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Search Results: 1 - 10 of 2096 matches for " Grundy Emily "
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Marital history, health and mortality among older men and women in England and Wales
Emily MD Grundy, Cecilia Tomassini
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-554
Abstract: We use data from the Office for National Statistics Longitudinal Study, a large record linkage study of 1% of the population of England & Wales, to analyse associations between marital history 1971-1991 and subsequent self-reported limiting long-term illness and mortality in a cohort of some 75,000 men and women aged 60-79 in 1991. We investigate whether prior marital status and time in current marital status influenced risks of mortality or long term illness using Poisson regression to analyse mortality differentials 1991-2001 and logistic regression to analyse differences in proportions reporting limiting long-term illness in 1991 and 2001. Co-variates included indicators of socio-economic status at two or three points of the adult life course and, for women, number of children borne (parity).Relative to men in long-term first marriages, never-married men, widowers with varying durations of widowerhood, men divorced for between 10 and twenty years, and men in long-term remarriages had raised mortality 1991-2001. Men in long-term remarriages and those divorced or widowed since 1971 had higher odds of long-term illness in 1991; in 2001 the long-term remarried were the only group with significantly raised odds of long-term illness. Among women, the long-term remarried also had higher odds of reporting long-term illness in 1991 and in 2001 and those remarried and previously divorced had raised odds of long-term illness and raised mortality 1991-2001; this latter effect was not significant in models including parity. All widows had raised mortality 1991-2001 but associations between widowhood of varying durations and long-term illness in 1991 or 2001 were not significant once socio-economic status was controlled. Some groups of divorced women had higher mortality risks 1991-2001 and raised odds of long-term illness in 1991. Results for never-married women showed a divergence between associations with mortality and with long-term illness. In models controlling for socio
The association of cancer survival with four socioeconomic indicators: a longitudinal study of the older population of England and Wales 1981–2000
Andrew Sloggett, Harriet Young, Emily Grundy
BMC Cancer , 2007, DOI: 10.1186/1471-2407-7-20
Abstract: This study uses prospective record linkage data from The Office for National Statistics Longitudinal Study for England and Wales. The participants are Longitudinal Study members, recorded at census in 1971 and 1981 and with a primary malignant cancer diagnosed at age 45 or above, between 1981 and 1997, with follow-up until end 2000. The outcome measure is relative survival/excess mortality, compared with age and sex adjusted survival of the general population. Relative survival and Poisson regression analyses are presented, giving models of relative excess mortality, adjusted for covariates.Different socioeconomic indicators detect survival differentials of varying magnitude and definition. For all cancers combined, the four indicators show similar effects. For individual cancers there are differences between indicators. Where there is an association, all indicators show poorer survival with lower socioeconomic status.Cancer survival differs markedly by socio-economic status. The commonly used ecological measure, the Carstairs Index, is adequate at demonstrating socioeconomic differentials in survival for combined cancers and some individual cancers. A combination of car access and housing tenure is more sensitive than the ecological Carstairs measure at detecting socioeconomic effects on survival – confirming Carstairs effects where they occur but additionally identifying effects for other cancers. Social class is a relatively weak indicator of survival differentials.The objective of this study is to investigate socio-economic differentials in cancer survival in England and Wales using four indicators of socioeconomic status; three individual and one ecological. Previous studies have generally demonstrated poorer cancer survival with decreasing socioeconomic status but often used only ecological measures of status, or less extensive analytical methods.Most recent work on cancer survival in England and Wales has used patient data from cancer registries, which are co
Promo??o da saúde, epidemiologia social e capital social: inter-rela??es e perspectivas para a saúde pública
Souza, Elza Maria de;Grundy, Emily;
Cadernos de Saúde Pública , 2004, DOI: 10.1590/S0102-311X2004000500030
Abstract: the idea of health promotion predates the use of the actual term. however, the incorporation of this idea and the practice of health promotion were influenced by the canadian health reform movement, which echoed the voices of many others who were concerned with the influence of the physical and social environment on health. this provided the basis for the world health organization to launch a series of conferences beginning with the alma ata conference in 1977 and followed by the ottawa conference, from which resulted the first international document on health promotion, known as the ottawa charter. although health promotion has been the subject of a wide range of studies, the concept is still not well understood and its explicit practice is limited. health conferences have been important for keeping the notion of equity in health alive, while the gap between the rhetoric of these conferences and practice remains to be bridged. however, the rise of social epidemiology and the development of the concept of social capital for health could bring new insights into traditional epidemiology in order to narrow this gap. the purpose of this paper is to elucidate these concepts and to describe the roles they play in public health in order to stimulate further debate.
Promo o da saúde, epidemiologia social e capital social: inter-rela es e perspectivas para a saúde pública
Souza Elza Maria de,Grundy Emily
Cadernos de Saúde Pública , 2004,
Abstract: A idéia de promover saúde antecede o uso explícito do termo. No entanto, a incorpora o dessa idéia e da prática no campo da saúde pública foi influenciado especialmente pela reforma de saúde iniciada no Canadá, em 1974, a qual refletiu os anseios de muitos outros preocupados com influência do meio físico e social na saúde. Essa reforma serviu de base para o lan amento de várias conferências desencadeados pela Organiza o Mundial da Saúde, come ando pela de Alma Ata em 1977, e seguida pela Conferência de Ottawa, da qual resultou o primeiro documento internacional em promo o de saúde: a Carta de Ottawa. Embora promo o da saúde esteja presente em uma grande e variada literatura, seu conceito ainda n o é bem entendido e sua prática dificultada. Parece que a importancia dessas conferências tem servido para n o deixar fenecer a idéia de eqüidade em saúde, uma vez que os esfor os para reduzir a distancia entre retórica e prática continuam longe de ser alcan ados. Entretanto, o crescimento da epidemiologia social associado ao conceito de capital social para saúde podem complementar os preceitos da epidemiologia tradicional e, conseqüentemente, contribuir para a efetiva o do modelo estruturalista para a promo o da saúde. O propósito desse artigo é elucidar esses conceitos e descrever o papel que eles desempenham no campo da saúde pública a fim de estimular debates futuros.
Health differentials in the older population of England: An empirical comparison of the materialist, lifestyle and psychosocial hypotheses
George B Ploubidis, Bianca L DeStavola, Emily Grundy
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-390
Abstract: We empirically compared the materialist, psychosocial and lifestyle/behavioural theoretical mechanisms of explanation for socio-economic variation in health using data from two waves of the English Longitudinal Study of Ageing (ELSA), a nationally representative multi-purpose sample of the population aged 50 and over living in England. Three dimensions of health were examined: somatic health, depression and well-being.The materialist and lifestyle/behavioural paths had the most prominent mediating role in the association between socio-economic position and health in the older population, whereas the psychosocial pathway was less influential and exerted most of its influence on depression and well-being, with part of its effect being due to the availability of material resources.From a policy perspective there is therefore an indication that population interventions to reduce health differentials and thus improve the overall health of the older population should focus on material circumstances and population based interventions to promote healthy lifestyles.The 20th century witnessed significant improvements in health in most countries including substantial increases in survival to older ages and large reductions in late age mortality. However, substantial inequalities or disparities in the health of different socio-economic groups remain[1-3]. In developed countries with old age structures most deaths occur at older ages and older people account for the majority of those in poor health, which suggests a particular need to investigate health inequalities in the older population [4]. Early work on health inequalities tended to focus on younger age groups, particularly middle aged men. Socioeconomic disparities were thought to be small in early adulthood and later old age and increasingly large during the period between early adulthood and early old age [5], with the declining strength of health inequalities in later life being at least partly attributed to selective m
Women's Risk of Repeat Abortions Is Strongly Associated with Alcohol Consumption: A Longitudinal Analysis of a Russian National Panel Study, 1994–2009
Katherine Keenan, Emily Grundy, Michael G. Kenward, David A. Leon
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090356
Abstract: Abortion rates in Russia, particularly repeat abortions, are among the highest in the world, and abortion complications make a substantial contribution to the country's high maternal mortality rate. Russia also has a very high rate of hazardous alcohol use. However, the association between alcohol use and abortion in Russia remains unexplored. We investigated the longitudinal predictors of first and repeat abortion, focussing on women's alcohol use as a risk factor. Follow-up data from 2,623 women of reproductive age (16–44 years) was extracted from 14 waves of the Russian Longitudinal Monitoring Survey (RLMS), a nationally representative panel study covering the period 1994–2009. We used discrete time hazard models to estimate the probability of having a first and repeat abortion by social, demographic and health characteristics at the preceding study wave. Having a first abortion was associated with demographic factors such as age and parity, whereas repeat abortions were associated with low education and alcohol use. After adjustment for demographic and socioeconomic factors, the risk of having a repeat abortion increased significantly as women's drinking frequency increased (P<0.001), and binge drinking women were significantly more likely to have a repeat abortion than non-drinkers (OR 2.28, 95% CI 1.62–3.20). This association was not accounted for by contraceptive use or a higher risk of pregnancy. Therefore the determinants of first and repeat abortion in Russia between 1994–2009 were different. Women who had repeat abortions were distinguished by their heavier and more frequent alcohol use. The mechanism for the association is not well understood but could be explained by unmeasured personality factors, such as risk taking, or social non-conformity increasing the risk of unplanned pregnancy. Heavy or frequent drinkers constitute a particularly high risk group for repeat abortion, who could be targeted in prevention efforts.
A factorial-design cluster randomised controlled trial investigating the cost-effectiveness of a nutrition supplement and an exercise programme on pneumonia incidence, walking capacity and body mass index in older people living in Santiago, Chile: the CENEX study protocol
Alan D Dangour, Cecilia Albala, Cristian Aedo, Diana Elbourne, Emily Grundy, Damian Walker, Ricardo Uauy
Nutrition Journal , 2007, DOI: 10.1186/1475-2891-6-14
Abstract: The aim of the CENEX cluster randomised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme, and a specially designed physical exercise intervention for older people of low to medium socio-economic status living in Santiago, Chile.The study has been conceptualised as a public health programme effectiveness study and has been designed as a 24-month factorial cluster-randomised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago. The main outcomes are incidence of pneumonia, walking capacity and change in body mass index over 24 months of intervention. Costing data (user and provider), collected at all levels, will enable the determination of the cost-effectiveness of the two interventions individually and in combination. The study is supported by the Ministry of Health in Chile, which is keen to expand and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness.ISRCTN48153354United Nations estimates show that in 2000, individuals aged 60 years or older represented 10% of the world's population, or about 600 million people, and they project that by the year 2050 this group will represent 22% of the world's population, or about 2 billion people. Furthermore, the population of individuals aged 80 years or older is projected to more than triple in the period 2000–2050, from 1.2% to 4.3% of the world's population, or about 73 million to 400 million people [1]. These changes will be most dramatic in the less developed countries in Asia and Latin America, where the population age structure will change rapidly from one that is predominantly young, with relatively low proportions of older people, to one with more balanced numbers across age groups. Promoting good health in later life is desirable whatever the demographic context, but the growing proportions of older people make this par
Methods for economic evaluation of a factorial-design cluster randomised controlled trial of a nutrition supplement and an exercise programme among healthy older people living in Santiago, Chile: the CENEX study
Damian G Walker, Cristian Aedo, Cecilia Albala, Elizabeth Allen, Alan D Dangour, Diana Elbourne, Emily Grundy, Ricardo Uauy
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-85
Abstract: The base-case analysis will adopt a societal perspective, including the direct medical and non-medical costs borne by the government and patients. The cost of the interventions will be calculated by the ingredients approach, in which the total quantities of goods and services actually employed in applying the interventions will be estimated, and multiplied by their respective unit prices. Relevant information on costs of interventions will be obtained mainly from administrative records. The costs borne by patients will be collected via exit and telephone interviews. An annual discount rate of 8% will be used, consistent with the rate recommended by the Government of Chile. All costs will be converted from Chilean Peso to US dollars with the 2007 average period exchange rate of US$1 = 522.37 Chilean Peso. To test the robustness of model results, we will vary the assumptions over a plausible range in sensitivity analyses.The protocol described here indicates our intent to conduct an economic evaluation alongside the CENEX study. It provides a detailed and transparent statement of planned data collection methods and analyses.ISRCTN48153354The United Nations Population Division has estimated great increases in both the proportion and absolute size of the older person population over the next fifty years [1]. At the 2nd World Assembly on Ageing, policy initiatives were proposed to promote active and healthy lifestyles in later life [2]. Emphasis was placed, among other things, on adequate nutrition throughout the life course and national food policies designed to recognise older people as potentially vulnerable. The aim was to increase healthy life-years in older people, and thereby decrease the number of years, and the proportion of time, spent in poor health. Some governments have responded to these increased demands by designing innovative programmes aimed at tackling the twin problems of food and nutrition insecurity among older people [3]. For example, food baskets
Effect of a Nutrition Supplement and Physical Activity Program on Pneumonia and Walking Capacity in Chilean Older People: A Factorial Cluster Randomized Trial
Alan D. Dangour ,Cecilia Albala,Elizabeth Allen,Emily Grundy,Damian G. Walker,Cristian Aedo,Hugo Sanchez,Olivia Fletcher,Diana Elbourne,Ricardo Uauy
PLOS Medicine , 2011, DOI: 10.1371/journal.pmed.1001023
Abstract: Background Ageing is associated with increased risk of poor health and functional decline. Uncertainties about the health-related benefits of nutrition and physical activity for older people have precluded their widespread implementation. We investigated the effectiveness and cost-effectiveness of a national nutritional supplementation program and/or a physical activity intervention among older people in Chile. Methods and Findings We conducted a cluster randomized factorial trial among low to middle socioeconomic status adults aged 65–67.9 years living in Santiago, Chile. We randomized 28 clusters (health centers) into the study and recruited 2,799 individuals in 2005 (~100 per cluster). The interventions were a daily micronutrient-rich nutritional supplement, or two 1-hour physical activity classes per week, or both interventions, or neither, for 24 months. The primary outcomes, assessed blind to allocation, were incidence of pneumonia over 24 months, and physical function assessed by walking capacity 24 months after enrolment. Adherence was good for the nutritional supplement (~75%), and moderate for the physical activity intervention (~43%). Over 24 months the incidence rate of pneumonia did not differ between intervention and control clusters (32.5 versus 32.6 per 1,000 person years respectively; risk ratio = 1.00; 95% confidence interval 0.61–1.63; p = 0.99). In intention-to-treat analysis, after 24 months there was a significant difference in walking capacity between the intervention and control clusters (mean difference 33.8 meters; 95% confidence interval 13.9–53.8; p = 0.001). The overall cost of the physical activity intervention over 24 months was US$164/participant; equivalent to US$4.84/extra meter walked. The number of falls and fractures was balanced across physical activity intervention arms and no serious adverse events were reported for either intervention. Conclusions Chile's nutritional supplementation program for older people is not effective in reducing the incidence of pneumonia. This trial suggests that the provision of locally accessible physical activity classes in a transition economy population can be a cost-effective means of enhancing physical function in later life. Trial registration Current Controlled Trials ISRCTN 48153354 Please see later in the article for the Editors' Summary
Ejecta Transfer in the Pluto System
Simon Porter,William Grundy
Physics , 2014, DOI: 10.1016/j.icarus.2014.03.031
Abstract: The small satellites of the Pluto system (Styx, Nix, Kerberos, and Hydra) have very low surface escape velocities, and impacts should therefore eject a large amount of material from their surfaces. We show that most of this material then escapes from the Pluto system, though a significant fraction collects on the surfaces of Pluto and Charon. The velocity at which the dust is ejected from the surfaces of the small satellites strongly determines which object it is likely to hit, and where on the surfaces of Pluto and Charon it is most likely to impact. We also show that the presence of an atmosphere around Pluto eliminates most particle size effects and increases the number of dust impacts on Pluto. In total, Pluto and Charon may have accumulated several centimeters of small-satellite dust on their surfaces, which could be observed by the New Horizons spacecraft.
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