The impact of residential environment on older people's capabilities to live independently: a survey in Beijing.

BACKGROUND: Studies have shown how environmental factors influence older people's health and functional limitations, which are crucial for achieving healthy aging. However, such a healthy aging model has been criticized for defining health as an absence of disease, because chronic conditions cannot be reversed through medical treatments. In response to such critiques, this study refers to Huber's positive health definition, arguing that health should not be defined as the absence of disease but as the ability to adapt and self-manage in the face of social, physical, and emotional challenges. There is a need to develop a community-based approach to healthy aging that considers how the residential environment enables older people to adapt and self-manage. Drawing on Sen's capability approach, this study proposes that such a community-based approach should provide a supportive environment to enable older people's capabilities to live independently. METHODS: Using hierarchical multiple regression analysis of data from 650 older people (60 years and older) surveyed in Beijing, we unravel which features of the residential environment support older people' s capabilities to live independently and how these impacts differ depending on older people's frailty levels. RESULTS: The results show that four environmental factors, namely perceived accessibility (B = 0.238, p < 0.001 for physical capability, B = 0.126, p < 0.001 for social capability, B = 0.195, p < 0.001 for psychological capability), pleasant surroundings (B = 0.079, p < 0.05 for physical capability, B = 0.065, p < 0.05 for social capability), meeting opportunities (B = 0.256, p < 0.001 for social capability, B = 0.188, p < 0,001 for psychological capability, and life convenience B = 0.089, p < 0.05 for physical capability, B = 0.153, p < 0.001 for psychological capability) positively affect older people's capabilities to live independently. These four environmental factors cause differences in older people's capabilities between different neighborhood types. Moderation analysis shows that meeting opportunities are more relevant for frail older people (B = 0.090, p < 0.001 for social capability, B = 0.086, p < 0.01 for psychological capability). CONCLUSIONS: This study contributes to the literature by emphasizing the role of supportive residential environments in enabling older people to live independently. Furthermore, we identify four environmental factors that support older people's capabilities. Results can be used to develop effective community-based environmental support to enable older people to live independently.

Understanding the Institutional Logics of China's Community-Based Intervention for Older People.

Community-based policies have gained global popularity, signaling a paradigm shift from individual responsibility for healthy aging to an approach involving community-based intervention. Learning from Western experience, China has also experimented with this form of intervention. It has policy interventions aimed at providing community-based facilities and services that enable older people to age in place. However, the institutional foundations of Chinese communities differ greatly from those in Western countries. Implementing a critical realist case study focusing on a community-based program in Beijing, this study aims to examine the institutional logics that contribute toward a contextually appropriate community-based policy intervention in China. We identified three institutional logics. First, the Confucian moral obligation of benevolence requires authorities to provide social welfare for vulnerable citizens. Second, China's community-based interventions are state-led territorialized provisions prioritizing communities rather than individuals. Third, community-based social policies are subordinate to economic growth objectives. This study contributes to the understanding of contextually appropriate community-based policy interventions in China.

Being Poorer Than the Rest of the Neighborhood: Relative Deprivation and Problem Behavior of Youth.

According to the neighborhood effects hypothesis, there is a negative relation between neighborhood wealth and youth's problem behavior. It is often assumed that there are more problems in deprived neighborhoods, but there are also reports of higher rates of behavioral problems in more affluent neighborhoods. Much of this literature does not take into account relative wealth. Our central question was whether the economic position of adolescents' families, relative to the neighborhood in which they lived, was related to adolescents' internalizing and externalizing problem behavior. We used longitudinal data for youth between 12-16 and 16-20 years of age, combined with population register data (N = 926; 55% females). We employ between-within models to account for time-invariant confounders, including parental background characteristics. Our findings show that, for adolescents, moving to a more affluent neighborhood was related to increased levels of depression, social phobia, aggression, and conflict with fathers and mothers. This could be indirect evidence for the relative deprivation mechanism, but we could not confirm this, and we did not find any gender differences. The results do suggest that future research should further investigate the role of individuals' relative position in their neighborhood in order not to overgeneralize neighborhood effects and to find out for whom neighborhoods matter.

THE EFFECT OF PREGNANCY SPACING ON FETAL SURVIVAL AND NEONATAL MORTALITY IN RWANDA: A HECKMAN SELECTION ANALYSIS.

Most studies on birth intervals and infant mortality ignore pregnancies that do not result in live births. Yet, fetal deaths are important in infant mortality analyses for three reasons: ignoring fetal deaths between two live births lengthens the measured interval between births, implying that short intervals are underestimated; the recommended inter-pregnancy interval (IPI) after a fetal loss is shorter (6 months) than after a live birth (24 months), as the effect of IPI on outcomes might differ according to the previous type of pregnancy outcome; fetal death will selectively reduce the population at risk of neonatal mortality, leading to biased results. This study uses the Heckman selection model to simultaneously estimate the combined effect of IPI duration and the type of pregnancy outcome at the start of the interval on pregnancy survival and neonatal mortality. The analysis is based on retrospective data from the Rwanda Demographic Health Surveys of 2000, 2005 and 2010. The results show a significant selection effect. After controlling for the selection bias, short (60 months) intervals after a fetal death reduce the chances of pregnancy survival, but no longer have an effect on neonatal mortality. For intervals starting with a live birth, the reverse is true. Short intervals (<24 months) do not affect pregnancy survival but increase the odds of neonatal mortality. If the previous child died in infancy, the highest odds are found for neonatal death regardless of the IPI duration.

The association between neighbourhoods and educational achievement, a systematic review and meta-analysis.

Many studies have examined the effects of neighbourhoods on educational outcomes. The results of these studies are often conflicting, even if the same independent variables (such as poverty, educational climate, social disorganisation, or ethnic composition) are used. A systematic meta-analysis may help to resolve this lack of external validity. We identified 5516 articles from which we selected 88 that met all of the inclusion criteria. Using meta-regression, we found that the relation between neighbourhoods and individual educational outcomes is a function of neighbourhood poverty, the neighbourhood's educational climate, the proportion of ethnic/migrant groups, and social disorganisation in the neighbourhood. The variance in the findings from different studies can partly be explained by the sampling design and the type of model used in each study. More important is the use of control variables (school, family SES, and parenting variables) in explaining the variation in the strength of neighbourhood effects.

Inter-Pregnancy Intervals and Maternal Morbidity: New Evidence from Rwanda.

The effects of short and long pregnancy intervals on maternal morbidity have hardly been investigated. This research analyses these effects using logistic regression in two steps. First, data from the Rwanda Demographic and Health Survey 2010 are used to study delivery referrals to District hospitals. Second, Kibagabaga District Hospital's maternity records are used to study the effect of inter-pregnancy intervals on maternal morbidity. The results show that both short and long intervals lead to higher odds of being referred because of pregnancy or delivery complications. Once admitted, short intervals were not associated with higher levels of maternal morbidity. Long intervals are associated with higher risks of third trimester bleeding, premature rupture of membrane and lower limb edema, while a higher age at conception is associated with lower risks. Poor women from rural areas and with limited health insurance are less often admitted to a hospital, which might bias the results.

Neighbourhood effects on educational attainment of adolescents, buffered by personality and educational commitment.

Research has repeatedly shown that neighbourhood disadvantage negatively influences individual educational outcomes. However, the great variation in outcomes indicates substantial unobserved heterogeneity. Looking at the rates of obtaining a basic educational qualification, the hypothesis is that individual traits of adolescents can buffer neighbourhood effects. First, adolescents with a more resilient personality may be better able to cope with neighbourhood adversity. And second, educational commitments might buffer adolescents from negative neighbourhood influences. These hypotheses are tested employing survival analysis, using six wave panel data, containing information on ten years of adolescents' lives. The results show that resilients experience no negative influence of neighbourhood disadvantage, while both undercontrollers and overcontrollers do. And, the stronger adolescents' educational commitments, the less they experience the negative effect of neighbourhood adversity. In sum, neighbourhood effects are found, but not for everybody.

Neighbourhood immigrant concentration effects on migrant and native youth's educational commitments, an enquiry into personality differences.

In the literature examining neighbourhood effects on educational outcomes, the socialisation mechanism is usually investigated by looking at the association between neighbourhood characteristics and educational attainment. The step in between, that adolescents actually internalise educational norms held by residents, is often assumed. We attempt to fill this gap by looking at how the internalisation of educational norms (commitments) is influenced by neighbourhoods' immigrant concentration. We investigate this process for both migrant and native youth, as both groups might be influenced differently by immigrant concentrations. To test our hypothesis we used longitudinal panel data with five waves (N = 4255), combined with between-within models which control for a large portion of potential selection bias. These models have an advantage over naïve OLS models in that they predict the effect of change in neighbourhood characteristics on change in educational commitment, and therefore offer a more dynamic approach to modelling neighbourhood effects. Our results show that living in neighbourhoods with higher proportions of immigrants increases the educational commitments of migrant youth compared to living in neighbourhoods with lower proportions. Besides, we find that adolescents with a resilient personality experience less influence of the neighbourhood context on educational commitments than do adolescents with non-resilient personalities.

Neighbourhood Poverty, Work Commitment and Unemployment in Early Adulthood: A Longitudinal Study into the Moderating Effect of Personality.

We studied how personality moderates the effect of neighbourhood disadvantage on work commitment and unemployment in early adulthood. Using a personality typology of resilients, overcontrollers, and undercontrollers, we hypothesised that the association between neighbourhood poverty and both work commitment and unemployment would be stronger for overcontrollers and undercontrollers than for resilients. We used longitudinal data (N = 249) to test whether the length of exposure to neighbourhood poverty between age 16 and 21 predicts work commitment and unemployment at age 25. In line with our hypothesis, the findings showed that longer exposure was related to weaker work commitment among undercontrollers and overcontrollers and to higher unemployment among undercontrollers. Resilients' work commitment and unemployment were not predicted by neighbourhood poverty.

Biological sensitivity to context: Cortisol awakening response moderates the effects of neighbourhood density on the development of adolescent externalizing problem behaviours.

This four-year longitudinal study attempted to test person-environment interaction theory and biological sensitivity theory by assessing whether individuals' biological stress activity CARAUCg (Cortisol Awakening Response Area Under the Curve with respect to ground) moderates the effects of neighbourhood density on the development of adolescent externalizing problem behaviours. Participants were 358 Dutch adolescents with a mean age of 15 years at the first measurement. Our analyses showed that CARAUCg moderated the effects of neighbourhood density on the level of parent-reported delinquency and aggression and adolescent self-reported delinquency. More specifically, for adolescents with high CARAUCg, higher neighbourhood density significantly predicted higher levels of parent-reported and adolescent self-reported delinquency and aggression, whereas the association was reversed or non-significant for adolescents with low CARAUCg. Our findings suggest that adolescents with different levels of CARAUCg respond differentially to the density of the neighbourhood they live in, supporting for person-environment interaction perspectives and biological sensitivity theory.

The Effects of Interpregnancy Intervals and Previous Pregnancy Outcome on Fetal Loss in Rwanda (1996-2010).

In 2005, a WHO consultation meeting on pregnancy intervals recommended a minimum interval of 6 months after a pregnancy disruption and an interval of two years after a live birth before attempting another pregnancy. Since then, studies have found contradictory evidence on the effect of shorter intervals after a pregnancy disruption. A binary regression analysis on 21532 last pregnancy outcomes from the 2000, 2005, and 2010 Rwanda Demographic and Health Surveys was done to assess the combined effects of the preceding pregnancy outcome and the interpregnancy intervals (IPIs) on fetal mortality in Rwanda. Risks of pregnancy loss are higher for primigravida and for mothers who lost the previous pregnancy and conceived again within 24 months. After a live birth, interpregnancy intervals less than two years do not increase the risk of a pregnancy loss. This study also confirms higher risks of fetal death when IPIs are beyond 5 years. An IPI of longer than 12 months after a fetal death is recommended in Rwanda. Particular attention needs to be directed to postpregnancy abortion care and family planning programs geared to spacing pregnancies should also include spacing after a fetal death.

Demand and unmet need for means of family limitation in Rwanda.

CONTEXT: Rwanda is the most densely populated country in Africa, with substantial annual population growth. The current government seeks new policies for family limitation as a way to facilitate more sustainable development. METHODS: Data from the 2005 Rwanda Demographic and Health Survey were used for a two-step analysis; binary logistic regression was used to identify factors associated with desiring to stop childbearing and having unmet need. RESULTS: Eighty-seven percent of women aged 15-49 approve of family planning, but only 64% believe that their partner approves of it. There is a high level of unmet need for family limitation; 58% of women who want to stop childbearing do not use modern contraceptives. Demand was lower among women who did not approve of family planning, those who did not know their partner's attitude toward family planning and those who had discussed family planning with their partner fewer than three times. Unmet need was higher among women who did not approve of family planning, those who believed their partner did not approve of family planning or who did not know his attitude, and those who had never discussed family planning with their partner or had done so only once or twice. CONCLUSIONS: Negative attitudes toward family planning and failing structures of provision are the dominant constraints on the use of modern contraceptives in Rwanda. Community-based family planning services could greatly expand access, especially in underserved provinces.

Role of Conflict in Shaping Fertility Preferences in Rwanda

Conflicts affect the social and economic conditions that could account for the stall in fertility decline in Sub-Saharan Africa. For Rwanda; the total fertility rate decreased very rapidly to 6.1 in the eighties but stalled at that level in the nineties. Part of the stall can be attributed to a lack of fertility control; but the question is whether social upheaval also affects fertility preferences. We identify three mechanisms through which the Rwanda conflict have led to a preference for larger families: mortality experience; modernization and the attitudes of third parties. Using data from DHS; we tested the contribution of these mechanisms to the preference for small; medium or large families. With the exception of sibling mortality; there is a strong impact of these mechanisms on the preference for large families; yet they do not fully account for the shifts in preferences over the years