Health and the city: physical health and mental health

In France, city size has very little bearing on the mortality rate as a function of age and life expectancy and it is in large cities that these indicators are the most favorable. No increase in maternal or infant mortality rates or deaths due to cancers has been observed in large cities. The lower mortality rate linked to respiratory and cardiovascular diseases in large urban areas contradicts the fears concerning the impact of air pollution. Deaths linked to lifestyle are less frequent in big cities, which could be due to social structures (socio-professional level: the proportion of white-collar workers and professionals is higher in bigger cities than in the suburbs or small cities). However, although the overall mortality rate is lower, it should be emphasized that there is in large cities a greater incidence of sexually transmitted diseases, AIDS and certain infectious diseases (because of social diversity and the fact that certain individuals seeking anonymity and marginality are drawn to large cities). In terms of mental health, the breakdown of family structures, instability, unemployment, the lack of parental authority and failing schools render adolescents vulnerable and hinder their social integration. When the proportion of adolescents at risk is high in a neighborhood, individual problems are amplified and social problems result. In order to restore mental and social health to these neighborhoods, ambitious strategies are necessary which take into account family and social factors as well as environmental ones. At the present time, when physical health is constantly improving, the most pressing problems are those related to lifestyle and mental health which depend for a large part on social factors.     

Single motherhood and mental health: implications for primary prevention

In this issue (page 639) Dr. Ellen L. Lipman and colleagues show that single motherhood is associated with an increased risk of affective disorder and poverty and with increased rates of mental health services utilization. These findings have important implications for primary prevention interventions that focus on the social determinants of family health. Studies have shown that higher levels of psychological distress among single mothers are more closely related to their exposure to stressors than to their personal vulnerability to stress. Research has also shown that the stresses that affect single-parent families are greater in degree but not in kind than those that affect other families. Therefore, intervention programs that address the needs of all families are preferable to those that target specific types of families. Community-based primary prevention programs can promote the well-being of all families by improving the social and economic conditions in which they live.     

Cyprinid assemblages,and the physical and chemical characteristics of small northern Ontario lakes

Synopsis The cyprinid species, and physical and chemical characteristics were recorded from 58 small lakes in the Algoma district of northern Ontario. A group of typical stream-dwelling lithophilous species, which included common shiner, Notropis cornutus, creek chub, Semotilus atromaculatus, and blacknose dace, Rhinichthys atratulus, tended to occupy lakes of larger than average drainage areas. Phoxinus spp., pearl dace, Semotilus margarita, and fathead minnow, Pimephales promelas, occurred commonly in lakes with small drainage areas, and the average drainage area of lakes they occupied was near or below the overall average. Lakes without stream cyprinids were discriminated from lakes with them on a combination of chemical variables, including pH, alkalinity and calcium, which indicated that they were more susceptible to anthropogenic acidification.     

Contact allergy and sociodemographic characteristics

The aim of the study was to determine the frequency of positive patch test reaction to different contact allergens according to patients age, sex, occupation and clinical features. Between 1999 and 2003, patch testing was performed in 3,293 patients with respective clinical diagnoses. Patch testing was done by the standard technique proposed by the International Contact Dermatitis Research Group (ICDRG). Study results showed statistically significant differences in patch test response according to sex and age for three allergens (cobalt chloride, nickel sulphate and thiomersal); according to occupation for nine allergens (cobalt chloride, nickel sulphate, balsam of Peru, fragrance mix, thiuram mix, wood tars, neomycin sulphate, thiomersal and detergents), and clinical diagnosis for two allergens (nickel sulphate, and wood tars). The most common and relevant allergens were: nickel sulphate, cobalt chloride and carba mix. They were found in all examinees regardless of age, sex, occupation and diagnoses. The increased awareness of allergens and their potential sources may help to limit the usage of these chemicals in manufacture of consumer products.     

Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

Background:

Previous studies of differences in mental health care associated with children’s sociodemographic status have focused on access to community care. We examined differences associated with visits to the emergency department.

Methods:

We conducted a 6-year population-based cohort analysis using administrative databases of visits (n = 30 656) by children aged less than 18 years (n = 20 956) in Alberta. We measured differences in the number of visits by socioeconomic and First Nations status using directly standardized rates. We examined time to return to the emergency department using a Cox regression model, and we evaluated time to follow-up with a physician by physician type using a competing risks model.

Results:

First Nations children aged 15–17 years had the highest rate of visits for girls (7047 per 100 000 children) and boys (5787 per 100 000 children); children in the same age group from families not receiving government subsidy had the lowest rates (girls: 2155 per 100 000 children; boys: 1323 per 100 000 children). First Nations children (hazard ratio [HR] 1.64; 95% confidence interval [CI] 1.30–2.05), and children from families receiving government subsidies (HR 1.60, 95% CI 1.30–1.98) had a higher risk of return to an emergency department for mental health care than other children. The longest median time to follow-up with a physician was among First Nations children (79 d; 95% CI 60–91 d); this status predicted longer time to a psychiatrist (HR 0.47, 95% CI 0.32–0.70). Age, sex, diagnosis and clinical acuity also explained post-crisis use of health care.

Interpretation:

More visits to the emergency department for mental health crises were made by First Nations children and children from families receiving a subsidy. Sociodemographics predicted risk of return to the emergency department and follow-up care with a physician.Emergency departments are a critical access point for mental health care for children who have been unable to receive care elsewhere or are in crisis.¹ Care provided in an emergency department can stabilize acute problems and facilitate urgent follow-up for symptom management and family support.^1,2Race, ethnic background and socioeconomic status have been linked to a crisis-oriented care patterns among American children.^3,4 Minority children are less likely than white children to have received mental health treatment before an emergency department visit,^3,4 and uninsured children are less likely to receive an urgent mental health evaluation when needed.⁴ Other studies, however, have shown no relation between sociodemographic status and mental health care,^5,6 and it may be that different health system characteristics (e.g., pay-for-service, insurance coverage, publicly funded care) interact with sociodemographic status to influence how mental health resources are used. Canadian studies are largely absent in this discussion, despite a known relation between lower income and poorer mental health status,⁷ nationwide documentation of disparities faced by Aboriginal children,^8–10 and government-commissioned reviews that highlight deficits in universal access to mental health care.¹¹We undertook the current study to examine whether sociodemographic differences exist in the rates of visits to emergency departments for mental health care and in the use of post-crisis health care services for children in Alberta. Knowledge of whether differences exist for children with mental health needs may help identify children who could benefit from earlier intervention to prevent illness destabilization and children who may be disadvantaged in the period after the emergency department visit. We hypothesized that higher rates of emergency department use, lower rates of follow-up physician visits after the initial emergency department visit, and a longer time to physician follow-up would be observed among First Nations children and children from families receiving government social assistance.     

Stressful life events, social support networks, and the physical and mental health of urban black adults

The direct and the buffering effects of social support networks have been documented, but few studies have examined their health outcomes for blacks and, specifically, the differences in physical and mental health. This study uses six measures of social support to examine the relationships of social support to health outcomes for black males and females. The data are from a community sample of 451 urban black adults. Results show significant differences by sex according to source of social support and particular health outcomes. Number of nearby relatives and perceived social support have direct and buffering effects, respectively, on mental health for black females, but no significant influences emerge for black males. On the other hand, the number of confidants for black males and the degree of religiosity among black females were inversely related to physical health, suggesting differences in conceptual models of social support for mental and physical health.     

Recession, debt and mental health: challenges and solutions

Background During the economic downturn, the link between recession and health has featured in many countries' media, political, and medical debate. This paper focuses on the previously neglected relationship between personal debt and mental health.Aims Using the UK as a case study, this paper considers the public health challenges presented by debt to mental health. We then propose solutions identified in workshops held during the UK Government's Foresight Review of Mental Capital and Wellbeing.Results Within their respective sectors, health professionals should receive basic 'debt first aid' training, whilst all UK financial sector codes of practice should - as a minimum - recognise the existence of customers with mental health problems. Further longitudinal research is also needed to 'unpack' the relationship between debt and mental health. Across sectors, a lack of co-ordinated activity across health, money advice, and creditor organisations remains a weakness. A renewed emphasis on co-ordinated 'debt care pathways' and better communication between local health and advice services is needed.Discussion The relationship between debt and mental health presents a contemporary public health challenge. Solutions exist, but will require action and investment at a time of competition for funds.     

Lake sturgeon population characteristics in Rainy Lake, Minnesota and Ontario

Rainy Lake contains a native population of lake sturgeon Acipenser fulvescens that has been largely unstudied. The aims of this study were to document the population characteristics of lake sturgeon in Rainy Lake and to relate environmental factors to year‐class strength for this population. Gill‐netting efforts throughout the study resulted in the capture of 322 lake sturgeon, including 50 recaptures. Lake sturgeon in Rainy Lake was relatively plump and fast growing compared with a 32‐population summary. Population samples were dominated by lake sturgeon between 110 and 150 cm total length. Age–structure analysis of the samples indicated few younger (<10 years) lake sturgeon, but the smallest gill net mesh size used for sampling was 102 mm (bar measure) and would not retain small sturgeon. Few lake sturgeon older than age 50 years were captured, and maximum age of sampled fish was 59 years. Few correlations existed between lake sturgeon year‐class indices and both annual and monthly climate variables, except that mean June air temperature was positively correlated with year‐class strength. Analysis of Rainy Lake water elevation and resulting lake sturgeon year‐class strength indices across years yielded consistent but weak negative correlations between late April and early June, when spawning of lake sturgeon occurs. The baseline data collected in this study should allow Rainy Lake biologists to establish more specific research questions in the future.     

Rationing mental health care: parity,disparity, and justice

Recent policy debates in the US over access to mental health care have raised several philosophically complex ethical and conceptual issues. The defeat of mental health parity legislation in the US Congress has brought new urgency and relevance to theoretical and empirical investigations into the nature of mental illness and its relation to other forms of sickness and disability. Manifold, nebulous, and often competing conceptions of mental illness make the creation of coherent public policy exceedingly difficult. Referencing a variety of approaches to ethical reflection on health care, and drawing from the empirical literature on therapeutic efficacy and economic efficiency, we argue that differential rationing, 'disparity,' is unjustifiable.     

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban,Latina mothers: a prospective cohort study

Background

The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups.

Methods

In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders.

Results

In our cohort of Latina mothers, breastfeeding a previous infant was associated with breastfeeding initiation (OR 8.29 [95% CI 1.00, 68.40] p = 0.05) and breastfeeding at 6 months (OR 18.34 [95% CI 2.01, 167.24] p = 0.01). College education was associated with increased exclusive breastfeeding at 6 months (OR 58.67 [95% CI 4.97, 692.08] p = 0.001) and having other children was associated with reduced breastfeeding at six months (OR 0.08 [95% CI 0.01, 0.70] p = 0.02). A higher IIFAS score was not associated with breastfeeding initiation, breastfeeding at 6 or 12 months or exclusive breastfeeding at 6 months of age.

Conclusions

Initial choices about breastfeeding will likely influence future breastfeeding decisions, so breastfeeding interventions should specifically target new mothers. Mothers with other children also need additional encouragement to maintain breastfeeding until 6 months of age. The IIFAS, while predictive of breastfeeding decisions in other population groups, was not associated with feeding decisions in our population of Latina mothers.

     

Interoception beyond homeostasis: affect,cognition and mental health

Interoception refers to the sensing of the internal state of one''s body. Interoception is distinct from the processing of sensory information concerning external (non-self) stimuli (e.g. vision, hearing, touch and smell) and is the afferent axis to internal (autonomic and hormonal) physiological control. However, the impact of interoception extends beyond homeostatic/allostatic reflexes: it is proposed to be fundamental to motivation, emotion (affective feelings and behaviours), social cognition and self-awareness. This view is supported by a growing body of experimental evidence that links peripheral physiological states to mental processes. Within this framework, the representation of self is constructed from early development through continuous integrative representation of biological data from the body, to form the basis for those aspects of conscious awareness grounded on the subjective sense of being a unique individual. This theme issue of the Philosophical Transactions of the Royal Society B draws together state-of-the-art knowledge concerning theoretical, experimental and clinical facets of interoception with the emphasis on cognitive and affective neuroscience. The multidisciplinary and cross-disciplinary perspectives represented in this theme issue disseminate and entrench knowledge about interoception across the scientific community and provide a reference for the conceptualization and further study of interoception across behavioural sciences.     

WPA guidance on mental health and mental health care in migrants

The purpose of this guidance is to review currently available evidence on mental health problems in migrants and to present advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the process of migration and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed. The epidemiology of mental disorders in migrants is described. A series of recommendations to policy makers, service providers and clinicians aimed to improve mental health care in migrants are provided, covering the special needs of migrants concerning pharmacotherapies and psychotherapies.     

Size and sociodemographic characteristics of the Afghan refugee population in Pakistan

Some recent data are presented on the size and selected sociodemographic characteristics of the Afghan refugee population in Pakistan. Although the official figures show that there were 3.27 million registered Afghan refugees in Pakistan, it is estimated that the actual number may be as high as 3.6 million. There is an excess of females over males, mainly due to war-related activities and excessive casualties particularly among males. While infant and childhood mortality rates are declining and are lower than the levels prevalent in Pakistan, as well as in Afghanistan during the pre-war period, the fertility levels among Afghan refugees seem very high indeed.     

Physical and geochemical characteristics of suspended solids,Wilton Creek,Ontario

To understand the nature of sediment-associated nutrient and contaminant transport dynamics in fluvial systems, a stormflow sampling program of suspended solids is reported for one water year in a representative rural diffuse source catchment of southeastern Ontario. Bulk samples of subsieve suspended solids were obtained using field-portable continuous-flow centrifuge apparatus. The physical and geochemical properties of suspended solids show no significant intersite differences over reaches of 1 500–2 000 m, yet display distinctive seasonal trends. Systematic seasonal changes in particle size, organic content, and Ca, P, Mn, Al, Ti, Fe, and K appear to reflect the changing role of partial area hydrology. Ca, P, and Mn are bioaccumulated by stream algae. Mineral signature is relatively constant over the year. This article first appeared in the Canadian Journal of Earth Sciences. Volume 18, pp. 1365–1379 (1981). Permission of the copyright holders to reprint the article is gratefully acknowledged.     

Dysbiotic drift: mental health,environmental grey space,and microbiota

Advances in research concerning the mental health implications of dietary patterns and select nutrients have been remarkable. At the same time, there have been rapid increases in the understanding of the ways in which non-pathogenic microbes can potentially influence many aspects of human health, including those in the mental realm. Discussions of nutrition and microbiota are often overlapping. A separate, yet equally connected, avenue of research is that related to natural (for example, green space) and built environments, and in particular, how they are connected to human cognition and behaviors. It is argued here that in Western industrial nations a ‘disparity of microbiota’ might be expected among the socioeconomically disadvantaged, those whom face more profound environmental forces. Many of the environmental forces pushing against the vulnerable are at the neighborhood level. Matching the developing microbiome research with existing environmental justice research suggests that grey space may promote dysbiosis by default. In addition, the influence of Westernized lifestyle patterns, and the marketing forces that drive unhealthy behaviors in deprived communities, might allow dysbiosis to be the norm rather than the exception in those already at high risk of depression, subthreshold (subsyndromal) conditions, and subpar mental health. If microbiota are indeed at the intersection of nutrition, environmental health, and lifestyle medicine (as these avenues pertain to mental health), then perhaps the rapidly evolving gut-brain-microbiota conversation needs to operate through a wider lens. In contrast to the more narrowly defined psychobiotic, the term eco-psychotropic is introduced.