What is the prevalence of loneliness amongst older people living in residential and nursing care homes? A systematic review and meta-analysis.

BACKGROUND: the number of older people living in residential and nursing care homes is rising. Loneliness is a major problem for older people, but little is known about the prevalence of loneliness amongst older people living in care homes. AIM: to undertake a systematic review of literature on the prevalence of moderate and severe loneliness amongst older people living in residential and nursing care homes. DESIGN: we systematically reviewed the databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Embase, Scopus, Cochrane and Allied and Complementary Medicine Database (AMED) from inception to January 2019. We included all studies reporting data on the prevalence of loneliness amongst older people living in care homes. A random-effects meta-analysis was conducted on all eligible data. RESULTS: a total of 13 articles were included, representing 5,115 participants (age range of 55-102 years, mean age 83.5 years, 68% female). There was a significant variation between studies in estimates of prevalence. The prevalence of moderate loneliness ranged from 31 to 100%, and the prevalence of severe loneliness ranged from 9 to 81%. The estimated mean prevalence of 'moderate loneliness' was 61% (95% confidence interval (CI): 0.41, 0.80). The estimated mean prevalence of 'severe loneliness' was 35% (95% CI: 0.14, 0.60). CONCLUSION: the prevalence of both moderate loneliness and severe loneliness amongst care home residents is high enough to warrant concern. However, the significant variation in prevalence estimates warrants further research. Future studies should identify which interventions can address loneliness and promote meaningful social engagement to enhance quality of life in care homes.

Social inequality and children's health in Africa: a cross sectional study.

BACKGROUND: This study examines socioeconomic inequality in children's health and factors that moderate this inequality. Socioeconomic measures include household wealth, maternal education and urban/rural area of residence. Moderating factors include reproductive behavior, access to health care, time, economic development, health expenditures and foreign aid. METHODS: Data are taken from Demographic and Health Surveys conducted between 2003 and 2012 in 26 African countries. RESULTS: Birth spacing, skilled birth attendants, economic development and greater per capita health expenditures benefit the children of disadvantaged mothers, but the wealthy benefit more from the services of a skilled birth attendant and from higher per capita expenditure on health. CONCLUSION: Some health behavior and policy changes would reduce social inequality, but the wealthy benefit more than the poor from provision of health services.

Crop manuring and intensive land management by Europe's first farmers.

The spread of farming from western Asia to Europe had profound long-term social and ecological impacts, but identification of the specific nature of Neolithic land management practices and the dietary contribution of early crops has been problematic. Here, we present previously undescribed stable isotope determinations of charred cereals and pulses from 13 Neolithic sites across Europe (dating ca. 5900-2400 cal B.C.), which show that early farmers used livestock manure and water management to enhance crop yields. Intensive manuring inextricably linked plant cultivation and animal herding and contributed to the remarkable resilience of these combined practices across diverse climatic zones. Critically, our findings suggest that commonly applied paleodietary interpretations of human and herbivore δ(15)N values have systematically underestimated the contribution of crop-derived protein to early farmer diets.

Factors associated with cognitive achievement in late childhood and adolescence: the Young Lives cohort study of children in Ethiopia, India, Peru, and Vietnam.

BACKGROUND: There is a well-established link between various measures of socioeconomic status and the schooling achievement and cognition of children. However, less is known about how cognitive development is impacted by childhood improvements in growth, a common indicator of child nutritional status. This study examines the relationship between socioeconomic status and child growth and changes in cognitive achievement scores in adolescents from resource-poor settings. METHODS: Using an observational cohort of more than 3000 children from four low- and middle-income countries, this study examines the association between cognitive achievement scores and household economic, educational, and nutritional resources to give a more accurate assessment of the influence of families on cognitive development. A composite measure of cognition when children were approximately 8, 12, and 15 years of age was constructed. Household factors included maternal schooling, wealth, and children's growth. RESULTS: A positive and statistically significant relationship between household factors and child cognition was found for each country. If parents have more schooling, household wealth increases, or child growth improves, then children's cognitive scores improve over time. Results for control variables are less consistent. CONCLUSION: Our findings suggest there is a consistent and strong association between parental schooling, wealth, and child growth with child cognitive achievement. Further, these findings demonstrate that a household's ability to provide adequate nutrition is as important as economic and education resources even into late childhood and adolescence. Hence, efforts to improve household resources, both early in a child's life and into adolescence, and to continue to promote child growth beyond the first few years of life have the potential to help children over the life course by improving cognition.

Evidence for bias in measured δ15N values of terrestrial and aquatic organic materials due to pre-analysis acid treatment methods.

We investigate the effect of acid treatment methods on δ(15)N values from a range of environmental organic materials in the context of the increased application of 'dual-mode' isotope analysis (the simultaneous measurement of δ(13)C and δ(15)N from the same acid-treated sample). Three common methods are compared; (i) untreated samples; (ii) acidification followed by sequential water rinse (rinse method); and (iii) acidification in silver capsules (capsule method). The influence of capsule type (silver and tin) on δ(15)N is also independently assessed (as the capsule and rinse methods combust samples in different capsules; silver and tin, respectively). We find significant differences in δ(15)N values between methods and the precision of any one method varies significantly between sample materials and above the instrument precision (>0.3‰). The δ(15)N values of untreated samples did not produce the most consistent data on all sample materials. In addition, the capsule type appears to influence the measured δ(15)N value of some materials, particularly those combusted only in silver capsules. We also compare the new δ(15)N data with previously published δ(13)C data on the same materials. The response of δ(13)C and δ(15)N within and between methods and sample materials to acidification appears to be relatively disproportionate, which can influence the environmental interpretation of the measured data. In addition, statistical methods used to estimate inorganic nitrogen are shown to be seriously flawed.

The hydrological response of heavy clay grassland soils to rainfall in south-west England using delta2H.

Stable isotopes of water have been previously used in catchment studies to separate rain-event water from pre-event groundwater. However, there are a lack of studies at the smaller scale looking at the separation of event water from pre-event water. This is particularly relevant for heavy clay soil systems through which the movement of water is uncertain but is thought to be rainwater-dominated. The data presented here were collected at a rural site in the south-west of England. The historic rainfall at the site was isotopically varied but similar to the global meteoric water line, with annual weighted means of -37 per thousand for delta(2)H and -5.7 per thousand for delta(18)O and with no seasonal variation. Drainage was sampled from the inter-flow (surface runoff + lateral through-flow) and drain-flow (55 cm deep mole drains) pathways of two 1 ha lysimeters during two rainfall events, which had delta(2)H values of -68 per thousand and -92 per thousand, respectively. The delta(2)H values of the lysimeter drainage water suggest that there was no contribution of event water during the first, small discharge (Q) event; however, the second larger event did show isotopic variation in delta(2)H values negatively related to Q indicating that rainwater was contributing to Q. A hydrograph separation indicated that only 49-58% of the inter-flow and 18-25% of the drain-flow consisted of event water. This was surprising given that these soil types are considered retentive of soil water. More work is needed on heavy clay soils to understand better the nature of water movement from these systems.

The oxygen isotopic composition of phosphate in river water and its potential sources in the Upper River Taw catchment, UK.

The need to reduce both point and diffuse phosphorus pollution to aquatic ecosystems is widely recognised and in order to achieve this, identification of the different pollutant sources is essential. Recently, a stable isotope approach using oxygen isotopes within phosphate (δ18OPO4) has been used in phosphorus source tracing studies. This approach was applied in a one-off survey in September 2013 to the River Taw catchment in south-west England where elevated levels of phosphate have been reported. River water δ18OPO4 along the main channel varied little, ranging from +17.1 to +18.8‰. This was no >0.3‰ different to that of the isotopic equilibrium with water (Eδ18OPO4). The δ18OPO4 in the tributaries was more variable (+17.1 to +18.8‰), but only deviated from Eδ18OPO4 by between 0.4 and 0.9‰. Several potential phosphate sources within the catchment were sampled and most had a narrow range of δ18OPO4 values similar to that of river Eδ18OPO4. Discharge from two waste water treatment plants had different and distinct δ18OPO4 from one another ranging between +16.4 and +19.6‰ and similar values to that of a dairy factory final effluent (+16.5 to +17.8‰), mains tap water (+17.8 to +18.4‰), and that of the phosphate extracted from river channel bed sediment (+16.7 to +17.6‰). Inorganic fertilizers had a wide range of values (+13.3 to +25.9‰) while stored animal wastes were consistently lower (+12.0 to +15.0‰) than most other sources and Eδ18OPO4. The distinct signals from the waste water treatment plants were lost within the river over a short distance suggesting that rapid microbial cycling of phosphate was occurring, because microbial cycling shifts the isotopic signal towards Eδ18OPO4. This study has added to the global inventory of phosphate source δ18OPO4 values, but also demonstrated the limitations of this approach to identifying phosphate sources, especially at times when microbial cycling is high.

A multi-stable isotope framework to understand eutrophication in aquatic ecosystems.

Eutrophication is a globally significant challenge facing aquatic ecosystems, associated with human induced enrichment of these ecosystems with nitrogen (N) and phosphorus (P). However, the limited availability of inherent labels for P and N has constrained understanding of the triggers for eutrophication in natural ecosystems and appropriate targeting of management responses. This paper proposes and evaluates a new multi-stable isotope framework that offers inherent labels to track biogeochemical reactions governing both P and N in natural ecosystems. The framework couples highly novel analysis of the oxygen isotope composition of phosphate (δ(18)OPO4) with dual isotope analysis of oxygen and N within nitrate (δ(15)NNO3, δ(18)ONO3) and with stable N isotope analysis in ammonium (δ(15)NNH4). The River Beult in England is used as an exemplar system for initial evaluation of this framework. Our data demonstrate the potential to use stable isotope labels to track the input and downstream fate of nutrients from point sources, on the basis of isotopic differentiation for both P and N between river water and waste water treatment work effluent (mean difference = +1.7‰ for δ(18)OPO4; +15.5‰ for δ(15)NNH4 (under high flow); +7.3‰ for δ(18)ONO3 and +4.4‰ for δ(15)NNO3). Stable isotope data reveal nutrient inputs to the river upstream of the waste water treatment works that are consistent with partially denitrified sewage or livestock sources of nitrate (δ(15)NNO3 range = +11.5 to +13.1‰) and with agricultural sources of phosphate (δ(18)OPO4 range = +16.6 to +19.0‰). The importance of abiotic and metabolic processes for the in-river fate of N and P are also explored through the stable isotope framework. Microbial uptake of ammonium to meet metabolic demand for N is suggested by substantial enrichment of δ(15)NNH4 (by 10.2‰ over a 100 m reach) under summer low flow conditions. Whilst the concentration of both nitrate and phosphate decreased substantially along the same reach, the stable isotope composition of these ions did not vary significantly, indicating that concentration changes are likely driven by abiotic processes of dilution or sorption. The in-river stable isotope composition and the concentration of P and N were also largely constant downstream of the waste water treatment works, indicating that effluent-derived nutrients were not strongly coupled to metabolism along this in-river transect. Combined with in-situ and laboratory hydrochemical data, we believe that a multi-stable isotope framework represents a powerful approach for understanding and managing eutrophication in natural aquatic ecosystems.

Cross-national variation in family influences on child health.

Drawing on the family process literature, child health models, and recent studies of macro-level effects on health, we examine the effects of household structure, resources, care-giving, reproduction, and communication on child nutritional status and infant mortality. Using Demographic and Health Surveys, we analyze the influence of these factors across 42 countries in Latin America, Africa, and Asia. We also consider country-level including nontraditional family structure, level of economic development and expenditures on health care. Our results underscore the importance of family resources, decision-making, and health and feeding practices on child well-being in less developed countries. Although there is cross-national variability, the size of the variability was small relative to the overall effect. The country-level measures had modest effects on infant mortality and child nutritional status.

Are Improvements in Child Health Due to Increasing Status of Women in Developing Nations?

This research tests the hypothesis that change over time in women's status leads to improvements in their children's health. Specifically, we examine whether change in resources and empowerment in mother's roles as biological mothers, caregivers, and providers and social contexts that promote the rights and representation of and investment in women are associated with better nutritional status and survival of young children. Analysis is based on a broad sample of countries (n = 28), with data at two or more points in time to enable examination of change. Key indicators of child health show improvement in the last 13 years in developing nations. Much of this improvement--90 percent of the increase in nutritional status and 47 percent of the reduction in mortality--is associated with improving status of women. Increased maternal education, control over reproduction, freedom from violence, access to health care, legislation and enforcement of women's rights, greater political representation, equality in the education system, and lower maternal mortality are improving children's health. These results imply that further advancement of women's position in society would be beneficial.

Stable Carbon Isotope Evidence for Neolithic and Bronze Age Crop Water Management in the Eastern Mediterranean and Southwest Asia.

In a large study on early crop water management, stable carbon isotope discrimination was determined for 275 charred grain samples from nine archaeological sites, dating primarily to the Neolithic and Bronze Age, from the Eastern Mediterranean and Western Asia. This has revealed that wheat (Triticum spp.) was regularly grown in wetter conditions than barley (Hordeum sp.), indicating systematic preferential treatment of wheat that may reflect a cultural preference for wheat over barley. Isotopic analysis of pulse crops (Lens culinaris, Pisum sativum and Vicia ervilia) indicates cultivation in highly varied water conditions at some sites, possibly as a result of opportunistic watering practices. The results have also provided evidence for local land-use and changing agricultural practices.

Carbon isotope variations in a plantation of Sitka spruce, and the effect of acid mist.

Intra- and inter-tree variations in 13C/12C ratios were studied within a single clone plantation of 20-year-old Sitka spruce, some of which were treated with mist simulating acidic cloud water. For groups of trees of similar height and the same treatment, sampled at the same whorl height, δ13C values for current year needles showed variations (1 SD) of between 0.2 and 0.7‰. The variations reflect the seasonally averaged influences, on intercellular CO2 concentrations, of slight variations in the microhabitat within a group. For a typical intra-group variation of 0.4‰ one may be able to distinguish between groups whose mean intercellular CO2 concentrations differ by only 8 ppm. Acid misting resulted in a lowering of δ13C values by c. 0.7‰ (significant at the P≤0.05 level). This reflects higher intercellular CO2 concentrations for acid misted trees, which can be interpreted in terms of their having assimilation rates c. 10% lower than those of control trees, and might explain the observed reduction in stem growth for acid-misted trees. Without careful attention to sampling strategy, however, these small inter-tree δ13C variations can be easily masked by the much larger intra-tree variations with height. Large gradients of increasing needle δ13C with height, of c. 0.5‰ m-1, were observed in two untreated trees of different total height. The gradient was similar for both trees so, though δ13C values of both trees were identical close to their leaders (-27‰), the taller tree displayed much lower values close to the ground (-31‰). The gradients are believed to reflect lower light levels close to the ground, rather than the accumulation of respired CO2 in the atmosphere. The different height response of stems versus needles, reflected by an increase in δ13Cstems-δ13Cneedles with height (for cellulose), is discussed in terms of stem photosynthetic recapture of internally respired CO2.

Increasing maternal healthcare use in Rwanda: implications for child nutrition and survival.

Rwanda has made great progress in improving maternal utilization of health care through coordination of external aid and more efficient health policy. Using data from the 2005 and 2010 Rwandan Demographic and Health Surveys, we examine three related questions regarding the impact of expansion of health care in Rwanda. First, did the increased use of health center deliveries apply to women across varying levels of education, economic status, and area of residency? Second, did the benefits associated with being delivered at a health center diminish as utilization became more widespread? Finally, did inequality in child outcomes decline as a result of increased health care utilization? Propensity score matching was used to address the selectivity that arises when choosing to deliver at a hospital. In addition, the regression models include a linear model to predict child nutritional status and Cox regression to predict child survival. The analysis shows that the largest increases in delivery at a health center occur among less educated, less wealthy, and rural Rwandan women. In addition, delivery at a health center is associated with better nutritional status and survival and the benefit is not diminished following the dramatic increase in use of health centers. Finally, educational, economic and residential inequality in child survival and nutrition did not decline.

Child nutritional status by rural/urban residence: a cross-national analysis.

PURPOSE: Rural children in developing countries have poor health outcomes in comparison with urban children. This paper considers 4 questions regarding the rural/urban difference, namely: (1) do individual-level characteristics account for rural/urban differences in child nutritional status; (2) do community-level characteristics account for rural/urban differences net of individual-level characteristics; (3) does type of residence alter the influence of individual characteristics; and (4) does the rural/urban difference vary across national contexts? METHOD: Analysis is based on demographic and health survey data from 35 developing countries. Multilevel regression is used to examine rural/urban differences in nutritional status net of individual, community and national determinants of health status. FINDINGS: Rural children have a substantially higher risk of poor nutrition. Much of this disadvantage is because of socioeconomic disadvantage, reproductive norms favoring early and more rapid childbearing, and lack of access to modern medicine. Rural residence also structures the nature of the relationships between socioeconomic status, access to medical care, and nutrition. Finally, the rural/urban gap declines as countries develop. CONCLUSION: Rural/urban differences in child nutritional status are substantial, and some-but not all-of the differences are attributable to socioeconomic status, access to medical care, and reproductive norms.

URBANIZATION, EDUCATION AND RACIAL INTERMARRIAGE IN BRAZIL.

Urbanization and education have brought numerous changes in societies around the world. One change is the contact of different groups, often with an attendant increase in intergroup marriage. In this paper we examine the intergroup intermarriage in Brazil in the context of changing urbanization and education. While intergroup marriage has been intensively examined in the United States, the topic has received less attention in Brazil. We use census data from 1991 and 2000, and national survey data from 2001 and 2008 to examine factors predicting intergroup marriage and the trends in intergroup marriage in Brazil. The results show higher rates of intermarriage in urban than in rural areas. Intermarriage is less common among the most educated people. While the rates of intermarriage are increasing substantially, the rates of change are diffuse across urban and rural areas, regions and education groups.

Using delta15N and delta18O to evaluate the sources and pathways of NO3- in rainfall event discharge from drained agricultural grassland lysimeters at high temporal resolutions.

The origin of NO(3) (-) yielded in drainage from agricultural grasslands is of environmental significance and has three potential sources; (i) soil organic mater (SOM), (ii) recent agricultural amendments, and (iii) atmospheric inputs. The variation in delta(15)N-NO(3) (-) and delta(18)O-NO(3) (-) was measured from the 'inter-flow' and 'drain-flow' of two 1 ha drained lysimeter plots, one of which had received an application of 21 m(3) of NH(4) (+)-N-rich agricultural slurry, during two rainfall events. Drainage started to occur 1 month after the application of slurry. The concentrations of NO(3) (-)-N from the two lysimeters were comparable; an initial flush of NO(3) (-)-N occurred at the onset of drainage from both lysimeters before levels quickly dropped to <1 mg NO(3) (-)-N L(-1). The isotopic signature of the delta(15)N-NO(3) (-) and delta(18)O-NO(3) (-) during the first two rainfall events showed a great deal of variation over short time-periods from both lysimeters. Isotopic variation of delta(15)N-NO(3) (-) during rainfall events ranged between -1.6 to +5.2 per thousand and +0.4 to +11.1 per thousand from the inter-flow and drain-flow, respectively. Variation in the delta(18)O-NO(3) (-) ranged from +2.0 to +7.8 per thousand and from +3.3 to +8.4 per thousand. No significant relationships between the delta(15)N-NO(3) (-) or delta(18)O-NO(3) (-) and flow rate were observed in most cases although delta(18)O-NO(3) (-) values indicated a positive relationship and delta(15)N-NO(3) (-) values a negative relationship with flow during event 2. Data from a bulked rainfall sample when compared with the theoretical delta(18)O-NO(3) (-) for soil microbial NO(3) (-) indicated that the contribution of rainfall NO(3) (-) accounted for 8% of the NO(3) (-) in the lysimeter drainage at most. The calculated contribution of rainfall NO(3) (-) was not enough to account for the depletion in delta(15)N-NO(3) (-) values observed during the duration of the rainfall event 2. The relationship between delta(15)N-NO(3) (-) and delta(18)O-NO(3) (-) from the drain-flow indicated that denitrification was causing enrichment in the isotopes from this pathway. The presence of slurry seemed to cause a relative depletion in delta(18)O-NO(3) (-) in the inter-flow and delta(15)N-NO(3) (-) in the drain-flow compared with the zero-slurry lysimeter. This may have been caused by increased microbial nitrification stimulated by the presence of increased NH(4) (+)-N.

Multiple stable isotope (18O, 13C, 15N and 34S) analysis of human hair to identify the recent migrants in a rural community in SW England.

Relationships between recent migration and hair delta(18)O values were examined for 40 people living in a rural community in SW England. The isotopic contents of 35 'local' hair samples were compared with those of 5 recently arrived individuals (from Australia, Canada, Chile, Germany and the USA). The hair delta(18)O values of these 'visitors' were +7.9 (Omaha, USA), +11.2 (Jena, Germany), +12.1 (Osorno, Chile), +12.6 (Montreal, Canada) and +14.3 per thousand (Adelaide, Australia). The hair value for the USA visitor (+7.9 per thousand) fell outside the range for the 33 local adult residents, +10.5 to +14.3 per thousand (+12.7 +/- 0.8 per thousand). Hair delta(18)O values did not identify the individuals from Adelaide, Montreal and Osorno as 'visitors', but hair delta(13)C or delta(34)S data did. Combining the hair delta(18)O, delta(13)C and delta(34)S values using principal components analysis (two components explained 89% of the overall variation among the 40 subjects) helped to more clearly distinguish European from non-European individuals, indicating the existence of global overall isotope (geo-origin) relationships.