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1.
Within affluent societies, people who grow up in deprived areas begin reproduction much earlier than their affluent peers, and they display a number of other behaviors adapted to an environment in which life will be short. The psychological mechanisms regulating life-history strategies may be sensitive to the age profile of the people encountered during everyday activities. We hypothesized that this age profile might differ between environments of different socioeconomic composition. We tested this hypothesis with a simple observational study comparing the estimated age distribution of people using the streets in an affluent and a socioeconomically deprived neighborhood which were closely matched in other ways. We were also able to use the UK census to compare the age profile of observed street users with the actual age profile of the community. We found that people over 60?years of age were strikingly less often observed on the street in the deprived than in the affluent neighborhood, whereas young adults were observed more often. These differences were not reflections of the different age profiles of people who lived there, but rather of differences in which residents use the streets. The way people use the streets varies with age in different ways in the affluent and the deprived neighborhoods. We argue that chronic exposure to a world where there are many visible young adults and few visible old ones may activate psychological mechanisms that produce fast life-history strategies.  相似文献   

2.
Human cooperative behaviour, as assayed by decisions in experimental economic dilemmas such as the Dictator Game, is variable across human populations. Within-population variation has been less well studied, especially within industrial societies. Moreover, little is known about the extent to which community-level variation in Dictator Game behaviour relates to community-level variation in real-world social behaviour. We chose two neighbourhoods of the city of Newcastle upon Tyne that were similar in most regards, but at opposite ends of the spectrum in terms of level of socioeconomic deprivation. We administered Dictator Games to randomly-selected residents, and also gathered a large number of more naturalistic measures of cooperativeness. There were dramatic differences in Dictator Game behaviour between the two neighbourhoods, with the mean allocation to the other player close to half the stake in the affluent neighbourhood, and close to one tenth of the stake in the deprived neighbourhood. Moreover, the deprived neighbourhood was also characterised by lower self-reported social capital, higher frequencies of crime and antisocial behaviour, a higher frequency of littering, and less willingness to take part in a survey or return a lost letter. On the other hand, there were no differences between the neighbourhoods in terms of the probability of helping a person who dropped an object, needed directions to a hospital, or needed to make change for a coin, and people on the streets were less likely to be alone in the deprived neighbourhood than the affluent one. We conclude that there can be dramatic local differences in cooperative behaviour within the same city, and that these need further theoretical explanation.  相似文献   

3.
Objectives: To examine the relation between deprivation and acute emergency admissions for cancers of the colon, rectum, lung, and breast in south east England. Design: Ecological analysis with data from hospital episode statistics and 1991 census. Setting: North and South Thames Regional Health Authorities (population about 14 million), divided into 10 aggregations of 31 470 census enumeration districts (median population 462). Subjects: 146 639 admissions relating to 76 552 patients aged <100 years on admission, resident in the Thames regions, admitted between 1 April 1992 and 31 March 1995. Results: Residents living in deprived areas were more likely to be admitted as emergencies and has ordinary inpatient admissions and less likely to be admitted as day cases. Adjusted odds of ordinary admissions from the most deprived tenth occurring as emergencies (relative to admissions from the most affluent tenth) were 2.29 (95% confidence interval 2.09 to 2.52) for colorectal cancer, 2.20 (1.99 to 2.43) for lung cancer, and 2.41 (2.17 to 2.67) for female breast cancer; adjusted odds of admissions as day cases were 0.70 (0.64 to 0.76), 0.50 (0.44 to 0.56), and 0.56 (0.50 to 0.62), respectively. Patients from deprived areas with lung or breast cancers were less likely to be recorded as having surgical interventions. Adjusted odds of patients from the most deprived tenth receiving surgery were 0.88 (0.78 to 1.00), 0.58 (0.48 to 0.70), and 0.63 (0.56 to 0.71), respectively. Admissions for colorectal cancer from the most deprived areas were less likely to be to hospitals admitting 100 or more new patients a year; the opposite held true for breast cancer admissions. No association was found for lung cancer admissions. Conclusions: Earlier diagnostic and referral procedures in primary care in deprived areas are required if there are to be significant reductions in mortality from these cancers. A national information strategy is required to ensure the continued availability of population based data on NHS patients and to mandate standardised datasets from the private sector. Rationalisation of acute services, hospital mergers, and plans for bed closures must take into account the increased healthcare needs and inequities in access to treatment and care of residents in areas with high levels of deprivation. Health authorities and primary care groups should re-examine their purchasing intentions, service reviews, and monitoring arrangements in the light of these findings.

Key messages

  • A major reorganisation of cancer services is under way in England and Wales with the aim of improving access to and quality of treatment
  • Residents with cancers of the bowel, lung, or breast in deprived areas in the Thames region were more likely to be admitted as emergencies and ordinary inpatients than their counterparts from more affluent areas, and patients with lung or breast cancers from deprived areas were less likely to receive surgical treatment
  • Patients with colorectal cancer from the most deprived areas were less likely to be seen at hospitals with a large caseload than were patients from affluent areas; the opposite held true for patients with breast cancer, but no association was found for admissions for lung cancer
  • More effective early diagnostic and referral procedures in primary care in deprived areas are required if reductions in mortality are to be achieved
  • Hospital mergers and plans for service reconfiguration and bed closures must take into account inequities in access to treatment among residents in deprived areas
  相似文献   

4.
Nettle D 《PloS one》2011,6(6):e21051

Background

There are socioeconomic disparities in the likelihood of adopting unhealthy behaviours, and success at giving them up. This may be in part because people living in deprived areas are exposed to greater rates of unhealthy behaviour amongst those living around them. Conventional self-report surveys do not capture these differences in exposure, and more ethological methods are required in order to do so.

Methodology/Principal Findings

We performed 12 hours of direct behavioural observation in the streets of two neighbourhoods of the same city which were similar in most regards, except that one was much more socioeconomically deprived than the other. There were large differences in the publicly visible health behaviours observed. In the deprived neighbourhood, we observed 266 more adults smoking (rate ratio 3.44), 53 more adults drinking alcohol (rate ratio not calculable), and 38 fewer adults running (rate ratio 0.23), than in the affluent neighbourhood. We used data from the Health Survey for England to calculate the differences we ought to expect to have seen given the individual-level socioeconomic characteristics of the residents. The observed disparities between the two neighbourhoods were considerably greater than this null model predicted. There were also different patterns of smoking in proximity to children in the two neighbourhoods.

Conclusions/Significance

The differences in observed smoking, drinking alcohol, and physical activity between these two neighbourhoods of the same city are strikingly large, and for smoking and running, their magnitude suggests substantial area effects above and beyond the compositional differences between the neighbourhoods. Because of these differences, individuals residing in deprived areas are exposed to substantially more smoking and public drinking, and less physical activity, as they go about their daily lives, than their affluent peers. This may have important implications for the initiation and maintenance of health behaviours, and the persistence of health inequalities.  相似文献   

5.
Ethologists proposed the coevolution of pedomorphic characteristics in infants and caregiving responses to these features in parents. Human infants higher in pedomorphic characteristics are more likely to receive baby talk from adults and elicit stronger motivations for caretaking. Neotenous facial characteristics in human adults cue social approach and elicit helping. This study demonstrates generally strong differences in reactions to infants from non‐mammalian species requiring parental care (semiprecocial) and superprecocial species within the same class. People perceive semiprecocial infants as more neotenous (cute, immature, and helpless), had greater desires to hold or pet them, thought they would have a greater appreciation of being held or pet, thought they would be less likely to survive on their own, and anticipated being more likely to adopt them compared to superprecocial infants. Both avian and reptilian infants elicited these patterns. There was a moderate degree of sex differences in ratings, women saw the infants as more neotenous and were more willing to adopt them than men.  相似文献   

6.
1. The objective of the work reported here was to test the hypothesis that in insects that invest considerable energy in sexual displays and courtship, foraging successfully for food affects their subsequent performance and copulatory success in leks. Accordingly, the interactions between body size and diet on initiation of lekking behaviour and copulatory success in male Mediterranean fruit flies Ceratitis capitata (Diptera: Tephritidae) were investigated. 2. Protein‐fed males were heavier and contained more protein and less lipid reserves than protein‐deprived males. Protein‐fed males were more likely to emit pheromone in leks and, consequently, were more likely to copulate than protein‐deprived males. Furthermore, protein‐fed males tended to start calling earlier than their nutritionally deprived competitors. 3. Though size was not related to initiation of lek behaviour, large males were more likely to copulate than small males. Among protein‐fed males, large individuals tended to mate earlier than smaller individuals. 4. Generally, in lek mating systems where a considerable investment of time and energy is required by males, foraging successfully for nutritional resources prior to engaging in territorial or courtship behaviour is essential for reproductive success.  相似文献   

7.
Background: This study investigated the role that demographic and tumour factors play in explaining socioeconomic inequalities in breast cancer survival. Methods: Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. The New Zealand area-based deprivation index (NZDep) was used as a measure of socioeconomic position. Relative survival rates were estimated using sex-, deprivation- and ethnic-specific life tables. Multiple imputation was used to impute missing data. Excess mortality modelling was used to estimate the contribution of demographic and tumour factors to inequalities in survival. Results: There were 2968 breast cancer cases included and 433 recorded deaths. Relative survival rates at 4 years varied across deprivation groups. Using NZDep deciles 1–4 (least deprived) as the reference group, the age- and ethnicity-adjusted hazard ratio (HR) for NZDep deciles 7–8 was 2.03 (CI 1.36–3.04) and for NZDep deciles 9–10 was 1.93 (CI 1.28–2.92). In the fully adjusted model there remained 50% excess mortality for the two most deprived groups compared to the most affluent. Variables which measured timely access to care (extent/size) accounted for more of the survival disparity than breast cancer subtype variables (ER/PR/HER2). Conclusion: Women from deprived areas in New Zealand who are diagnosed with breast cancer are less likely to survive as long as those from affluent areas. A substantial proportion of these socioeconomic disparities can be attributed to differential access to health care although other factors, currently unknown, are also likely to play an important role.  相似文献   

8.
OBJECTIVE--To compare the mortality experience of Scottish postcode sectors characterised by socioeconomic census variables (Carstairs scores) in 1980-2 and 1990-2. METHODS--Variables derived from the 1981 and 1991 censuses were combined according to the method devised by Carstairs and Morris to obtain Carstairs scores for 1010 postcode sectors in Scotland in 1981 and 1001 sectors in 1991. For most analyses, these scores were grouped into seven deprivation categories ranging from affluent (category 1) to deprived (category 7) localities. MAIN OUTCOME MEASURES--Death rates and standardised mortality ratios for localities according to deprivation category. RESULTS--Postcode sectors in Scotland that were categorised as deprived in 1981 were relatively more deprived at the time of the 1991 census; the mortality experience of deprived localities relative to either Scotland or affluent neighbourhoods worsened over this period, with a 162% difference between the most affluent and most deprived categories in 1991-2. Although the age and sex standardised mortality for ages 0-64 in Scotland declined by 22% during the 1980s, the reduction in the deprived categories was only about half that of the affluent groups. Increases in the death rate for men (29%) and women (11%) aged 20-29 in the deprived groups were largely attributable to an increase in the rates of suicide. Death rates from ischaemic heart disease and carcinoma of the lung and bronchus at ages 40-69 were lower in all deprivation categories in 1990-2, but the reduction was greater in more affluent areas; the difference in rates for these conditions between affluent and deprived groups therefore increased over the decade. The observed worsening of the standardised mortality ratio for Glasgow relative to Scotland could be explained on the basis of these mortality differentials and the concentration of deprived postcode sectors in Glasgow. CONCLUSIONS--Differences in mortality experience linked to relative poverty increased in the 10 years between 1981 and 1991 censuses. Although mortality for Scotland as a whole is improving, the picture is one of an increasing distinction between the experience of the majority and that of a substantial minority of the population.  相似文献   

9.
ObjectiveTo explore and explain socioeconomic variations in perceptions of and behavioural responses to chest pain.DesignQualitative interviews.SettingCommunity based study in Glasgow, Scotland.Participants30 respondents (15 men and 15 women) from a socioeconomically deprived area of Glasgow and 30 respondents (15 men and 15 women) from an affluent area of Glasgow.ResultsResidents of the deprived area reported greater perceived vulnerability to heart disease, stemming from greater exposure to heart disease in family members and greater identification with high risk groups and stereotypes of cardiac patients. This greater perceived vulnerability was not associated with more frequent reporting of presenting to a general practitioner. People from the deprived area reported greater exposure to ill health, which allowed them to normalise their chest pain, led to confusion with other conditions, and gave rise to a belief that they were overusing medical services. These factors were associated with a reported tendency not to present with chest pain. Anxiety about presenting among respondents in the deprived area was heightened by self blame and fear that they would be chastised by their general practitioner for their risk behaviours.ConclusionsImportant socioeconomic variations in responses to chest pain may contribute to the known inequities in uptake of secondary cardiology services. Primary care professionals and health promoters should be aware of the ways in which perceptions of symptoms and illness behaviour are shaped by social and cultural factors.

What is already known on this topic

Socioeconomic variations in rates of angiography and revascularisation existAmong socioeconomically deprived patients with a diagnosis of angina, barriers to accessing services include fear, denial, low expectations, and diagnostic confusion

What this study adds

Perceived vulnerability to heart disease is associated with socioeconomic deprivation and is underpinned by positive family history and identification with high risk groups and stereotypesGreater perceived vulnerability to heart disease does not lead to reported presentation in deprived patientsIllness behaviour is influenced by normalisation of chest pain, comorbidity, and poor experience and low expectations of health care, which are more prominent in deprived patients  相似文献   

10.
Globally, men and women face markedly different risks of obesity. In all but of handful of (primarily Western European) countries, obesity is much more prevalent among women than men. We examine several potential explanations for this phenomenon. We analyze differences between men and women in reports and effects of potential underlying causes of obesity—childhood and adult poverty, depression, and attitudes about obesity. We evaluate the evidence for each explanation using data collected in an urban African township in the Cape Town metropolitan area. Three factors explain the greater obesity rates we find among women. Women who were nutritionally deprived as children are significantly more likely to be obese as adults, while men who were deprived as children face no greater risk. In addition, women of higher adult socioeconomic status are significantly more likely to be obese, which is not true for men. These two factors - childhood circumstances and adult SES - can fully explain the difference in obesity rates between men and women that we find in our sample. More speculatively, in South Africa, women's perceptions of an ‘ideal’ female body are larger than men's perceptions of the ‘ideal’ male body, and individuals with larger ‘ideal’ body images are significantly more likely to be obese.  相似文献   

11.
OBJECTIVE--To investigate the relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer as a possible explanation for socioeconomic differences in survival. DESIGN--Retrospective analysis of data from cancer registry and from pathology and biochemistry records. SETTING--Catchment areas of two large teaching hospitals in Glasgow. SUBJECTS--1361 women aged under 75 who had breast cancer diagnosed between 1980 and 1987. MAIN OUTCOME MEASURES--Tumour size, axillary lymph node status, histological grade, and oestrogen receptor concentration in relation to deprivation category of area of residence. RESULTS--There was no significant relation between socioeconomic deprivation and four pathological prognostic factors: 93 (32%) women in the most affluent group presented with tumours less than 20 mm in size compared with 91 (31%) women in the most deprived group; 152 (48%) of the most affluent group presented with negative nodes compared with 129 (46%) of the most deprived group; 23 (22%) of the most affluent group presented with grade I tumours compared with 12 (17%) of the most deprived group; and 142 (51%) of the most affluent group had a low oestrogen receptor concentration at presentation compared with 148 (52%) of the most deprived group. None of these differences was statistically significant. CONCLUSIONS--Differences in survival from breast cancer by socioeconomic deprivation category could not be accounted for by differences in tumour stage or biology. Other possible explanations, such as differences in treatment or in host response, should be investigated.  相似文献   

12.
Using a sample of men living in Albuquerque, NM, we examined the relationship between paternity confidence and men's investment in children. In humans, men may reduce their investment in a child in two ways: indirectly, by ending their relationship with the child's mother and ceasing to cohabit with the child (e.g., divorce), and directly, by allocating less time and fewer resources to the child. In this article, we tested two hypotheses regarding the effect of paternity confidence on investment in children: (1) men will be more likely to divorce women if they suspect or are sure that they are not the father of their wife's child, and (2) controlling for divorce, men will reduce direct investments in low paternity confidence children relative to high paternity confidence children. The first hypothesis was supported by the data. The second hypothesis was supported for two out of three measures of paternal investment we examined; low paternity confidence reduces the time men spend with a child in a group with other children or adults, and it reduces extensive involvement with the child's educational progress; there was no effect of paternity confidence on the amount of time men spend with children in one-on-one interactions. We also examined the effects of unstated paternity confidence (e.g., when men decline to answer the question) on divorce and paternal investment. Overall, the results suggested that paternity confidence plays an important role in shaping men's relationships with women and with their putative genetic children.  相似文献   

13.
The occurrence of male-care behaviour directed from juvenile and adult males to infants was studied in a free-ranging troop of Stumptail macaques. The study period lasted two months comprising about 140 hours of recorded observations. Infants were a focal subgroup and their interactions with older males were recorded. The following variables were examined in relationship to the sending and receiving of male-care: the infant (its age, sex, and dominance rank), older males (their age and dominance rank), and genetic ties. Infants I received more male-care than infants II and differences in the type of male-care received by infants I and II were found. Male infants received more male-care than female infants and sex differences in the type of care received were evident. No relationship was found between the infant’s dominance rank and the amount of male-care received. A substantial amount of male-care behaviour was sent to genetic kin. Two-three year olds displayed more male care than yearlings. Juveniles as a class displayed more male-care than adults. A positive association was found between the juveniles’ dominance rank and the sending of male-care. However, among the adults, the subordinate male displayed more care behaviour than the alpha male. The presence or absence of the mother was found to influence the older males’ interest in the infant. The results are discussed and compared with data available on other primate species. Supported by grants from the Behavioral Science Foundation (U.S.) and by the Mexican Institute of Anthropology.  相似文献   

14.

Background

There is striking social variation in the timing of the onset of childbearing in contemporary England, with the mean age at first motherhood about 8 years earlier in the most deprived compared to the least deprived neighbourhoods. However, relatively little is known about how these social differences in reproductive schedule develop in childhood.

Methodology/Principal Findings

We studied the development of differences in reproductive schedules, using a cross-sectional survey over 1000 school students aged 9–15 in the metropolitan borough of North Tyneside. Students from more deprived neighbourhoods had earlier ideal ages for parenthood than those from more affluent ones, and these differences were fully apparent by age 11. We found evidence consistent with three mechanisms playing a role in maintaining the socioeconomic gradient. These were: vertical intergenerational transmission (students whose own parents were younger at their birth wanted children younger); oblique intergenerational transmission (students in neighbourhoods where parents were younger in general wanted children earlier); and low parental investment (students who did not feel emotionally supported by their own parents wanted children at a younger age).

Conclusions/Significance

Our results shed some light on the proximate factors which may be involved in maintaining early childbearing in disadvantaged communities. They help understand why educational initiatives aimed at adolescents tend to have no effect, whereas improving the well-being of poor families with young children may do so. Our results also suggest that there will be considerable intergenerational inertia in the response of reproductive schedules to changing socioecological conditions.  相似文献   

15.
Infant facial features are typically perceived as “cute,” provoking caretaking behaviours. Previous research has focused on adults' perceptions of baby cuteness, and examined how these perceptions are influenced by events of the adult reproductive lifespan, such as ovulation and menopause. However, globally, individuals of all ages, including pre-pubertal children, provide notable proportions of infant care. In this study, we recruited participants in and around northern England, and tested 330 adults and 65 children aged 7–9 using a forced-choice paradigm to assess preferences for infant facial cuteness in two stimulus sets and (as a control task) preferences for femininity in women's faces. We analysed the data with Hierarchical Bayesian Regression Models. The adults and children successfully identified infants who had been manipulated to appear cuter, although children's performance was poorer than adults' performance, and children reliably identified infant cuteness in only one of the two infant stimuli sets. Children chose the feminised over masculinised women's faces as more attractive, although again their performance was poorer than adults' performance. There was evidence for a female advantage in the tasks: girls performed better than boys when assessing the woman stimuli and one of the infant stimulus sets, and women performed better than men when assessing one of the infant stimulus sets. There was no evidence that cuteness judgements differed depending upon exposure to infants (children with siblings aged 0–2; adults with a baby caregiving role), or depending upon being just younger or older than the average age of menopause. Children and grandparents provide notable portions of infant caretaking globally, and cuteness perceptions could direct appropriate caregiving behaviour in these age groups, as well as in adults of reproductive age.  相似文献   

16.
OBJECTIVE--To investigate whether an intervention designed to improve overall immunisation uptake affected social inequalities in uptake. DESIGN--Cross-sectional small area analyses measuring immunisation uptake in cohorts of children before and after intervention. Small areas classified into five groups, from most deprived to most affluent, with Townsend deprivation score of census enumeration districts. SETTING--County of Northumberland. SUBJECTS--All children born in country in four birth cohorts (1981-2, 1985-6, 1987-8, and 1990-1) and still resident at time of analysis. MAIN OUTCOME MEASURES--Overall uptake in each cohort of pertussis, diphtheria, and measles immunisation, difference in uptake between most deprived and most affluent areas, and odds ratio of uptake between deprived and affluent areas. RESULTS--Coverage for pertussis immunisation rose from 53.4% in first cohort to 91.1% in final cohort. Coverage in the most deprived areas was lower than in the most affluent areas by 4.7%, 8.7%, 10.2%, and 7.0% respectively in successive cohorts, corresponding to an increase in odds ratio of uptake between deprived and affluent areas from 1.2 to 1.6 to 1.9 to 2.3. Coverage for diphtheria immunisation rose from 70.0% to 93.8%; differences between deprived and affluent areas changed from 8.6% to 8.3% to 9.0% to 5.5%, corresponding to odds ratios of 1.5, 2.0, 2.5, and 2.6. Coverage for measles immunisation rose from 52.5% to 91.4%; differences between deprived and affluent areas changed from 9.1% to 5.7% to 8.2% to 3.6%, corresponding to odds ratios of 1.4, 1.4, 1.7, and 1.5. CONCLUSION--Despite substantial increase in immunisation uptake, inequalities between deprived and affluent areas persisted or became wider. Any reduction in inequality occurred only after uptake in affluent areas approached 95%. Interventions that improve overall uptake of preventive measures are unlikely to reduce social inequalities in uptake.  相似文献   

17.
OBJECTIVE--To compare proportions of low birthweight babies and mean heights of schoolchildren between rural and urban areas at different levels of social deprivation. DESIGN--Cross sectional population based study classifying cases by Townsend material deprivation index of enumeration district of residence and by rural areas, small towns, and large towns. SETTING--Northumberland Health District. SUBJECTS--18,930 singleton infants delivered alive during January 1985 to September 1990 and resident in Northumberland in October 1990; 9055 children aged 5 to 8 1/2 years attending Northumberland schools in the winter of 1989-90. MAIN OUTCOME MEASURES--Odds ratios for birth weight less than 2800 g; difference in mean height measured by standard deviation (SD) score. RESULTS--Between the most deprived and most affluent 20% of enumeration districts the odds ratio for low birth weight adjusted for rural or urban setting was 1.71 (95% confidence interval 1.51 to 1.93) and the difference in mean height -0.232 SD score (-0.290 to -0.174). Between large towns and rural areas the odds ratio for low birth weight adjusted for deprivation was 1.37 (1.23 to 1.53) and the difference in mean height -0.162 SD score (-0.214 to -0.110). Results for small towns were intermediate between large towns and rural areas. CONCLUSIONS--Inequalities in birth weight and height exist in all rural and urban settings between deprived and affluent areas. In addition, there is substantial disadvantage to living in urban areas compared with rural areas which results from social or environmental factors unrelated to current levels of deprivation.  相似文献   

18.
Matrifocality is a feature of Caribbean communities in which mothers and adult daughters often form the household core. I argue that daughter-biased parental care underlies matrifocality. Parental investment (PI) theory predicts sex-biased care, but factors promoting daughter preference are not always clearly specified. If sons are more likely than daughters to experience unpredictable hazards, then parents may bias their efforts toward daughters. In this study, I examine gender differences in rural Dominica and test PI predictions. Men were more likely to be poor and develop alcoholism and less likely to migrate or attend high school than women were. Educational outcomes showed a Trivers-Willard effect: Boys from unfavorable family environments were less likely to receive secondary education than were other boys, but there was no association for girls. PI variables generally accounted for less variance in men's outcomes than women's, suggesting that unpredictable hazards for sons may promote daughter preference and matrifocality.  相似文献   

19.
The frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%–2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% –1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR)  = 2.19, (1.90–2.54, p<0.001)) and adults (IRR 2.26, (2.01–2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation.  相似文献   

20.
Parental care and alloparental care are major evolutionary dimensions of the biobehavioral repertoire of many species, including human beings. Despite their importance in the course of human evolution and the likelihood that they have significantly shaped human cognition, the nature of the cognitive mechanisms underlying alloparental care is still largely unexplored. In this study, we examined whether one such cognitive mechanism is a visual attentional bias toward infant features, and if so, whether and how it is related to the sex of the adult and the adult’s self-reported interest in infants. We used eye-tracking to measure the eye movements of nulliparous undergraduates while they viewed pairs of faces consisting of one adult face (a man or woman) and one infant face (a boy or girl). Subjects then completed two questionnaires designed to measure their interest in infants. Results showed, consistent with the significance of alloparental care in human evolution, that nulliparous adults have an attentional bias toward infants. Results also showed that women’s interest in and attentional bias towards infants were stronger and more stable than men’s. These findings are consistent with the hypothesis that, due to their central role in infant care, women have evolved a greater and more stable sensitivity to infants. The results also show that eye movements can be successfully used to assess individual differences in interest in infants.  相似文献   

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