Influence of socio-economic status on Shiga toxin-producing Escherichia coli (STEC) infection incidence, risk factors and clinical features.

Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010-2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19-2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10-1.75) and hospitalisation (OR 1.71, 95% CI 1.36-2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16-2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40-2.27; OR 1.85, 95% CI 1.35-2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22-2.70; soil contact, OR 1.52, 95% CI 2.13-1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.

An examination of demographic variables, nurturance, and empathy among homosexual and heterosexual big brother/big sister volunteers.

Potential volunteers are often screened for sexual orientation and, in most circumstances, excluded if they are gay men or lesbians. This is especially true if the volunteer's work involves children. Big Brothers/Big Sisters of San Francisco deviates from this practice and screens volunteers based on other attributes. This study investigates differences in demographic variables, nurturance, and empathy among homosexual and heterosexual Big Brothers/Big Sisters of San Francisco. Two hundred nineteen questionnaires were returned and results indicated that there were no significant differences in demographic factors, nurturance, or empathy based on sexual orientation. Gender differences for the study variables were found and these are consistent with the results of earlier studies. Three significant factors were identified: stability, social support and personality attributes. Sexual orientation was not a significant factor.

Where do we stand? Research and policy issues concerning inequalities in health and in healthcare.

There are signs that the seriousness of the challenge posed by social inequalities in health and in healthcare is filtering through to governments in an increasing number of countries. The problem includes a large, and in some cases widening, gap between the health of the rich and the poor within countries, coupled with serious social and economic inequalities across society in general. Healthcare reforms are posing further dilemmas in relation to equity. The first part of this paper outlines some of the latest evidence on the scale and nature of the problem and the key research questions selected for future study in the national research programmes set up on the subject. The second part considers unemployment and health in more detail, illustrating some of the policy issues which this raises. The last part focuses on practical strategies for the health sector to adopt to build a more equitable policy response.