Socio-economic health inequalities: Their origins and implications

Abstract

Evidence attests to substantial variations in health contingent on socioeconomic position. It is argued that these effects cannot be dismissed as artefact nor can they be explained, in the main, by either social selection or an unequal distribution of accepted behavioural risk factors among different social groups. The most likely explanation would seem to be social causation. However, it is continuing social and material inequality that appears most implicated; accounts which locate the effects in childhood social and material causes are far less compelling. The persistence of socioeconomic health differentials into the materially better-off social strata and the possible determining role of relative as well as absolute living standards suggest that psychological, in addition to material, variables are likely to be involved. Isolating the key psychological variables and identifying the nature of their influences will not be easy tasks, although social relations, psychological stress, uplifts, and control have emerged as possible candidates. However, psychological mediators of this sort most probably constitute surface rather than basic causes. Socio-economic inequality, it is contended, remains the basic cause, and, as such, the proper target for intervention. Psychological interventions are unlikely to yield much in the way of dividends in this context and indeed could inadvertently contribute to victim blaming.     

Quality-of-life assessment in HIV-infected psychiatric outpatients: Perceived health,functional status,symptoms, and preferences for cardiopulmonary resuscitation

Abstract

The current study had two purposes: (1) to describe the reliability and validity of a measure of quality of life (QOL) in HIV-infected psychiatric outpatients, and (2) to predict cardiopulmonary resuscitation (CPR) preferences from disease stage, depression, and other QOL factors. We studied 63 patients, who were seen in one year at an HIV/AIDS psychiatry clinic. The results provide evidence for the validity of our instrument as a measure of health status in an HIV-infected psychiatric population. Overall symptoms were the strongest associates of functional limitations. disability, and perceived health, but depression was also significantly associated with all measures of QOL. Twenty-two patients (35.5%) would not have wanted to be revived if their heart stopped beating the day of the study. Disease stage and poor mental health were independent predictors of this preference, but severity of depression, social support, fatigue, perceived health, functional limitations, and life satisfaction were not.     

Quality-of-life after penile prosthesis placed at radical prostatectomy

Abstract

The clinical and psychosocial effects of immediate penile prosthesis implantation at the time of radical prostatectomy (RP) were investigated in 97 consecutive patients and 68 partners. Prosthesis recipients reported more frequent sexual contact, fewer marital problems and slightly fewer sexual functioning problems than the RP-alone patients. There were no group differences on any sociodemographic characteristics, on disease recurrence, on physical and psychosocial functioning, or on reported depression. Patients who chose the prosthesis did, however, evidence less of a link between depression and functional limitations and between depression and marital problems. They also had lower levels of agreement with their partners in reporting their own depression, as compared to the patients who opted for RP surgery alone. We conclude that the penile prosthesis was associated with an increased frequency of sexual contact, a reduction in reported marital problems, and stylistic differences between the two patient groups in dealing with affect.     

New evidence on the reliability and validity of the pediatric oncology quality of life scale

Abstract

The present paper replicates and extends previous studies on the psychometric properties of the Pediatric Oncology Quality of Life Scale (POQOLS). The research questions were focused on (a) internal consistency; (b) relation with demographics; and (c) ability to discriminate between patient groups. Data were gathered in a Dutch-speaking Belgian sample of 73 pediatric oncology patients, drawn from the population of a university hospital. The parents completed the POQOLS, a 21-item parent-report inventory for the assessment of physical restriction, emotional distress and discomfort from medical treatment in pediatric oncology patients. The results support the psychometric quality of the POQOLS. Three of the core aspects of quality of life are tapped using sufficiently short and internally consistent subscales. The instrument is free from relations with demographics and shows good discriminant ability to differentiate between patient groups according to time since diagnosis, treatment status and diagnosis.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

Finding benefit in breast cancer: Relations with personality,coping, and concurrent well-being

Cancer patients experience positive as well as adverse consequences from cancer diagnosis and treatment. The work reported here was part of an effort to characterize the experiences of benefit finding in breast cancer patients. A sample of 230 early-stage breast cancer patients completed a set of benefit finding items in the year post-surgery. This measure was then related to measures of concurrent coping, several aspects of psychosocial well-being, demographic variables, and several other personality traits. Benefit finding related positively to trait optimism, and to positive reframing and religious activity as coping reactions. Benefit finding related inversely to emotional distress, but was relatively unrelated to other measures of well-being.     

Cognitive Functioning,Behavior, and Quality of Life After Stroke in Childhood

Rationale: To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion).

Methods: Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN).

Results: Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10–21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79–129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p?=?.000; Digit Span p?=?.000, Arithmetic's p?=?.007, Divided Attention p?=?.028, Alertness p?=?.002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p?=?.000; impulsivity/hyperactivity p?=?.006; psychosomatics p?=?.006). Certain aspects of quality of life were reduced (autonomy p?=?.003; parents' relation p?=?.003; social acceptance p?=?.037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p?=?.000, hand alternation p?=?.001, foot tapping p?=?.043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5–10 years) led to better cognitive outcome than lesion in the very early (0–5 years) or late childhood (10–18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis.

Conclusion: Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.     

Time-Based Prospective Memory Performance and Time-Monitoring in Children with ADHD

The current study investigated prospective memory (PM) performance in children with attention deficit/hyperactivity disorder (ADHD) and controls and aimed at exploring possible underlying factors of PM performance. Twenty-two children with ADHD and 39 age- and ability-matched typically developing children performed a computerized time-based PM task. As predicted, children with ADHD had fewer correct PM responses than controls. Neither differences in overall ongoing task performance nor, remarkably, differences in overall frequency and accuracy of time monitoring were found. Exploratory analyses suggest that individual differences in time monitoring in the final interval before target times may be related to PM performance in ADHD.     

Predictors of quality of life enjoyment and satisfaction in individuals living with HIV and AIDS in a resource-constrained setting in South Africa

The burden of HIV disease is concentrated in sub-Saharan Africa, particularly in South Africa (SA). Whilst there have been many studies conducted on the biomedical and socio-psychological aspects of HIV and AIDS, insufficient attention has been paid to the quality of life of those infected with the virus. The primary purpose of the study was to determine the predictors of quality of life enjoyment and satisfaction (Q-LES) among individuals infected with HIV. A battery of questionnaires, which included the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), were administered to 121 participants. Data was analysed using SPSS. Of the total sample (n = 121), 74% were females. The study found that a large proportion (49.5%) of the sample within the age group 25–49 years old experienced psychological distress. Those who were not on antiretroviral treatment (ART) were significantly affected (66%). Psychological distress was significantly prevalent among HIV positive individuals and also the strongest predictor of Q-LES among these individuals.     

The psychosocial well-being of a “forgotten” South African community: the case of Ndumo,KwaZulu-Natal

This study investigated the psychosocial well-being of an indigenous cultural community in South Africa, using a sequential explanatory mixed-methods design. Data on life satisfaction and emotional, social and psychological well-being were collected from 521 local residents (48% female) of Ndumo in KwaZulu-Natal, South Africa using the Satisfaction-with-Life Scale and Mental Health Continuum. In addition, interviews were conducted with 20 Ndumo residents (35% female). Findings revealed that community members had above-average levels of psychosocial well-being and exhibited significant resilience towards countering socio-economic under-resourcing, including poverty and unemployment. The community resources found to aid resilient living included being able to live off the land, a pleasant climate, personal safety, hope for a better future, and instrumental, material, and social support from philanthropic organisations.