Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis.

BACKGROUND: Characteristics of social environments are potential risk factors for adolescent injury. Impacts of social capital on the occurrence of such injuries have rarely been explored. METHODS: General health questionnaires were completed by 8910 youth aged 14 years and older as part of the 2010 Canadian Health Behaviour in School-Aged Children study. These were supplemented with community-level data from the 2006 Canada Census of Population. Multilevel logistic regression models with random intercepts were fit to examine associations of interest. The reliability and validity of variables used in this analysis had been established in past studies, or in new analyses that employed factor analysis. RESULTS: Between school differences explained 2% of the variance in the occurrence of injuries. After adjustment for all confounders, community social capital did not have any impact on the occurrence of injuries in boys: OR: 1.01, 95% CI 0.80 to 1.29. However, living in areas with low social capital was associated with lower occurrence of injuries in girls (OR 0.78, 95% CI 0.63 to 0.96). Other factors that were significantly related to injuries in both genders were younger age, engagement in more risky behaviours, and negative behavioural influences from peers. CONCLUSIONS: After simultaneously taking into account the influence of community-level and individual-level factors, community levels of social capital remained a relatively strong predictor of injury among girls but not boys. Such gender effects provide important clues into the social aetiology of youth injury.

Life-Space Assessment scale to assess mobility: validation in Latin American older women and men.

BACKGROUND: The Life-Space Assessment (LSA) instrument of the University of Alabama and Birmingham study is a useful and innovative measure of mobility in older populations. The purpose of this article was to assess the reliability, construct and convergent validity of the LSA in Latin American older populations. METHODS: In a cross-sectional study, a total of 150 women and 150 men, aged 65-74 years, were recruited from seniors' community centers in Manizales, Colombia and Natal, Brazil. The LSA questionnaire summarizes where people travel (5 levels from room to places outside of town), how often and any assistance needed. Four LSA variables were obtained according to the maximum life space achieved and the level of independence. As correlates of LSA, education, perception of income sufficiency, depression, cognitive function, and functional measures (objective and subjectively measured) were explored. The possible modifying effect of the city on correlates of LSA was examined. RESULTS: Reliability for the composite LSA score was substantial (ICC = 0.70; 95 % CI 0.49-0.83) in Manizales. Average levels of LSA scores were higher in those with better functional performance and those who reported less mobility difficulties. Low levels of education, insufficient income, depressive symptoms, and low scores of cognitive function were all significantly related to lower LSA scores. Women in both cities were more likely to be restricted to their neighborhood and had lower LSA scores. CONCLUSION: This study provides evidence for the validity of LSA in two Latin American populations. Our results suggest that LSA is a good measure of mobility that reflects the interplay of physical functioning with gender and the social and physical environment.

Adaptation and Pilot Evaluation of an Intervention Addressing the Sexual Health Needs of Gay Men Living with HIV Infection in Colombia.

Interventions addressing the sexual health need of HIV-positive men who have sex with men (MSM) in Latin America are scarce. We adapted and evaluated GPS, a group-based intervention led by peers, developed using the Information-Motivation-Behavioral (IMB) model and motivational interviewing (MI). We used McKleroy et al framework to culturally adapt GPS to MSM living with HIV infection in Colombia. Then, a one-armed pilot trial examined changes in depressive symptoms, loneliness, self-efficacy for engaging in sexual risk reduction behaviors, sexual sensation seeking and sexual compulsivity at pre-intervention, post-intervention, and 3-month follow-up. These results were complemented with semistructured interviews with participants 3 months after the intervention. GPS was identified to be culturally acceptable with few changes in materials and exercises. Facilitators showed high levels of adherence and fidelity to MI principles. Seven of 11 eligible participants finished the intervention; GPS positively influenced self-efficacy for condom negotiation, depressive symptoms, and condomless anal sex with partners of unknown HIV status. Exit interviews revealed that GPS was well-designed, relevant, facilitated discussion of sex in a nonjudgmental manner, and helped make positive changes in participants' sexual lives. These results provided preliminary evidence of an intervention to address sexual and mental health of MSM living with HIV in Latin America.

Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging.

OBJECTIVE: In women, the risk of cardiovascular disease (CVD) is higher in the postmenopausal period. The effect that menopausal type, natural versus surgical, or the age at natural menopause has on CVD needs further investigation. To this end, we assessed the association between menopausal type and timing and the 10-year office-based Framingham Risk Score (FRS) in women from the Canadian Longitudinal Study on Aging. METHODS: We included women aged 45 to 85 years from the Canadian Longitudinal Study on Aging Comprehensive cohort of seven Canadian provinces who were menopausal at the time of recruitment and had no prior CVD. Poisson regressions were used to evaluate the association between menopausal characteristics and the FRS. Natural menopause was defined as the cessation of menstrual periods for at least 1 year in women with no history of hysterectomy. Surgical menopause was defined as hysterectomy with or without oophorectomy prior to natural menopause. As main covariates, we examined age, education, province of residency, and hormone therapy. RESULTS: A total of 10,090 women (8,200 natural menopausal and 1,890 surgical menopausal) were eligible for the study. In the multivariable model, surgical menopause was associated with a higher mean FRS compared with natural menopause (CVD risk 12.4% vs 10.8%, P < 0.001). Compared with women with age at natural menopause from 50 to 54 years (CVD risk 10.2%), natural menopause before age 40, 40 to 44, or 45 to 49 had a higher CVD risk (12.2%, 11.4%, and 10.6%, respectively, P < 0.001). CONCLUSIONS: Our study supports an association between menopausal type and timing on CVD risk prediction and highlights the need to be judicious about surgical menopause. Preventative interventions for CVD should be considered in surgical menopausal women and women with an age at natural menopause less than 45 years.

Video Summary:http://links.lww.com/MENO/A701 .

Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging.

OBJECTIVE: The aim of this study was to evaluate the association between categories of age at natural menopause (ANM) and gait speed (slowness) and grip strength (weakness), common measures of physical functioning in older women. METHODS: We analyzed data from the Canadian Longitudinal Study on Aging, which included participants from seven cities across Canada collected in 2012. The sample was restricted to women who reported to have entered menopause (N = 9,920). Women who had a hysterectomy before menopause were excluded since the age at which this surgical procedure was performed was not available. ANM was categorized into five groups: less than 40 (premature), 40 to 44 (early), 45 to 49, 50 to 54, and more than 54. We conducted linear regressions to assess the association between ANM and gait speed (m/s) and grip strength (kg) adjusting for participant age, education, body mass index, smoking, use of hormone therapy, height, and province of residence. RESULTS: Mean ANM was 49.8 (95% confidence interval [CI]: 49.7-50.0), with 3.8% of women having a premature menopause; the average gait speed was 0.98 m/s (standard deviation: 0.22), the average grip strength was 26.6 kg (standard deviation: 6.39). Compared to women with ANM of 50 to 54, women with premature menopause had 0.054 m/s (95% CI -0.083, -0.026) lower gait speed when adjusting for age and study site. In the fully adjusted model, the association was attenuated, 0.032 m/s (95% CI -0.060, -0.004). ANM was not associated with grip strength. CONCLUSION: Our study suggests that premature menopause (<40 years) may be associated with lower gait speed (slowness) among Canadian women. No association was observed between ANM and grip strength. Future studies should include a life course approach to evaluate whether social and biological pathways modify the association between age at menopause and physical function in populations from different contexts.

Life course social and health conditions linked to frailty in Latin American older men and women.

BACKGROUND: Gender, social conditions, and health throughout the life course affect functional health in later life. This article addresses two specific hypotheses: i) life-course social and health conditions are associated with frailty; and ii) differential exposure and/or vulnerability of women and men to life-course conditions may account for gender differences in frailty. METHODS: Data originated from a cross-national survey of older adults living in five large Latin American cities. Frailty was defined as the presence of three or more of five criteria: unintentional weight loss (10 pounds during the past year), self-reported exhaustion/poor endurance, weakness (grip strength), limitations in lower extremities, and low physical activity; a prefrail state was defined as the presence of one or two of the above criteria. Associations between frailty and social and health indicators were examined using a proportional odds ordinal logistic regression. RESULTS: Prevalence of frailty varied from 0.30 to 0.48 in women and from 0.21 to 0.35 in men. Childhood (hunger, poor health, and poor socioeconomic conditions), adulthood (little education and non-white-collar occupation), and current social conditions (insufficient income) were associated with higher odds of frailty in both men and women. Comorbidity and body mass index were related to frailty, but their effects differed in women and men. Male/female age-adjusted odds of frailty varied from 1.55 (Bridgetown) to 2.77 (Havana). Differential exposure and vulnerability partially explained differences between women and men. CONCLUSION: Theoretical models to explain gender and social differences in frailty should use a life-course perspective.

Life course socioeconomic disadvantage and cognitive function among the elderly population of seven capitals in Latin America and the Caribbean.

OBJECTIVE: To examine the influence of life course socioeconomic disadvantages (SED) on cognitive function in later life. METHOD: Data originate from a survey of people 60 and older living in seven Latin American and Caribbean cities. Cognitive function was measured with a modified Mini-Mental State Examination and the Pfeffer Scale of Functional Capacity. Homogeneity tests were used to pool data. Associations between cognitive function and SED were evaluated, fitting logistic regressions. RESULTS: Cognitive impairment (CI) prevalence ranged from 0.3% to 6.5% in men and 1.2% to 10.1% in women. Childhood rural living, poor childhood health, illiteracy, housewife or farmer occupation, and insufficient income were associated with CI in all seven cities. The odds of CI increase with cumulative exposure to disadvantages along life course. CONCLUSIONS: Life course SED is related to cognitive function later in life. Difficulty in properly distinguishing cognitive function from test performance remains an issue.

Relationships Between Neighborhood Social Capital and The Occurrence of Outdoor Falls in Canadian Older Adults: A Multilevel Analysis.

OBJECTIVE: The aim of this study was to examine whether neighborhood-level social capital is a risk factor for falls outside of the home in older adults. METHODS: Health questionnaires were completed by community-dwelling Canadians aged +65 years living in Kingston (Ontario) and St-Hyacinthe (Quebec), supplemented by neighborhood-level census data. Multilevel logistic regression models with random intercepts were fit. Variations in the occurrence of falls across neighborhoods were quantified by median odds ratio and 80% interval odds ratio. RESULTS: Between-neighborhood differences explained 7% of the variance in the occurrence of falls; this variance decreased to 2% after adjustment for neighborhood-level variables. In the fully adjusted models, higher levels of social capital increased the odds of falls by almost 2 times: (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.19, 3.71]). DISCUSSION: Living in neighborhoods with higher levels of social capital was associated with higher risk of falling in older adults, possibly through more involvement in social activities.

Neighbourhood social and built environment factors and falls in community-dwelling canadian older adults: A validation study and exploration of structural confounding.

Older persons are vulnerable to the ill effects of their social and built environment due to age-related limitations in mobility and bio-psychological vulnerability. Falls are common in older adults and result from complex interactions between individual, social, and contextual determinants. We addressed two methodological issues of neighbourhood-health and social epidemiological studies in this analysis: (1) validity of measures of neighbourhood contexts, and (2) structural confounding resulting from social sorting mechanisms. Baseline data from International Mobility in Aging Study were used. Samples included community-dwelling Canadians older than 65 living in Kingston (Ontario) and St-Hyacinthe (Quebec). We performed factor analysis and ecometric analysis to assess the validity of measures of neighbourhood social capital, socioeconomic status, and the built environment and stratified tabular analyses to explore structural confounding. The scales all demonstrated good psychometric and ecometric properties. There was an evidence of the existence of structural confounding in this sample of Canadian older adults as some combinations of strata for the three neighbourhood measures had no population. This limits causal inference in studying relationships between neighbourhood factors and falls and should be taken into account in aetiological aging research.

Fear of falling as a risk factor of mobility disability in older people at five diverse sites of the IMIAS study.

BACKGROUND: Fear of falling (FoF) is a common health problem among older adults. Although the relationship between FoF and limitation in daily activities has been reported, FoF's relationship to mobility disability, a transitional phase to end-stage disability, is not yet understood. We examined the relationship between FoF and mobility disability among community-dwelling older adults and explored the differences in this relationship among socio-culturally diverse sites. DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: 1875 participants (65-74 years) were recruited from five sites and included in the analysis (Kingston, Canada: 394; St-Hyacinthe, Canada: 397; Tirana, Albania: 359; Manizales, Colombia: 341; and Natal, Brazil: 384). MEASUREMENT: FoF was quantified using the Falls Efficacy Scale-International (FES-I, range: 16-64). Mobility disability was defined as difficulty climbing a flight of stairs or walking 400m without assistance. RESULTS: Overall, 21.5% of participants reported high FoF (FES-I>27). The average FoF scores were significantly different between the sites (p<0.001) and higher in women (p<0.001). In general, 36.2% of participants reported mobility disability. The distribution of mobility disability was significantly different at the five study sites (ranged from 19.8% at Kingston, Canada to 50.7% at Tirana, Albania, p<0.001). After adjusting for covariates, those with high and moderate FoF had about 3 times (95% CI: 2.59-3.83) and 2.5 times (95% CI: 1.99-2.91) higher risk of mobility disability, respectively, compared to those with no/low FoF. CONCLUSIONS: FoF was significantly associated with risk of mobility disability across the sites. The strength of this relationship appears to be different between the five sites.

Psychometric properties of a Spanish version of the 10-item Berger's stigma scale in Colombia: a validation study / Propiedades psicométricas de una versión en español de la escala de Berger de diez ítems en Colombia: un estudio de validación

Introduction: HIV-related stigma is detrimental to people living with HIV (PLH), and reducing it is essential for achieving an HIV/AIDS-free generation. Abbreviated stigma scales can improve the feasibility of surveys that broadly explore factors affecting PLH. This study tested the psychometric properties of a Spanish translation of the abbreviated 10-item Berger's HIV stigma scale. Methods:We recruited a sample of 105 PLH regularly attending a specialized clinic in Cali, Colombia. English-to-Spanish and Spanish-to-English back translation was performed of the Berger's 10-item HIV stigma scale.Exploratory and confirmatory factor analyses were carried out to assess its validity. Pre- and post-test reliability (15 days) was estimated with the intra-class correlation coefficient (ICC). Results: The Confirmatory Factor Analysis (CFA) was used to confirm a two-factor solution with three poor items removed, resulting in a 7-item HIV Stigma Scale. The resulting 7-item HIV stigma scale had a Cronbach's alpha of 0.73 with an ICC of 0.83 (CI 95%: 0.75­0.89). One factor loaded three items related to negative self-image (internalised stigma), and the other four items were related to personalized (enacted) HIV stigma. Both factors were related to depression and adherence to antiretroviral therapy. Conclusion: The Spanish translation of the 10-item HIV stigma scale did not perform well due to problems in items 4, 5, and 6. Rather, a modified 7-item version had a good fit with a two-factor loading in which both HIV stigma factors correlated significantly with depression and HIV medication adherence.

Introducción: el estigma asociado al VIH atenta contra la salud de las personas que viven con VIH (PVV), así que reducirlo es esencial para erradicar el VIH/SIDA. Las escalas abreviadas para estigma pueden facilitar la ejecución de encuestas amplias sobre factores que afectan a las PVV. Este estudio examinó las propiedades psicométricas de una traducción al español de la escala de Berger de 10 ítems. Métodos: se reclutaron 105 PVV en una clínica de VIH en Cali, Colombia. La escala de Berger de 10 ítems se tradujo del inglés al español y después del español al inglés. La validez de constructo se evaluó con análisis factoriales (exploratorios/confirmatorios). La confiabilidad pre y postest (15 días) se estimó con el coeficiente de correlación intraclase (CCI). Resultados: el análisis factorial confirmó una solución de dos factores carente de tres ítems de pobre desempeño, resultando en una escala final de siete ítems, la cual tuvo un coeficiente alfa de Cronbach de 0,73 y un CCI de 0,83 (IC 95%: 0,75-0,89). Un factor cargó tres ítems relacionados con autoimagen negativa (estigma internalizado), y otros cuatro ítems relacionados con el estigma personalizado (estigma declarado/ejercido por terceros). Ambos factores estuvieron asociados a depresión y baja adherencia a tratamiento antirretroviral. Conclusión: la escala de 10 ítems en español para estigma asociado al VIH tuvo pobre desempeño por problemas con los ítems 4, 5 y 6. En cambio, una versión modificada de siete ítems tuvo mejor desempeño, cargando dos factores correlacionados significativamente con depresión y adherencia al tratamiento antirretroviral.

Application of the "syndemics" theory to explain unprotected sex and transactional sex: A cross- sectional study in men who have sex with men (MSM), transgender women, and non-MSM in Colombia / Aplicación de la teoría de la "sindemia" para entender el sexo sin protección y el sexo comercial: un estudio transversal en hombres que tienen sexo con hombres (HSH), mujeres transexuales y hombres que no tienen sexo con hombres en Colombia

Introduction: Men who have sex with men (MSM) and transgender women (TW) in Colombia are highly affected by HIV. To improve understanding of the role of HIV risk behaviors in HIV acquisition, we used the syndemic framework, a useful concept to inform prevention efforts. Objective: To examine the effect of four psychosocial conditions, namely, forced sex, history of childhood sexual abuse, frequent alcohol use, and illicit drug use on unprotected sex and the synergistic effects ("syndemic" effects) of these conditions on HIV risk behavior. Materials and methods: We enrolled a total of 812 males (54.7% men who have sex with men, MSM; 7.3% transgender women, and 38% non-MSM). The participants were recruited from neighborhoods of low socioeconomic status through free HIV-counseling and -testing campaigns. We performed Poisson regression analysis to test the associations and interactions between the four psychosocial conditions and unprotected sex with regular, occasional, and transactional partners. To test the "syndemic" model, we assessed additive and multiplicative interactions. Results:The prevalence of any psychosocial condition was 94.9% in transgender women, 60.1% in MSM, and 72.2% in non-MSM. A higher likelihood of transactional sex was associated in MSM (prevalence ratio (PR)=7.41, p<0.001) and non-MSM (PR=2.18, p< 0.001) with three or all four conditions compared to those with one condition. Additive interactions were present for all combinations of psychosocial problems on transactional sex in MSM. No cumulative effect or additive interaction was observed in transgender women. Conclusions: Our study highlights the need for bundled mental health programs addressing childhood sexual abuse, illicit drug use, and frequent alcohol use with other HIV prevention programs.

Introducción. Los hombres que tienen sexo con hombres (HSH), y las mujeres transgenero (MT) en Colombia continuan estando a mayor riesgo de VIH. Para entender como los comportamientos se asocian al VIH, se uso la teoria de la sindemia, la cual se ha considerado muy útil en el desarrollo de estrategias de prevención. Objetivo. Examinar el efecto de cuatro afecciones psicosociales, a saber: historia de sexo forzado, historia de abuso sexual infantil, consumo frecuente de alcohol y consumo de drogas ilícitas en las relaciones sexuales sin protección, así como los efectos sinérgicos (efectos "sindémicos") de estas afecciones sobre el comportamiento de riesgo para HIV. Materiales y métodos. Se hizo un estudio transversal que incluyó 812 participantes (hombres que tienen sexo con hombres, HSH: 54,7 %; mujeres transgénero: 7,3 % y hombres que no tenían sexo con otros hombres: 38 %). Los participantes se reclutaron en barrios de estratos socioeconómicos bajos a través de campañas gratuitas de asesoramiento y pruebas de HIV. Se hizo un análisis de regresión de Poisson para probar las asociaciones e interacciones entre las cuatro condiciones psicosociales y las relaciones sexuales sin protección con parejas regulares, ocasionales y comerciales. Para probar el modelo "sindémico" se evaluaron las interacciones aditivas y multiplicativas. Resultados. La prevalencia de cualquiera de las condiciones psicosociales fue de 94,9 % en mujeres transexuales, de 60,1 % en HSH y de 72,2 % en hombres que no tienen sexo con hombres. Se encontró una mayor probabilidad de tener sexo comercial en los HSH (razón de prevalencia (RP)=7,41, p<0,001) y en los que no tienen sexo con otros hombres (RP=2.18, p<0,001) con tres de las condiciones psicosociales, o con las cuatro, en comparación con aquellos con una sola condición. Las interacciones aditivas se registraron entre todas las combinaciones de problemas psicosociales con el sexo comercial en los HSH. No se observó un efecto acumulativo ni interacciones en mujeres transexuales. Conclusiones. El estudio resalta la necesidad de combinar programas de salud mental que aborden el abuso sexual infantil, el abuso de drogas y el consumo frecuente de alcohol con otros programas de prevención del HIV.

Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults.

OBJECTIVES: To examine the influence of social networks and social engagement on cognitive decline in a population-based cohort of elderly people, and to assess gender differences in the effect of social relations on cognition. METHODS: A longitudinal study of community-dwelling people over 65 was carried out. Cognitive function (orientation and memory) in 1997 and cognitive decline (absent, mild, and severe) over 4 years (1993-1997) were assessed using an instrument previously validated for populations with a low level of education. The effect of social networks, social integration, and social engagement with friends, children, and relatives on cognitive function and cognitive decline was estimated by multiple linear and logistic regressions after adjusting for age, sex, education, depressive symptoms, systolic and diastolic blood pressure, and functional status. RESULTS: Poor social connections, infrequent participation in social activities, and social disengagement predict the risk of cognitive decline in elderly individuals. The probability of cognitive decline was lower for both men and women with a high frequency of visual contact with relatives and community social integration. Engagement with friends seemed to be protective for cognitive decline in women but not in men. DISCUSSION: This longitudinal study indicates that few social ties, poor integration, and social disengagement are risk factors for cognitive decline among community-dwelling elderly persons. The nature of the ties that influence cognition may vary in men and women.

Neighbourhood environment factors and the occurrence of injuries in Canadian adolescents: a validation study and exploration of structural confounding.

OBJECTIVES: Social sorting mechanisms or analogous selection processes may impose confounding effects in the study of aetiological relationships. Such processes are referred to as structural confounding. If present, certain strata of social factors could hypothetically never be exposed to specific risk factors. This prohibits exchangeability across groups that is needed for meaningful causal inference. The objectives of this study were to: (1) develop and test the reliability and validity of composite scales for the measurement of social capital (SC), socioeconomic status (SES) and built environment (BE) and (2) to explore the possible roles of community level SC, SES and BE factors in studies of the aetiology of youth injury. SETTING/PARTICIPANTS: A nationally representative sample of over 26 000 Canadian students aged 11-15 years. MEASURES/ANALYSIS: Scales describing these key factors were developed and validated via exploratory and confirmatory factor analyses. We then used tabular analyses to explore structural confounding in our population. RESULTS: The proposed scales all demonstrated good psychometric properties. Despite variations in the number of adolescents across social and environmental strata, no evidence for the presence of structural confounding was detected in our data. CONCLUSIONS: Relationships between social capital and the occurrence of injuries in Canadian youth aged 11-16 can potentially be studied without consideration of structural confounding biases. Canada is a suitable place to disentangle the effects of different neighbourhood social and environmental exposures on occurrence of injuries and other outcomes in adolescent populations. Exchangeability is possible across exposure strata and therefore a meaningful multilevel regression analysis is feasible. However, more studies are needed to test the consistency of our findings in other populations and for different outcomes.

Evaluation of the Late-Life Disability Instrument (LLDI) in low-income older populations.

OBJECTIVE: To assess the construct and convergent validity of the 16 items of the Late-Life Disability Instrument (LLDI) in Latin American seniors. METHOD: Exploratory and confirmatory factor analyses were performed to assess the factor structure of frequency and limitation sub-scales of the LLDI. ANOVA and t test were used to determine the convergent and construct validity of the LLDI by exploring associations with physical performance tests, mobility limitations, depression, cognition, self-reported health, as well as with sex, education, and income. RESULTS: Factor analysis resulted in one-factor solution and acceptable model fit. Participants with better physical function, less mobility limitations, better self-reported health, and intact cognition reported more frequent activities and fewer limitations, indicating good convergent and construct validity of our measure. CONCLUSION: LLDI is a good instrument to assess disability in low-income populations. Further research is needed to include culturally acceptable activities for the frequency sub-scale.

Unemployment among Canadians with physical and a co-morbid mental disability: an examination of the 2006 Participation and Activity Limitation Survey (PALS).

BACKGROUND: Co-occurring disabilities are common and data indicate that those with both physical and mental disabilities face greater discrimination in the workforce. However, studies that consider disability type in determining labor market outcomes are needed; particularly in Canada. OBJECTIVE: The objective was to examine the association of disability type and unemployment among working-aged Canadians using data from the 2006 Participation and Activity Limitation Survey (PALS). METHODS: The 2006 PALS is a post-censal sample survey of individuals whose everyday activities are limited due to a physical/mental condition. The study design is cross-sectional. Two groups were compared: persons with one or more physical disabilities exclusively vs. those with one or more physical disabilities and a mental disability. We calculated the prevalence of unemployment and used multiple logistic regression to measure the association between disability type and unemployment, while considering relevant covariates. RESULTS: The prevalence of unemployment was 20% overall; 35.4% in those with a co-morbid mental disability and 18.5% in those with exclusively physical disabilities. Those with a mental co-morbidity had approximately double the odds of being unemployed relative to those with exclusively physical disabilities and the effect remained significant (at p < 0.05) after adjustment for socio-economic indicators and disability severity. CONCLUSIONS: Compared to those with exclusively physical disabilities, individuals with co-morbid physical and mental disabilities were found to be at a significantly greater disadvantage when accessing employment. More research is needed to clarify whether these findings are indicative of discrimination and to proceed toward removing workplace barriers that persist in this population.

Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis.

BACKGROUND: Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood. METHODS AND FINDINGS: Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations. CONCLUSIONS: Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.

Would achieving healthy people 2010's targets reduce both population levels and social disparities in heart disease?

BACKGROUND: The US Healthy People 2010 (HP2010) agenda set targets for major risk factors for coronary heart disease (CHD). However, the potential impact of achieving those risk factor reductions on both population levels and social disparities in CHD has not been quantified. METHODS AND RESULTS: Data on 10-year risk of CHD (from the First National Health and Nutrition Examination Epidemiological Follow-Up study 1971 to 1982), prevalence of major CHD risk factors (from the National Health and Nutrition Examination Survey 2003 to 2004), and HP2010 targets for CHD risk factors (reduction of smoking rate to 12%, hypertension to 14%, high cholesterol levels to 17%, diabetes to 2.5%, and obesity to 15%) were used to estimate effects of different scenarios on population levels and social disparities in CHD. Over a 10-year period, the largest relative reductions in population levels of CHD (20.0% in men; 23.9% in women) would be achieved if all social groups met the HP2010 targets. CHD disparities would be most reduced if the less educated (absolute disparities reduced by 66.1% in men; 56.3% in women) and the low income group (absolute disparities reduced by 93.7% in men; 94.3% in women) achieved the targets before the most advantaged. These reductions are larger than those expected if targets were achieved overall for the population but relative social group differences in risk factors remained, or under leveling-up approaches in which the least advantaged achieved the current levels of risk factors of the most advantaged. CONCLUSIONS: Interventions to reduce CHD risk factors to HP2010 targets that focus on all social groups would produce the best overall scenario for both population levels and disparities in CHD.

Cognitive decline is related to education and occupation in a Spanish elderly cohort.

BACKGROUND AND AIMS: The type of education and occupation can sensibly influence cognitive decline. The aim of this study was to examine their impact on cognitive function in a longitudinal study of community-dwelling Spanish people over 65 with low levels of formal education and predominantly unskilled occupations. METHODS: Cognitive function was assessed in 1993 and 1997 using a simple scale including items of memory and orientation that has been previously validated for populations with low levels of formal education. Cognitive score in 1997 and cognitive decline over 4 years (1993-1997) were used as outcomes. Education and occupation were analyzed as determinants of cognitive function using multiple linear regression, and of cognitive decline using logistic and multinomial regressions. RESULTS: Of the 557 subjects who completed the follow-up in 1997, 11% had experienced severe decline and 20.6% mild decline. Overall and mild cognitive decline were predicted by low education and being a farm worker (OR: 2.36, CI 95%: 1.164.81 and OR: 2.37, CI 95%: 1.05-5.37) after controlling for age. CONCLUSIONS: Cognitive decline in the elderly is partially explained by early life events, such as education, and living in a deprived environment over a long period of time. We cannot ascertain whether these effects are direct or mediated by other associated conditions but sample attrition does not account for our results.