Low food intake in hospital: patient, institutional, and clinical factors.

In-hospital malnutrition and inadequate food intake have been associated with negative outcomes (e.g., prolonged length of stay, readmission, mortality, and increased hospital costs). Studies examining the factors associated with low food intake in hospital, commonly defined as the consumption of ≤50% of meals, have produced mixed results. We examined the correlates of food intake including patient socioeconomic, demographic, and health characteristics, institutional factors, and common clinical strategies in 1129 medical patients from 5 Canadian hospitals. Low food intake was found in 35% of patients (41% of females and 29% of males) (p < 0.001). In multivariate analyses, sex, socioeconomic status, demographics, and diagnoses were not significantly related to food intake. Patients assessed as malnourished (subjective global assessment (SGA) B/C) (odds ratio (OR), 2.41; p = 0.003) or as not at risk of malnutrition (OR, 1.67; p = 0.040) were more likely to have low intake when compared with those assessed as well nourished (SGA A). Patient reports of mealtime challenges (OR, 2.70; p < 0.001) and barriers to food intake (OR, 1.11; p = 0.008) were positively related to low intake throughout the study sample. Higher 12-Item Short Form Health Survey Mental Component Summary scores were related to better food intake (OR, 0.98; p < 0.001). Clinical strategies such as between-meal snacks lowered the likelihood of low food intake (OR, 0.55; p = 0.037), whereas a group of "other strategies" increased the odds (OR, 2.77; p = 0.001). These results offer a better understanding of the correlates of in-hospital low food intake. The conclusion discusses some avenues for improving food intake in the clinical setting, such as better mealtime monitoring and a reduction in barriers to food intake.

An economic perspective on the causal explanations for the socioeconomic inequalities in health

[ABSTRACT]. Socioeconomic inequality, or the socioeconomic status (SES) gradient, is arguably one of the most-studied phenomena in health. The gradient in health is apparent in objective and subjective measures, across virtually all countries, and is evident at individual and population levels. There is no longer much debate over the relationship between SES and health. However, exact causal pathways remain elusive. Advocating for strong policy to reduce or eliminate the SES-health gradient necessitates understanding the causal pathways, from intervention to outcome. While economists are not convinced that there is a clear enough understanding of the causal pathways of the SEShealth gradient, they have produced a substantial body of work from which to move forward. The article briefly discusses the theoretical underpinnings used by economists as a basis for the study of the causal pathways for the health gradient. That presentation is followed by a concise overview of some of the evidence that economists have produced. The paper concludes with a discussion of how current economic evidence may be used to help policymakers advocate for interventions to limit the SES gradient in noncommunicable diseases.

[RESUMEN]. La desigualdad socioeconómica, o el gradiente según la situación socioeconómica, es posiblemente uno de los fenómenos más estudiados en el campo de la salud. El gradiente de la salud es evidente en mediciones objetivas y subjetivas, en prácticamente todos los países y tanto a nivel individual como poblacional. Ya no se debate mucho la relación entre la situación socioeconómica y la salud. Sin embargo, las vías causales exactas siguen siendo difíciles de definir. A fin de promover políticas enérgicas que reduzcan o eliminen el gradiente socioeconómico de la salud, es necesario entender las vías causales, de la intervención al resultado. Si bien los economistas no están convencidos de que se conozcan suficientemente las vías causales del gradiente socioeconómico de la salud, han producido un volumen sustancial de trabajo a partir del cual avanzar. En este artículo se comentan brevemente los fundamentos teóricos usados por los economistas como base para estudiar las vías causales del gradiente de salud. Luego se brinda un panorama conciso de algunos de los datos científicos generados por los economistas. El artículo concluye con una discusión de cómo pueden usarse los datos científicos económicos actuales para ayudar a los responsables de formular políticas a proponer intervenciones que limiten el gradiente socioeconómico en materia de enfermedades no transmisibles.

[RESUMO]. A desigualdade socioeconômica, ou o gradiente socioeconômico, é possivelmente um dos fenômenos mais estudados em saúde. O gradiente em saúde é evidente nas medidas objetivas e subjetivas em praticamente todos os países e é evidente ao nível do indivíduo e de população. Já não existe muito debate sobre a relação entre nível socioeconômico e saúde, mas as exatas vias causais continuam mal definidas. Defender uma firme política para reduzir ou eliminar o gradiente socioeconômico em saúde requer conhecer as vias causais, da intervenção ao resultado. Por não estarem convencidos de que existe um entendimento claro razoável das vias causais do gradiente socioeconômico em saúde, os economistas produziram um volume substancial de estudos que servem de base. O artigo aborda resumidamente os princípios teóricos para embasar o estudo das vias causais do gradiente em saúde e apresenta de forma concisa o panorama das evidências geradas pelos economistas. Por fim, se discute como as evidências econômicas atuais podem ser empregadas para ajudar os responsáveis pelas políticas a defender intervenções visando reduzir o gradiente socioeconômico nas doenças não transmissíveis.

An economic perspective on the causal explanations for the socioeconomic inequalities in health.

Socioeconomic inequality, or the socioeconomic status (SES) gradient, is arguably one of the most-studied phenomena in health. The gradient in health is apparent in objective and subjective measures, across virtually all countries, and is evident at individual and population levels. There is no longer much debate over the relationship between SES and health. However, exact causal pathways remain elusive. Advocating for strong policy to reduce or eliminate the SES-health gradient necessitates understanding the causal pathways, from intervention to outcome. While economists are not convinced that there is a clear enough understanding of the causal pathways of the SES-health gradient, they have produced a substantial body of work from which to move forward. The article briefly discusses the theoretical underpinnings used by economists as a basis for the study of the causal pathways for the health gradient. That presentation is followed by a concise overview of some of the evidence that economists have produced. The paper concludes with a discussion of how current economic evidence may be used to help policymakers advocate for interventions to limit the SES gradient in noncommunicable diseases.

La desigualdad socioeconómica, o el gradiente según la situación socioeconómica, es posiblemente uno de los fenómenos más estudiados en el campo de la salud. El gradiente de la salud es evidente en mediciones objetivas y subjetivas, en prácticamente todos los países y tanto a nivel individual como poblacional. Ya no se debate mucho la relación entre la situación socioeconómica y la salud. Sin embargo, las vías causales exactas siguen siendo difíciles de definir. A fin de promover políticas enérgicas que reduzcan o eliminen el gradiente socioeconómico de la salud, es necesario entender las vías causales, de la intervención al resultado. Si bien los economistas no están convencidos de que se conozcan suficientemente las vías causales del gradiente socioeconómico de la salud, han producido un volumen sustancial de trabajo a partir del cual avanzar. En este artículo se comentan brevemente los fundamentos teóricos usados por los economistas como base para estudiar las vías causales del gradiente de salud. Luego se brinda un panorama conciso de algunos de los datos científicos generados por los economistas. El artículo concluye con una discusión de cómo pueden usarse los datos científicos económicos actuales para ayudar a los responsables de formular políticas a proponer intervenciones que limiten el gradiente socioeconómico en materia de enfermedades no transmisibles.

A desigualdade socioeconômica, ou o gradiente socioeconômico, é possivelmente um dos fenômenos mais estudados em saúde. O gradiente em saúde é evidente nas medidas objetivas e subjetivas em praticamente todos os países e é evidente ao nível do indivíduo e de população. Já não existe muito debate sobre a relação entre nível socioeconômico e saúde, mas as exatas vias causais continuam mal definidas. Defender uma firme política para reduzir ou eliminar o gradiente socioeconômico em saúde requer conhecer as vias causais, da intervenção ao resultado. Por não estarem convencidos de que existe um entendimento claro razoável das vias causais do gradiente socioeconômico em saúde, os economistas produziram um volume substancial de estudos que servem de base. O artigo aborda resumidamente os princípios teóricos para embasar o estudo das vias causais do gradiente em saúde e apresenta de forma concisa o panorama das evidências geradas pelos economistas. Por fim, se discute como as evidências econômicas atuais podem ser empregadas para ajudar os responsáveis pelas políticas a defender intervenções visando reduzir o gradiente socioeconômico nas doenças não transmissíveis.

An economic perspective on the causal explanations for the socioeconomic inequalities in health / Una perspectiva económica sobre las explicaciones causales de las desigualdades socioeconómicas en materia de salud / Uma perspectiva econômica da explicação causal para as desigualdades socioeconômicas em saúde

ABSTRACT Socioeconomic inequality, or the socioeconomic status (SES) gradient, is arguably one of the most-studied phenomena in health. The gradient in health is apparent in objective and subjective measures, across virtually all countries, and is evident at individual and population levels. There is no longer much debate over the relationship between SES and health. However, exact causal pathways remain elusive. Advocating for strong policy to reduce or eliminate the SES-health gradient necessitates understanding the causal pathways, from intervention to outcome. While economists are not convinced that there is a clear enough understanding of the causal pathways of the SES-health gradient, they have produced a substantial body of work from which to move forward. The article briefly discusses the theoretical underpinnings used by economists as a basis for the study of the causal pathways for the health gradient. That presentation is followed by a concise overview of some of the evidence that economists have produced. The paper concludes with a discussion of how current economic evidence may be used to help policymakers advocate for interventions to limit the SES gradient in noncommunicable diseases.

RESUMEN La desigualdad socioeconómica, o el gradiente según la situación socioeconómica, es posiblemente uno de los fenómenos más estudiados en el campo de la salud. El gradiente de la salud es evidente en mediciones objetivas y subjetivas, en prácticamente todos los países y tanto a nivel individual como poblacional. Ya no se debate mucho la relación entre la situación socioeconómica y la salud. Sin embargo, las vías causales exactas siguen siendo difíciles de definir. A fin de promover políticas enérgicas que reduzcan o eliminen el gradiente socioeconómico de la salud, es necesario entender las vías causales, de la intervención al resultado. Si bien los economistas no están convencidos de que se conozcan suficientemente las vías causales del gradiente socioeconómico de la salud, han producido un volumen sustancial de trabajo a partir del cual avanzar. En este artículo se comentan brevemente los fundamentos teóricos usados por los economistas como base para estudiar las vías causales del gradiente de salud. Luego se brinda un panorama conciso de algunos de los datos científicos generados por los economistas. El artículo concluye con una discusión de cómo pueden usarse los datos científicos económicos actuales para ayudar a los responsables de formular políticas a proponer intervenciones que limiten el gradiente socioeconómico en materia de enfermedades no transmisibles.

RESUMO A desigualdade socioeconômica, ou o gradiente socioeconômico, é possivelmente um dos fenômenos mais estudados em saúde. O gradiente em saúde é evidente nas medidas objetivas e subjetivas em praticamente todos os países e é evidente ao nível do indivíduo e de população. Já não existe muito debate sobre a relação entre nível socioeconômico e saúde, mas as exatas vias causais continuam mal definidas. Defender uma firme política para reduzir ou eliminar o gradiente socioeconômico em saúde requer conhecer as vias causais, da intervenção ao resultado. Por não estarem convencidos de que existe um entendimento claro razoável das vias causais do gradiente socioeconômico em saúde, os economistas produziram um volume substancial de estudos que servem de base. O artigo aborda resumidamente os princípios teóricos para embasar o estudo das vias causais do gradiente em saúde e apresenta de forma concisa o panorama das evidências geradas pelos economistas. Por fim, se discute como as evidências econômicas atuais podem ser empregadas para ajudar os responsáveis pelas políticas a defender intervenções visando reduzir o gradiente socioeconômico nas doenças não transmissíveis.

The relationship between work hours and utilization of general practitioners in four Canadian provinces.

OBJECTIVE: To assess whether long work hours act as a barrier to accessing general practitioner (GP) services. DATA SOURCES: Secondary data from the 1996/1997 National Population Health Survey (NPHS) and administrative health services utilization data from four Canadian provinces. STUDY DESIGN: This study was cross-sectional, however, employment variables and GP utilization were reflective of the 12-month period preceding the NPHS interview date. Negative binomial regression was used to model the relationship between the number of GP visits in a 1-year period and employment-related variables while adjusting for other determinants of GP utilization including education, income, and health status. DATA EXTRACTION METHODS: NPHS and administrative data were linked to create an analysis file. PRINCIPAL FINDINGS: Subjects with long, standard work hours (>45 hours/week, with most hours during the day) had significantly lower GP utilization rates compared with full-time workers. White-collar workers with long work hours visited a GP significantly less often than white-collar workers with regular hours. CONCLUSIONS: Long work hours may act as a nonfinancial barrier to accessing GP services independent of health status.

Social assistance, lone parents and health: what do we know, where do we go?

BACKGROUND: A mounting body of evidence indicates that lone mothers and their children are at higher risk of a variety of health problems. The dynamics of the relationship between social assistance, poverty and health are not well understood, and the study of this population presents substantial challenges. The purpose of this paper is to present an analysis of the state of research on lone parents, social assistance and health in an effort to make recommendations that will move the research forward. METHODS: Reviews of the relevant literature and social policies were conducted to identify (1) trends in social assistance policy and the extent of interprovincial variation in policy, and (2) research gaps. A series of interviews were conducted with key informants in government, non-governmental organizations and academia to gather information regarding research obstacles, opportunities and priorities. Finally, a consensus-building workshop was held to form research recommendations. RESULTS: A substantial degree of variation exists among provinces and territories with regard to social assistance policies. The nature of the variation, however, is complex and does not fall into tightly defined categories. This variation creates the possibility for "natural experiments" to examine the health implications of policies and practices. The pace of policy change, however, creates problems with respect to evaluation of specific policy initiatives. Interviewees and workshop participants recognized substantial impediments to research in this area, particularly regarding the availability of appropriate data. CONCLUSION: A research agenda, data development and dissemination activities were proposed to increase the research activity; these would be based upon multi-disciplinary, multi-sectoral collaborations using multiple methodologies. The creation of a multi-disciplinary, multi-sectoral national consortium in social assistance and health, reflecting the appropriate mix of urban, rural, anglophone, francophone and First Nations communities, is proposed.

Mutual influences on maternal depression and child adjustment problems.

Often undetected and poorly managed, maternal depression and child adjustment problems are common health problems and impose significant burden to society. Studies show evidence of mutual influences on maternal and child functioning, whereby depression in mothers increases risk of emotional and behavioral problems in children and vice versa. Biological mechanisms (genetics, in utero environment) mediate influences from mother to child, while psychosocial (attachment, child discipline, modeling, family functioning) and social capital (social resources, social support) mechanisms mediate transactional influences on maternal depression and child adjustment problems. Mutual family influences in the etiology and maintenance of psychological problems advance our understanding of pathways of risk and resilience and their implications for clinical interventions. This article explores the dynamic interplay of maternal and child distress and provides evidence for a biopsychosocial model of mediating factors with the aim of stimulating further research and contributing to more inclusive therapies for families.

Temporal relations in daily-reported maternal mood and disruptive child behavior.

Examined temporal relations between maternal mood and disruptive child behaviour using daily assessments of 30 mother-child dyads carried out over 8 consecutive weeks (623 pooled observations). Pooled time-series analyses showed synchronous fluctuation in child behaviour and maternal distress. Time-lagged models showed temporal relations between maternal and child outcomes that changed according to the type of maternal mood and child behaviour being reported. Controlling for cross-sectional relations, maternal anger and fatigue were related to previous child inattentive/impulsive/overactive behaviour (IO) and maternal confusion related to previous child oppositional/defiant behaviour (OD). However, maternal depression, low vigour, anger, and anxiety each predicted subsequent child IO and maternal confusion and anxiety each predicted subsequent child OD. Mutual influences on maternal and child functioning were interpreted in the context of interpersonal mechanisms that mediate psychological problems within families and their implications for treatment.

Antecedent-consequence conditions in maternal mood and child adjustment: a four-year cross-lagged study.

Examined the mutual influence on maternal depressive symptoms and child adjustment problems and their antecedent-consequence conditions across 3 cycles of panel data collected over a 4-year period in the National Longitudinal Survey of Children and Youth (NLSCY). Results indicated stability in, and relations between, maternal and child outcomes. Cross-lagged panel correlations showed that maternal depressive symptoms tended to precede child aggression and hyperactivity but tended to follow child emotional problems. Temporal relations were interpreted in the context of mechanisms that transmit risk between mothers and children. Logistic regression analysis showed bidirectional risk between maternal mood and child adjustment after earlier symptoms were statistically controlled. These findings indicate that maternal depression increases the risk of adjustment problems in children, and vice versa, underscoring the intergenerational transmission of psychopathology.