Structural malformations of the brain, eye, and pituitary gland in PHACE syndrome

PHACE syndrome is the association of segmental facial hemangiomas with congenital arterial, brain, cardiac, and ocular anomalies. Structural brain malformations affect 41–52% of PHACE patients and can be associated with focal neurologic deficits, developmental delays, and/or intellectual disability. To better characterize the spectrum of structural brain and other intracranial anomalies in PHACE syndrome, MRI scans of the head/neck were retrospectively reviewed in 55 patients from the PHACE Syndrome International Clinical Registry and Genetic Repository. All registry patients with a diagnosis of definite PHACE syndrome who had MRI scans of satisfactory quality were included. Of 55 patients, 34 (62%) demonstrated ≥1 non-vascular intracranial anomaly; structural brain malformations were present in 19 (35%). There was no difference in the prevalence of brain anomalies between genders. Brain anomalies were more likely in patients with S1 and/or S2 distribution of facial hemangioma. The most common structural brain defects were cerebellar hypoplasia (25%) and fourth ventricle abnormalities (13%). Dandy–Walker complex and malformations of cortical development were present in 9% and 7%, respectively. Extra-axial findings such as pituitary anomalies (18%) and intracranial hemangiomas (18%) were also observed. Six patients (11%) had anomalies of the globes or optic nerve/chiasm detectable on MRI. Brain malformations comprise a diverse group of structural developmental anomalies that are common in patients with PHACE syndrome. Along with brain malformations, numerous abnormalities of the pituitary, meninges, and globes were observed, highlighting the need for careful radiologic assessment of these structures in the neuroimaging workup for PHACE syndrome.

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Inactive lifestyles and sedentary behavior in persons with chronic aneurysmal subarachnoid hemorrhage: evidence from accelerometer-based activity monitoring

Aneurysmal subarachnoid hemorrhage (a-SAH) is a potential life-threatening stroke. Because survivors may be at increased risk for inactive and sedentary lifestyles, this study evaluates physical activity (PA) ...

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From electromyographic activity to frequency modulation in zebra finch song

Abstract

Behavior emerges from the interaction between the nervous system and peripheral devices. In the case of birdsong production, a delicate and fast control of several muscles is required to control the configuration of the syrinx (the avian vocal organ) and the respiratory system. In particular, the syringealis ventralis muscle is involved in the control of the tension of the vibrating labia and thus affects the frequency modulation of the sound. Nevertheless, the translation of the instructions (which are electrical in nature) into acoustical features is complex and involves nonlinear, dynamical processes. In this work, we present a model of the dynamics of the syringealis ventralis muscle and the labia, which allows calculating the frequency of the generated sound, using as input the electrical activity recorded in the muscle. In addition, the model provides a framework to interpret inter-syllabic activity and hints at the importance of the biomechanical dynamics in determining behavior.

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Respiratory regulation by steroids in newborn rats: a sex-specific balance between allopregnanolone and progesterone receptors

Abstract

We tested the hypothesis that the effects of progesterone on apnoea frequency in newborn rats are the result of a balance between its neuroactive metabolite allopregnanolone (GABAa receptor modulator) and progesterone receptors. We used male and female rats between 10 and 12 days of age and recorded respiratory and metabolic parameters (whole-body plethysmography), and assessed the frequency and duration of apnoeas under normoxia. We tested the effects of a single injection of progesterone (4 mg kg⁻¹, i.p.), finasteride (10 mg kg⁻¹, i.p. – 5α-reductase antagonist: blocks the conversion of progesterone to allopregnanolone), finasteride+progesterone, or agonists of the nuclear or membrane progesterone receptors (R5020 or Org-od-02-0, 4 mg kg⁻¹). To test the hypothesis that chronic exposure to progesterone reduces the frequency of apnoeas we used male and female daily treated with progesterone between postnatal days 3–12. The acute injection of progesterone reduced minute ventilation and metabolic rate and increased the frequency of apnoeas. Finasteride decreased the frequency of apnoeas, and finasteride+progesterone did not increase apnoea frequency but decreased minute ventilation in female rats. While R5020 decreased apnoea frequency only in males, Org-od-02-0 decreased apnoea frequency in males and females and decreased respiratory frequency in females. Chronic progesterone treatment reduced apnoea frequency more efficiently in males than in females, but in females (not in males) an acute injection of caffeine (the gold standard for the treatment of apnoea in preterm neonates) further reduced apnoea frequency. Apnoea frequency in newborn rats is in part determined by a sex-specific balance between allopregnanolone, GABAa receptors, and progesterone receptors.

This article is protected by copyright. All rights reserved

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Interventions to improve social determinants of health among elderly ethnic minority groups: a review

Abstract

Background

Like the European general population, ethnic minorities are aging. In this group, important social determinants of health (social participation, social isolation and loneliness) that lead to negative health outcomes frequently occur. Interventions targeting these determinants may decrease negative health outcomes. The goal of this article was to identify effective interventions that improve social participation, and minimise social isolation and loneliness in community dwelling elderly ethnic minorities.

Methods

An electronic database (PubMed) was systematically searched using an extensive search strategy, for intervention studies in English, French, Dutch of German, without time limit. Additional articles were found using references. Articles were included if they studied an intervention aimed to improve social participation or minimise social isolation or loneliness and were focusing on community dwelling elderly ethnic minorities. Data regarding studies characteristics and results were extracted.

Results

Six studies (three randomized controlled trials, three non-controlled intervention studies) were included in the review. All studies were group-based interventions and had a theoretical basis. Five out of six studies showed improvement on a social participation, -isolation or loneliness outcome. Type of intervention included volunteering-, educational- and physical activities. In three studies active participation of the participant was required, these interventions were not more effective than other interventions.

Conclusion

Some interventions improved the included social determinants of health in community dwelling elderly ethnic minorities. Investment in further development and implementation of these interventions may help to improve social determinants of health in these populations. It is necessary to evaluate these interventions in the European setting.

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Socioeconomic differences in the pathways to diagnosis of coronary heart disease: a qualitative study

Abstract

Background

Socioeconomic inequalities in coronary heart disease (CHD)-related morbidity and mortality are well explored. However, less is known about the causes of inequalities in CHD treatment. In this qualitative study, we explored socioeconomic differences in the pathways to diagnosis of CHD.

Methods

The data originated from 38 semi-structured interviews with older CHD patients, aged 59–80 years, conducted at the university hospital in Halle, Germany, between November 2014 and April 2015. We analysed the narratives related to the time before CHD was confirmed by coronary angiography electively or urgently. Transcripts were analysed following inductive qualitative content analysis and we identified socioeconomic differences by comparing and contrasting patients' narratives.

Results

The patients interpreted their symptoms based on expectations, normalization, relief and obtaining help from third parties. For those experiencing chronic CHD symptoms, only patients with low socioeconomic status (SES) waited to seek healthcare until they suffered myocardial infarction. Mainly low-SES patients procrastinated in undergoing diagnostic procedures. We found no socioeconomic differences in the urgent pathway. However, along the elective pathway, only low-SES patients reported receiving assistance from a general practitioner in accessing a cardiologist.

Conclusions

Socioeconomic differences in CHD diagnosis were mainly apparent before patients sought healthcare. These differences were more pronounced when CHD was electively diagnosed due to chronic symptoms rather than urgently diagnosed due to acute symptoms. To address socioeconomic differences, general practitioners should focus on any indication of symptoms and interpretation mentioned by low-SES patients, and coordinate these patients' pathways to diagnosis while emphasizing the seriousness of CHD.

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A systematic literature review on the use and outcomes of maternal and child healthcare services by undocumented migrants in Europe

Abstract

Background

Undocumented migrants, in particular pregnant women and their newborns, constitute a particularly vulnerable group of migrants. The aim of this study was to systematically review the academic literature on the use and outcomes of maternal and child healthcare by undocumented migrants in the European Union (EU) and European Free Trade Association (EFTA) countries.

Methods

The databases, MEDLINE, Embase, CINAHL Plus, Global Health and Popline were searched for the period 2007 to 2017. Two independent reviewers judged the eligibility of studies. The final number of included studies was 33.

Results

The results of quantitative, qualitative and mixed methods studies were analysed separately due to their differences in study design, sample size and quality. Overall, the quantitative studies found that undocumented women underutilised essential maternal and child healthcare services, and experienced worse health outcomes. Qualitative studies supported these results, indicating that undocumented migrants were hesitant to use services due to a lack of knowledge and fear of deportation. Studies included in the review covered 10 of 32 EU or EFTA countries, making a European comparison impossible.

Conclusions

Despite major methodological differences between included studies, the results of this review indicate that the status of undocumented migrants exacerbates known health risks and hampers service use.

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Maternal serum bisphenol A levels and risk of pre-eclampsia: a nested case–control study

Abstract

Background

Although recent studies have indicated the potential adverse effects of maternal bisphenol A (BPA) exposure on pregnancy such as increasing the risk of pre-eclampsia, epidemiological evidence is limited. We aimed to evaluate the relationship between maternal BPA exposure and the risk of pre-eclampsia.

Methods

We conducted a nested case–control study among 173 women (74 cases of pre-eclampsia and 99 controls). BPA concentrations were measured using liquid chromatography-mass spectrometry in the maternal serum samples collected during 16–20 gestational weeks. Multivariate logistic models were used to examine the relationship between maternal serum BPA concentrations and the risk of pre-eclampsia.

Results

BPA was detectable (>0.1 µg/l) in 78.6% of the maternal serum samples at three levels: low (<2.24 µg/l), medium (2.24-4.44 µg/l), and high (>4.44 µg/l). BPA concentrations were significantly higher in the serum samples collected from the pre-eclampsia cases than those from controls (median: 3.40 vs. 1.50 µg/l, P < 0.01). With adjustment for maternal age, primiparous and BMI, the odds of developing pre-eclampsia were significantly elevated in subjects with high serum BPA levels compared with those with low levels (adjusted OR = 16.46, 95%CI = 5.42–49.85) regardless of subcategories of pre-eclampsia including severity and onset time. Among the pre-eclampsia subjects, the maternal serum concentration of BPA was not different between the early- and late-onset subjects (median: 3.09 vs. 3.50 µg/l, P = 0.57), but surprisingly higher in mild pre-eclampsia subjects compared with severe pre-eclampsia subjects (median: 5.20 vs. 1.80 µg/l, P < 0.01).

Conclusions

These results demonstrated that maternal exposure to high level of BPA could be associated with an increased risk of pre-eclampsia.

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Does public reporting influence quality, patient and provider’s perspective, market share and disparities? A review

Abstract

Background

Public reporting (PR) of healthcare (HC) provider's quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider's perspective; patient experience; and unintended consequences.

Methods

PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016.

Results

Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients' choice, 7 evaluated the provider's perspective, 4 economic outcome, 4 service utilization, 2 purchasers' use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies—mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider's perspective and economic outcome (27%) and mainly negative on unintended consequences (68%).

Conclusions

Our research covering different outcomes and settings reported that PR is associated with changes in HC provider's behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user's perception of the providers' quality of care, helping them to make empowered choices.

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European Public Health News

In this last European public health news of 2017, we are happy to look back at a successful year. Azzopardi Muscat highlights EUPHA's 25^th anniversary and challenges the public health community to move outside of its comfort zone. Jakab emphasizes the need for country support, a successful tool by WHO to shape (public) health and identify gaps and challenges for further enhancing WHO's performance in countries.

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Secondary stressors are associated with probable psychological morbidity after flooding: a cross-sectional analysis

Abstract

Background

The impact of flooding on mental health is exacerbated due to secondary stressors, although the mechanism of action is not understood. We investigated the role of secondary stressors on psychological outcomes through analysis of data collected one-year after flooding, and effect modification by sex.

Methods

We analysed data from the English National Study on Flooding and Health collected from households flooded, disrupted and unexposed to flooding during 2013–14. Psychological outcomes were probable depression, anxiety and post-traumatic stress disorder (PTSD). Parsimonious multivariable logistic regression models were fitted to determine the effect of secondary stressors on the psychological outcomes. Sex was tested as an effect modifier using subgroup analyses.

Results

A total of 2006 people participated (55.5% women, mean age 60 years old). Participants reporting concerns about their personal health and that of their family (concerns about health) had greater odds of probable depression (adjusted odds ratio [aOR] 1.77, 95% CI 1.17–2.65) and PTSD (aOR 2.58, 95% CI 1.82–3.66). Loss of items of sentimental value was associated with probable anxiety (aOR 1.82, 95% CI 1.26–2.62). For women, the strongest associations were between concerns about health and probable PTSD (aOR 2.86, 95% CI 1.79–4.57). For men, the strongest associations were between 'relationship problems' and probable depression (aOR 3.25, 95% CI 1.54–6.85).

Conclusions

Concerns about health, problems with relationships and loss of sentimental items were consistently associated with poor psychological outcomes. Interventions to reduce the occurrence of these secondary stressors are needed to mitigate the impact of flooding on probable psychological morbidity.

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Regional contextual determinants of internet addiction among college students: a representative nationwide study of China

Abstract

Background

Many studies have reported factors associated with internet addiction (IA) but little attention has been paid to contextual influences. The present study examined the association between regional contextual determinants of IA among college students in China.

Methods

Participants comprised 6929 college students, who were identified through a multistage survey sampling process conducted in 28 university/colleges in China. Individual data was obtained through a self-administered questionnaire, and regional variables were retrieved from a national database. Multilevel logistic regression models were used to examine individual and regional influences on IA.

Results

The overall IA prevalence was 13.6%. The final multiple level logistic models showed that higher frequent air pollution and PM2.5 level had 4.34 and 1.56 times the likelihood of suffering from IA, respectively; but higher regional per capita area of paved roads had lower likelihood of IA, ORs were from 0.66 to 0.39.

Conclusions

The results of this study add important insights about the role of contextual regional factors, especially air pollution, affecting IA among college students in China, and demonstrates the need to account for environmental influences in addressing IA.

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Activation of older patients through PRACTA intervention for primary healthcare doctors: does the method matter?

Abstract

Background

Activating older adults in medical practice can benefit patients' health and quality of life, as well as the economy and burden of the healthcare system. Placing general practice in the public healthcare system gives the elderly population easy access to the promotion of active attitudes toward health, provided that the doctors have and use relevant activating tools. The aim of this study was to verify the possibility of activating senior patients through an educational intervention for doctors.

Methods

Two waves of data collection from primary care patients and their doctors were separated by an intervention for doctors. The intervention took the form of an e-learning programme or article and was developed so as to improve general practitioners' (GP) communication and activation skills, especially when working with older adults. The outcome variable was the change between the waves in patients' scores on the PRACTA Attitude Toward Treatment and Health (ATH) Scale and PRACTA Self-efficacy Scale. Data from patients aged 50 + (n = 2175; 55.6% women; age: M = 69.56, SD = 9.10) appointed at the primary care facilities were analysed.

Results

The analysis revealed the effect of doctors' e-learning and, to a lesser extent, the effect of article reading on patients' attitudes toward treatment and health as well as on their self-efficacy. In facilities in which the intervention was implemented, patients' attitudes were more active on follow-up than at baseline when compared with facilities without the intervention.

Conclusions

Educational intervention among doctors can result in patients' ATH becoming more active. The form of intervention might diversify the impact.

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Validation of a short-form questionnaire to check patients’ adherence to antibiotic treatments in an outpatient setting

Abstract

Antimicrobial resistance challenge requests to be able to measure patient medication-adherence in outpatient setting, where more than 90% of antibiotics are prescribed. We take advantage of an original dataset where adherence to treatment has been measured through two alternative measurements: pills count and the Morisky scale. Considering the first measure as benchmark, we test the validity of each of the Morisky items and their composition in a synthetic scale. We show that the short-form version of the medication-adherence scale with three items has the best predictive properties in the domain of antibiotic treatments. Given its concision, this tool could even be used by clinicians to quickly assess patients' adherence and modify it in the course, when needed.

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The digital technology revolution and its impact on the public’s health

The use of health-related digital technologies (DT) has skyrocketed over the past two decades. DTs transcend all of the Sustainable Development Goals and are seen to play a crucial role within human development. They have the potential to transform not only health care but the way we live. The Internet is replete with stories about the use of DT within clinical medicine and health care. Within the public health domain, DT is used, among other applications, to improve immunization uptake and coverage, to deliver medicines to remote clinics, to encourage and help people adopt healthier lifestyles, to monitor the environment and to improve civil registration.

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Influenza and pneumococcal vaccination in older adults living in nursing home: a survival analysis on the shelter study

Abstract

Background

Influenza and pneumococcal vaccines have been proved to be effective and safe in preventing and controlling infection among elderly, reducing morbidity and mortality. However, some evidences raised health concerns related to these vaccinations. This study aims to identify prevalence and outcomes related to influenza and pneumococcal vaccinations in a large European population of frail old people living in nursing homes (NHs).

Methods

We conducted a survival analysis of NH residents participating to the Services and Health for Elderly in Long-TERm project, a prospective cohort study collecting information on residents admitted to 57 NH in eight countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands and Israel). Clinical and demographical data were collected using the international resident assessement instrument for long-term care facilities. Incident mortality was recorded during 1-year follow-up. A shared-frailty Cox regression model was used to assess the impact of vaccination status on mortality.

Results

Mean age of 3510 participants was 84.6 years (SD = 7.7). In total, 81.7 and 27.0% received influenza and pneumococcal vaccination, respectively. Overall, 727 (20.7%) residents died during the follow-up period. After adjusting for potential confounders, which included age, sex, number of diseases, depression, cognitive and functional status, influenza (HR = 0.80; 95% CI 0.66–0.97) and the combination of influenza and pneumococcal vaccination (HR = 0.72; 95% CI 0.57–0.91), but not pneumococcal vaccination alone (HR = 0.52; 95% CI 0.25–1.06), were associated with a statistically significant reduction in mortality in respect of no vaccinations.

Conclusion

In a population of older adult living in NH influenza and the combination of influenza and pneumococcal vaccination were associated with a reduction in all-cause mortality respect to no vaccination.

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Sex-specific associations of different anthropometric indices with acute and chronic insomnia

Abstract

Background

Sleep disorders, including insomnia, are risk factors for weight gain. However, few epidemiological studies have investigated the association of anthropometric markers with insomnia as an outcome.

Methods

In this observational, cross-sectional study, we assessed the association of 3 different anthropometric indices with acute and chronic insomnia. We used data from 13 389 French adults (mean age= 51.9 ± 13.1 years; 70.3% women) enrolled in the NutriNet-Santé-Biobank cohort. Body weight, height, waist and hip circumference were measured once during a clinic visit (2011–14). Body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were the main predictors. Acute (past 8 days) and chronic (≥3 months) insomnia were assessed in 2014 via a self-report questionnaire. We fit multivariable logistic regression models providing odds ratios (OR) and 95% confidence intervals (CI).

Results

Overweight (25.0 ≤ BMI < 30.0 kg/m²) and general obesity (BMI ≥ 30.0 kg/m²) appeared to have an inverse association with acute insomnia only among men (overweight: OR= 0.80, 95% CI: 0.70, 0.92; obesity: OR= 0.78, 95% CI: 0.63, 0.98). Obesity assessed by BMI and WHR appeared to be positively associated with chronic insomnia only among women (BMI: OR= 1.23, 95% CI: 1.04, 1.45; WHR: OR= 2.24, 95% CI: 1.07, 4.72). WC did not display any significant associations in either sex.

Conclusions

These cross-sectional results revealed sex-specific associations of overweight/obesity with different types of insomnia, and merit confirmation longitudinally with objectively assessed sleep parameters. Nonetheless, the findings reinforce the critical importance of joint health behaviour promotion.

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Short-run and long-run effects of unemployment on suicides: does welfare regime matter?

Abstract

Background

Disentangling the immediate effects of an unemployment shock from the long-run relationship has a strong theoretical rationale. Different economic and psychological forces are at play in the first moment and after prolonged unemployment. This study suggests a diverse impact of short- and long-run unemployment on suicides in liberal and social-democratic countries.

Methods

We take a macro-level perspective and simultaneously estimate the short- and long-run relationships between unemployment and suicide, along with the speed of convergence towards the long-run relationship after a shock, in a panel of 10 high-income countries. We also account for unemployment benefit spending, the share of the population aged 15–34, and the crisis effects.

Results

In the liberal group of countries, only a long-run impact of unemployment on suicides is found to be significant (P = 0.010). In social-democratic countries, suicides are associated with initial changes in unemployment (P = 0.028), but the positive link fades over time and becomes insignificant in the long run. Further, crisis effects are a much stronger determinant of suicides in social-democratic countries. Once the broad welfare regime is controlled for, changes in unemployment-related spending do not matter for preventing suicides.

Conclusions

A generous welfare system seems efficient at preventing unemployment-related suicides in the long run, but societies in social-democratic countries might be less psychologically immune to sudden negative changes in their professional lives compared with people in liberal countries. Accounting for the different short- and long-run effects could thus improve our understanding of the unemployment–suicide link.

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Trajectories of long-term care in 28 EU countries: evidence from a time series analysis

Abstract

Background

This study aims to confirm whether an increase in the number of elderly people and a worsening in the auto-evaluation of the general health state and in the limitation of daily activities result in increases in the offered services (beds in residential LTC facilities), in the social and healthcare expenditure and, consequently, in the percentage of LTC users

Methods

This study used a pooled, cross-sectional, time series design focusing on 28 European countries from 2004 to 2015. The indicators considered are: population aged 65 years and older; self-perceived health (bad and very bad) and long-standing limitations in usual activities; social protection benefits (cash and kind); LTC beds in institutions; LTC recipients at home and in institutions; healthcare expenditures and were obtained from the Organization for Economic Co-operation and Development and Eurostat.

Results

The proportion of elderly people increased, and conversely, the percentage of subjects who had a self-perceived bad or very bad health decreased. Moreover, there was an orientation to reduce the share of elderly people who received LTC services and to focus on the most serious cases. Finally, the combination of formal care at home and in institutions resulted in most Member States shifting from institutional care to home care services.

Conclusions

Demographic, societal, health changes could considerably affect LTC needs and services, resulting in higher LTC related costs. Thus, knowledge of LTC expenditures and the demand for services could be useful for healthcare decision makers.

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Geissler C., Powers H. (eds). Human Nutrition

GeisslerC., PowersH. (eds). Human Nutrition. Oxford: Oxford University Press, 2017. 769 pp. ISBN 978-0-19-876802-9

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Corrigendum

Epidemiology of chronic respiratory diseases and associated factors in the adult Italian population

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Haemorrhagic fever with renal syndrome in Montenegro, 2004–14

Abstract

From 2004 to 2014, 106 cases of Human haemorrhagic fever with renal syndrome were notified in Montenegro, with a peak in 2014. Most of the cases occurred in summer, in the North-east and Central Montenegro, a hilly/mountainous area, that provides suitable habitats for the main rodent carriers. Cases were mainly males (71) and exposures were often working outdoor or spending time visiting mountains and lakes. Incidence correlated with average annual temperature increase and average annual rainfalls decrease, but not with land cover. Environment and climate effects on HFRS in Montenegro need further investigation to get insight into future trends.

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Monthly variation in mammographic screening attendance in Norway

Abstract

Breast Cancer Awareness Month (BCAM) increases screening attendance in the USA. However, this effect has not been investigated in Europe, where organized screening is widespread. We examined monthly attendance within the Norwegian Breast Cancer Screening Programme, 2005–15. Relative to October, the odds of attending screening in January, February, March, August, September or December were slightly decreased (OR_adj 0.93–0.98, P ≤ 0.003 for all). BCAM may marginally increase attendance in October but seasonal factors such as weather may also explain this observed variation. Furthermore, it is possible that organized screening with predetermined appointments evens out the effect BCAM has on screening attendance.

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Do work and family care histories predict health in older women?

Abstract

Background

Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health.

Methods

We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours.

Results

Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories.

Conclusion

Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

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