The relevance of a local cohort: the case for generalisability over representativeness

Eleonora Uphoff, Neil Small, Rosie McEachan and Kate Pickett

For some years, our research has been based in the city of Bradford in northern England. We are often asked to justify our research setting. There seems to be a concern that a cohort population that is not representative of the nation as a whole or of the ‘average person’ cannot produce valuable insights beyond its local setting.

While such concerns are not new, they now seem more present, perhaps due to the rise of Big Data or the increased sharing of and access to data from national surveys and cohorts. Do these reservations represent a push for representativeness and generalisability in epidemiology? If so, this might come at the expense of research aiming to paint a more detailed picture of population health.

Continue reading “The relevance of a local cohort: the case for generalisability over representativeness”

Smoke exposure in early life and Rheumatic Heart Disease

david-phillipsDavid Phillips

Rheumatic Heart Disease (RHD) is caused by a bacterial (streptococcal) throat infection acquired in childhood.  Although this type of infection is common and widespread, a small proportion of children so affected go on to develop an inflammatory condition that leads to scarring and narrowing of the heart valves and, in time, heart failure. Early on in the course of the disease the joints may be affected – hence the term “rheumatic”.

Still an important disease
At one time Rheumatic Heart Disease was common throughout the UK, Europe and the US; it was the most important cause of heart disease among young adults in Victorian Britain and probably caused the death of Mozart.  Although rare now in most developed countries, it remains an important public health problem in many low and middle income countries. The disease is widespread in the Middle East and Asia, and the the poor indigenous populations of some wealthy countries, for example among Australian Aboriginees and New Zealand Maoris. It is particularly prevalent in sub-Saharan Africa, where it is one of the commonest causes of heart disease, typically affecting children or young adults. There it carries a grim prognosis because of the lack of specialised treatment. Continue reading “Smoke exposure in early life and Rheumatic Heart Disease”

Did extending compulsory education in the 1950s improve cognitive and emotional outcomes?

Anton LagerLager_Anton_DSC_0051_SIR.jpg

Extending compulsory education from 8 to 9 years had a postive effect on intelligence in our large study of boys exposed to a school reform in Sweden in the 1950s. Extending education benefited sons of farmers and workers most, reducing socioeconomic differences in intelligence. In contrast, the reform seems to have led to reduced emotional control, suggesting that for this outcome alternative activities (e.g. working or attending the old lower secondary school) was better. Continue reading “Did extending compulsory education in the 1950s improve cognitive and emotional outcomes?”

Are We There Yet? Assessing the Burden of Travel on Maternal Health Care Utilization and Child Mortality in Developing Countries

Mahesh Karra, Günther Fink, David Canning

David Canning Guenther FinkMahesh Karra

 

The problem
Over the past two decades, low- and middle-income countries (LMICs) have made considerable progress towards reducing child mortality. In spite of these achievements, almost six million children under the age of five are estimated to have died in 2015. Many of these deaths could likely be avoided if high quality antenatal care and delivery at health facilities were available to mothers and their children. Yet access to high quality health services remains low in many settings.

Distance to health care facilities has been identified as one of the main potential barriers to health service access. However, while there is strong evidence that long distances to facilities lead to lower utilization of health services, the evidence is less clear about whether long distances to facilities are linked to poor health outcomes. Continue reading “Are We There Yet? Assessing the Burden of Travel on Maternal Health Care Utilization and Child Mortality in Developing Countries”

Parkinson’s disease and cancer risk: is there a relationship?

Freedman_Michal_2015_ORIG_160x140WEBD. Michal Freedman

Some previous epidemiologic studies have suggested that having Parkinson’s disease decreases your risk of developing cancer, and vice versa. If true, this finding could provide insight into underlying biologic mechanisms for the two diseases.

How we set out to answer the question
In a study published in the International Journal of Epidemiology we used data from Medicare, a U.S. federal health insurance programme for those aged ≥65 years, linked to U.S. cancer registry data to examine the relationship between Parkinson’s disease and cancer. Because we used Medicare data, we were limited to people aged 65 years and older. However, as the Medicare database is very large, we were able to examine relationships in whites and non-whites, in men and women, and in different age groups (all above 65 years).

We hypothesized that previous studies may have found a lower risk of cancer after Parkinson’s disease because cancer screening or medical work-ups were less frequent in people with a debilitating condition such as Parkinson’s than in people without such a condition. Continue reading “Parkinson’s disease and cancer risk: is there a relationship?”

Economic recession, mental health and suicide

DGphoto 2014_0052David Gunnell

It’s over seven years since the onset of the 2008 Global Financial Crisis and we’re beginning to get a clear idea of its impact on mental health and suicide.

In keeping with previous economic recessions, the 2008 financial crisis was followed by rises in suicide deaths in many affected countries. As documented in an article published in the British Medical Journal in 2013, younger men appear to have been particularly badly affected.

Recently published research in the International Journal of Epidemiology has provided new insights into the impact of economic down turns on mental health. Using Ireland’s impressive National Registry of Deliberate Self-Harm and national suicide data, Paul Corcoran and colleagues found that there were increases in suicide and self-harm in men and women in Ireland in the years after recession began. The greatest rises were seen in men. There were an estimated 8,800 excess episodes of self-harm (mainly suicide attempts) and 560 suicide deaths in 2008-12 compared to pre-recession trends.  Continue reading “Economic recession, mental health and suicide”

What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research

Joan Benach, Alejandra Vives, Gemma Tarafa, Carlos Delclós and Carles Muntaner

João was 14 when he got his first job at a Brazilian bank. By the time he was 19, he was working part-time as an assistant to the board of directors of a multinational bank while working on a technical degree in foreign trade. He was earning about US$150 a month when he applied for a full-time position in the trade sector, but his application was denied because he was seen as too valuable in the position he held at the time. He then began to work on getting a university degree, but monthly payments cost more than what he was earning per month. When he saw his next transfer application for a different position in the trade sector denied, he left the university and decided to move to Canada. He felt that learning English would be a good way to improve his employment prospects.

bricklayers at work-free image
Bricklayers at work. Source: http://www.morguefile.com/archive/display/669032

 

Once there, he realised everything was more expensive than he had originally anticipated. Despite having only a tourist visa, João got a series of short-term jobs to support his English training. He worked brief stints as a carpet installer, an office assistant and, finally, as a bricklayer. It was in this final position that he earned CDN$29 an hour, over three times more than the minimum wage he’d earned in his previous jobs. Yet, as an undocumented worker, he was denied political, health and educational rights, and was constantly exposed to abuse by his employers and severe income insecurity. Moreover, the overlong work shifts, the exhausting nature of his tasks and a constant exposure to toxins took a substantial toll on his body.

João’s story, recounted by Denise Gastaldo in Employment, Work and Health Inequalities: A Global Perspective, is highly complex (see page 48 in this free e-book available at: https://www.upf.edu/greds-emconet/_pdf/Employmentweb_low.pdf). As he moves across occupational classes, pay grades and documentation statuses, the only constant is the precariousness of his employment situation. Yet precariousness is a concept that we are only beginning to grasp. Continue reading “What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research”