Knowledge and attitudes to prescription charges in New Zealand and England

Prescription charge regimes vary between countries but there is little research on how much people know about these or support values underlying them. To explore, in New Zealand (NZ) and England, the public's knowledge of, and attitudes to, charges and whether knowledge and attitudes varied by demographic characteristics or by values about entitlement to public goods. A questionnaire was developed and administered to people over 18 recruited in public places in NZ and England. 451 people in NZ and 300 people in England participated. Less than half in each country knew the current prescription charge. In each country 62% of people were unaware of arrangements to protect people from excessive annual charges. Support for free or lower cost medicines for children, people over 65, people on low incomes, people on benefits, and people with chronic health problems was higher in England than in NZ. Support varied by participants' demographic characteristics and, in the case of people on low incomes and people on benefits, by values about universal entitlements. Gaps in knowledge, particularly about mechanisms to protect people from high costs, are concerning and may lead to people paying excessive charges. There was consensus about the elderly, children and the chronically ill being "deserving" of lower prescription charges, but people who did not believe in universal access to public goods appeared to see people on low incomes or benefits as less "deserving". In general, public views resembled those underlying the prescription charge regime in their country. [Abstract copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Social Connection, Relationships and Older Lesbian and Gay People

This paper presents data from a small study exploring the impacts of homophobia on the lives of older lesbian and gay Australians. Eleven in-depth interviews were conducted with older lesbians (6) and gay men (5) ranging in age from 65 to 79 years. The study found that participants’ sense of self was shaped by the dominant medical, legal and religious institutions of their youth that defined them as sick, immoral or criminal. Participants described enforced “cure” therapies, being imprisoned, having employment terminated and being disowned and disinherited by family. In this context, intimate relationships and social networks provided refuge where trust was rebuilt and sexuality affirmed. Many created safe spaces for themselves. This equilibrium was threatened with increasing age, disability and the reliance on health and social services. Participants feared a return to institutional control and a need to “straighten up” or hide their sexuality. In response, partners stepped into the role of caregiver, at times beyond their capacity and at a cost to their relationship. The study describes the importance of understanding social connections in the lives of older lesbians and gay men. It highlights the need for inclusive services to ensure that social networks are supported and that health and well-being are promoted

One year prospective survey of Candida bloodstream infections in Scotland

A 12 month survey of candidaemia in Scotland, UK, in which every Scottish hospital laboratory submitted all blood isolates of yeasts for identification, strain typing and susceptibility testing, provided 300 isolates from 242 patients, generating incidence data of 4.8 cases per 100 000 population per year and 5.9 cases per 100 000 acute occupied bed days; 27.9 % of cases occurred in intensive care units. More than half the patients with candidaemia had an underlying disease involving the abdomen, 78 % had an indwelling intravenous catheter, 62 % had suffered a bacterial infection within the 2 weeks prior to candidaemia and 37 % had undergone a laparotomy. Candida albicans was the infecting species in 50 % of cases, followed by Candida glabrata (21 %) and Candida parapsilosis (12 %). Seven cases of candidaemia were caused by Candida dubliniensis, which was more prevalent even than Candida lusitaniae and Candida tropicalis (six cases each). Among C. glabrata isolates, 55 % showed reduced susceptibility to fluconazole, but azole resistance among other species was extremely low. Multilocus sequence typing showed isolates with high similarity came from different hospitals across the country, and many different types came from the hospitals that submitted the most isolates, indicating no tendency towards hospital-specific endemic strains. Multiple isolates of C. albicans and C. glabrata from individual patients were of the same strain type with single exceptions for each species. The high prevalence of candidaemia in Scotland, relative to other population-based European studies, and the high level of reduced fluconazole susceptibility of Scottish C. glabrata isolates warrant continued future surveillance of invasive Candida infections

[En]gendering the norms of customary inheritance in Botswana and South Africa

The article responds to the article by Weinberg in this issue. She traces the trajectory of court hearings concerning the contested inheritance of land in Botswana, which, after several prior judgements eventually resulted in a positive outcome for the woman litigants. I acknowledge the author’s key argument, which concerns the impact of power relations on the construction of customary law and the reproduction of knowledge in the courts. Certain versions of “custom” were promoted and others stilled to the disadvantage of women. I argue that the normative patterns of landholding are indeed gendered, but do not result in a binary structure of men and women. “Gender” should be disaggregated to take into account a range of status criteria within and across the categories of male and female in order to understand the differential impact of social relations on the outcomes of property struggles. The normative lines of property transmission frequently follow a logic of “family property” that allows for qualifying women to rights of property. Family property has vastly different social and legal consequences to private, individualised property rights. The corollary is that it is misleading to speak of the processes of succession to rights of access to, and control of customary property in terms of one-to-one “inheritance” of land. The concept of “living law” inadequately reflects these social dynamics.IBS

Association of FcγRIIa R131H polymorphism with idiopathic pulmonary fibrosis severity and progression

<p>Abstract</p> <p>Background</p> <p>A significant genetic component has been described for idiopathic pulmonary fibrosis (IPF). The R131H (rs1801274) polymorphism of the IgG receptor FcγRIIa determines receptor affinity for IgG subclasses and is associated with several chronic inflammatory diseases. We investigated whether this polymorphism is associated with IPF susceptibility or progression.</p> <p>Methods</p> <p>In a case-control study, we compared the distribution of FcγRIIa R131H genotypes in 142 patients with IPF and in 218 controls using allele-specific PCR amplification.</p> <p>Results</p> <p>No differences in the frequency of FcγRIIa genotypes were evident between IPF patients and control subjects. However, significantly impaired pulmonary function at diagnosis was observed in HH compared to RR homozygotes, with evidence of more severe restriction (reduced forced vital capacity (FVC)) and lower diffusing capacity for carbon monoxide (D<smcaps>L</smcaps>_CO). Similarly, increased frequency of the H131 allele was observed in patients with severe disease (D<smcaps>L</smcaps>_CO< 40% predicted) (0.53 vs. 0.38; p = 0.03). Furthermore, the H131 allele was associated with progressive pulmonary fibrosis as determined by > 10% drop in FVC and/or > 15% fall in D<smcaps>L</smcaps>_COat 12 months after baseline (0.48 vs. 0.33; p = 0.023).</p> <p>Conclusions</p> <p>These findings support an association between the FcγRIIa R131H polymorphism and IPF severity and progression, supporting the involvement of immunological mechanisms in IPF pathogenesis.</p

Hospital use by an ageing cohort: an investigation into the association between biological, behavioural and social risk markers and subsequent hospital utilization

Background: The aims of the study were to describe the pattern of hospital utilization (acute and mental health sectors) of the Paisley-Renfrew MIDSPAN cohort and assess the influence of biological, behavioural and social ‘risk factors’ (established at the time of screening) on subsequent hospital admissions. Method: A cohort analysis was carried out in Paisley and Renfrew, two post-industrial towns in West Central Scotland.This used a linked data set covering a 23 year follow-up period to combine original ‘risk’-related data with subsequent routine hospital admissions data. The subjects were 8349 women and 7057 men, aged 45–64 in the early to mid-1970s, and representing approximately 80 per cent of the eligible population. The main outcome measures were patterns of hospital utilization (acute and mental health sectors), ‘any acute hospital admission’, ‘a serious acute hospital admission’ and ‘death’ (relative risks of each outcome were calculated for all risk factors). Results: The following patterns of hospital utilization were found. Only 5 per cent experienced a mental health admission but mean stay was long (265 bed days per cohort member admitted). In contrast, 79 per cent experienced atleast one acute hospital stay. The age-specific proportions of cohort members requiring admission increased over time but the growth in acute episodes was even higher (suggesting increasing rates of multiple admission). For non-survivors, 42 per cent of all acute episodes (55 per cent of bed days) took place during the 12 months before death. Analysis of risk factors (using Cox's proportional hazards model) of ‘any admission’ and ‘a serious admission’ showed forced expiratory volume (FEV1), age, sex, smoking status, blood pressure, blood sugar, body mass index, cholesterol and deprivation category to be important predictors. Conclusions: Despite the desirability of alternative settings of care for the chronically ill and dying, a high proportion of hospital bed days were required near the time of death. The absolute size of the demand for hospital services within the cohort was strikingly large and increasing over time.Strategies to address the tide of rising admissions will have to confront the increasing proportion of individuals requiring admission as well as the growth in multiple admissions.Those who were at higher risk of admission were the older members of the cohort (especially men), those with low FEV1, smokers, those who were under weight or obese, the small number with abnormal levels of blood sugar, those with high blood pressure and those who lived in the most deprived areas. Thus, programmes which affect these determinants of ill health may be useful in reducing age specific admission rates