Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress.

BACKGROUND: Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. However, the impact of sex, and subsequent gender inequity, is likely to be more multifaceted than this explanation implies. Not least because of historical inequities in access to education between the sexes and the gender and socio-economic gradients in risk factors such as stress, depression and social isolation. Consequently, the present study sought to test whether differences in educational attainment and experiences of general psychological distress mediate the association between female sex and dementia. METHODS: The study utilizes data obtained through the Gothenburg H70 Birth Cohort Study and the Prospective Populations Study on Women (n = 892). Data were analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) with Weighted Least Squares Means and Variance adjusted (WLSMV) estimation. General psychological distress was indicated by a latent variable and constructed from five manifest items (previous depression, stress, self-esteem, chronic loneliness and satisfaction with social situation) that were all measured at baseline. RESULTS: While the results could not corroborate that education directly mediates the effect of sex on dementia, level of distress was predicted by both female sex (0.607, p < .001) and education (- 0.166, p < .01) and, in turn, shown to be significantly associated with dementia (0.167, p < .05), also after controlling for confounders. When time from baseline to diagnosis was increased through sequential exclusion of dementia cases, the effect of distress on dementia was no longer significant. CONCLUSION: The overall findings suggest that social (dis) advantage predicts general psychological distress, which thereby constitutes a potential, and rarely acknowledged, pathway between female sex, education, and dementia. They further underline the importance of attending to both education and distress as 'gendered' phenomena when considering the nature of their associations with dementia. However, the possibility of reverse causality bias must be acknowledged and the need for longitudinal studies with longer follow-up stressed.

Men's Economic Abuse Toward Women in Sweden: Findings From a National Survey.

Drawing from a nationally representative survey (n = 6,611), this article analyses the prevalence of men's economic abuse toward women in Sweden. Economic abuse is still a relatively marginalized area of research but is increasingly recognized as a distinct type of intimate partner violence. A few Swedish studies have specifically focused on economic abuse, yet none of which with a quantitative approach. A main finding is that motherhood significantly increases the risk of exposure. Furthermore, women report economic abuse from expartners (25%) to a much greater extent than from current partners (8%).

Fall-related injuries for three ages groups - Analysis of Swedish registry data 1999-2013.

INTRODUCTION: The objective of this study was to analyze which factors (including factors pertaining to the individual, the household, and the local area) increase the risk of fall injuries for the three age groups with the highest risk for fall injuries in Sweden. METHOD: The study combined longitudinal data covering the period 1999-2013 from several different official registries from Statistics Sweden as well as from the Swedish health care system and fitted the models to data using mixed model regressions. RESULTS: Three age groups had a markedly heightened risk for fall injuries: 1-3-year olds, 12-14 year olds, and the elderly (65+). The home was the most common location for fall injuries, as about 40% of all fall injuries occur in the home. Only for the elderly strong predictors for fall injuries were found, and these were: age, single household, and special housing. CONCLUSIONS: There is preventive potential in the special residences for the elderly and disabled. People living in these special residences make up a strongly selected group that needs extra safe environments. Our findings indicate that their needs are currently not meet. Practical applications: Design of special residences for the elderly and disabled should aim at reducing the consequences of falling.

The influence of maternal agency on severe child undernutrition in conflict-ridden Nigeria: Modeling heterogeneous treatment effects with machine learning.

Nigeria is one of the fastest growing African economies, yet struggles with armed conflict, poverty, and morbidity. An area of high concern is how this situation affects vulnerable families and their children. A key pathway in improving the situation for children in times of conflict is to reinforce maternal agency, for instance, through education. However, the state of the art of research lacks a clear understanding of how many years of education is needed before children benefit. Due to mother's differing social context and ability, the effect of maternal education varies. We study the heterogeneous treatment effects of maternal agency, here operationalized as length of education, on severe child undernutrition in the context of armed conflict. We deploy a repeated cross-sectional study design, using the Nigeria 2008 and 2013 Demographic and Health Survey (DHS). The sample covers 25,917 children and their respective mothers. A key methodological challenge is to estimate this heterogeneity inductively. The causal inference literature proposes a machine learning approach, Bayesian Additive Regression Trees (BART), as a promising avenue to overcome this challenge. Based on BART-estimation of the Conditional Average Treatment Effect (CATE) this study confirms earlier findings in that maternal education decreases severe child undernutrition, but only when mothers acquire an education that lasts more than the country's compulsory 9 years; that is 10 years of education and higher. This protective effect remains even during the exposure of armed conflict.

Socioeconomic status, gender and dementia: The influence of work environment exposures and their interactions with APOE ɛ4.

It is a well-established fact that unfavourable social and economic conditions have a negative impact on health and longevity. Recent findings suggest that this is also true of age-related dementias. Yet most common indicators of socioeconomic status (SES) say very little about the actual mechanisms at play in disease development. The present paper explores five work exposure characteristics, all of which have a clear social gradient, that could potentially shed further light on the relationship between SES and dementia. Specifically, it investigates whether these exposures could moderate the impact of a well-known genetic risk factor: the APOE ɛ4 allele. The empirical analyses are based on data from a Swedish population study (n = 1019). Main occupation was linked to The Job Exposure Matrix to estimate the individuals' exposure to the following work environment factors: work control, support, psychological demands, physical demands and job hazards. All analyses were conducted using binary logistic regression and focused specifically on gene-work exposure interactions. A significant main effect of work control on dementia risk was detected for males (OR = 0.68; p< 0.05), but not for females. However, control was found to significantly moderate the effect of APOE ɛ4 in both genders, albeit in different ways. These findings do not only underscore the importance of considering interactions between social and genetic risk factors to better understanding multifactorial diseases such as dementia. They also propose that gender- and class-based inequities interact, and hence must be considered simultaneously, also in relation to this particular disease.