on the major changes undergone by Dama, transitioning from being pas sively covered by media to becoming active users of social media, and this research ana lyzes the motivations and hallmarks of their social media activity. Although the use of social media by Chinese Dama, the traditional nucleus of Chinese society, has contributed to narrowing the digital divide and resulted in the Dama’s gaining more discourse power and ushered in new diverse lifestyles, we argue that the Dama also exert a far-reaching positive and negative influence on society, pushing for the modernization transformation of the Chinese society.
Keywords: Chinese Dama | Social media | Social change | Discourse power | Digital divide | Life style
Time, terrain and trust: Impacts of rurality on case management in rural Australia
زمان، زمین و اعتماد: اثرات روستایی در مدیریت پرونده روستای استرالیا-2017
There is a ‘black hole’ in our understanding of case management practice with earlier studies identifying this as a particular concern for rural contexts. Using grounded theory methodology, focus groups were conducted with Australian rural case managers to understand how the rural context impacts on the provision of case management services. Findings identified behaviours associated with lengthy rural travel, stemming from a demand for constant output; lack of familiarity with the rural landscape combined with the loss of mobile communication, led to early feelings of trepidation for some women accessing rural spaces; lastly, building inter-agency relationships are critical to successful collaborative work, yet are threatened by lack of trust and frequent turnover of rural programs. Further exploration of these themes, in the international context, would be of benefit.
Keywords: Case management | Rural | Grounded theory | Focus groups