Primary prevention of coronary heart disease in women

The British Menopause Society Council is committed to provide up-to-date authoritative reviews to aid health professionals to inform and advise women about key issues in postreproductive health. Coronary heart disease (CHD) is a leading cause of death in women. Observational studies have consistently shown estrogen to help prevent CHD in postmenopausal women. The large randomized controlled Women's Health Initiative (WHI) trial did not confirm these observational findings. However, further analyses of the WHI study as well as the observational Nurses' Health Study have now found that the timing of onset of hormone replacement therapy (HRT) use is important and that estrogen may have a protective role in CHD in women aged 50-59 years. This consensus statement will examine the evidence regarding HRT and non-estrogen therapies (lipid lowering agents, aspirin, antihypertensives, antidiabetic medications, selective estrogen receptor modulators [SERMs]) as well as diet, lifestyle and smoking cessation in the primary prevention of CHD in women.     

The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease

The acceptability of a high-calorie-expenditure (HCE) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated. Seventy-four overweight patients (median age 63 yr) were randomly assigned to a 5-mo intervention of HCE exercise (3,000-3,500 kcal/wk daily walking) or standard cardiac-rehabilitation (CR) exercise (700-800 kcal/wk). Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk. Assessments at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables. The HCE group experienced significantly greater weight loss (8.2 ± 4 vs. 3.7 ± 5 kg, p < .001). Changes from baseline to 5 mo on scores of physical, emotional, and social functioning were greater for the HCE than CR group (p < .05). HCE exercise also resulted in greater positive change in exercise enjoyment (p = .05), which was mediated by weight change. Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes.     

Association of shorter mean telomere length with large artery stiffness in patients with coronary heart disease

Background.?Accumulating evidence implicates leukocyte telomere length (LTL) shortening as a potential risk predictor for cardiovascular disease. Arterial stiffness chronicles the cumulative burden of cardiovascular disease risk factors. Therefore, the capacity of LTL to predict arterial stiffness was examined.

Methods.?A total of 275 unrelated Chinese males: 163 patients with coronary artery disease (CAD) and 112 healthy controls, 40–73 years of age were included in this study. The relative telomere length of leukocytes was determined by a real-time fluorescence quantitative polymerase chain reaction (PCR). Large artery stiffness was measured with carotid-femoral pulse wave velocity (PWV).

Results.?The relative telomere length (T/S) ratio was significantly shorter in patients with CAD (0.79?±?0.26) than in control subjects (1.08?±?0.22) (p?<?0.001). The correlation between LTL and PWV in patients with CAD was stronger than that in the controls (r?=??0.467, r²?=?0.227, p?<?0.001 for patients with CAD versus r?=??0.223; r ²?=?0.050; p?=?0.018 for controls). The log_e-transformed T/S ratio was inversely correlated with age (r?=??0.345; p?<?0.001), PWV (r?=??0.326; p?<?0.001) and C-reactive protein ( r?=??0.133; p?=?0.027).

Conclusions.?The data show an association of leukocyte telomere length shortening with increased arterial stiffness and cardiovascular burden, suggesting that telomere length is a biomarker of large artery elasticity and CAD. Further studies are warranted to study the role of LTL dynamics in the pathogenesis of atherosclerosis.     

Social exclusion,mobility and access1

Much of the literature on social exclusion ignores its ‘spatial’ or ‘mobility’ related aspects. This paper seeks to rectify this by examining the mobile processes and infrastructures of travel and transport that engender and reinforce social exclusion in contemporary societies. To the extent to which this issue is addressed, it is mainly organized around the notion of ‘access’ to activities, values and goods. This paper examines this discourse in some detail. It is argued that there are many dimensions of such access, that improving access is a complex matter because of the range of human activities that might need to be ‘accessed’, that in order to know what is to be accessed the changing nature of travel and communications requires examination, and that some dimensions of access are only revealed through changes in the infrastructure that ‘uncover’ previously hidden social exclusions. Claims about access and socio‐spatial exclusion routinely make assumptions about what it is to participate effectively in society. We turn this question around, also asking how mobilities of different forms constitute societal values and sets of relations, participation in which may become important for social inclusion. This paper draws upon an extensive range of library, desk and field research to deal with crucial issues relating to the nature of a fair, just and mobile society.     

Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms"

Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.     

Cultural transmission,educational attainment and social mobility

This paper examines the relationship between cultural socialisation, educational attainment and intergenerational social mobility. Picking up on debates about the transmission of cultural capital and social advantage, we use data from the Taking Part Survey of England to analyse how far socialisation into cultural activities and encouragement play a role in educational attainment, intergenerational mobility and in the reproduction of class. This survey has unprecedented data on whether respondents had been taken to museums/art galleries, theatre/dance/classical music performances, sites of historic interest, and libraries when they were growing up. This is buttressed by information on how much parents or other adults encouraged the respondents to read books or to be creatively active in different domains of the arts, literature and music. Using these rich measures of childhood socialisation, we can show that part of the effect of parental class on educational attainment is due to the transmission of this kind of cultural capital. Moreover, this transmission also has a direct effect on the level of educational attainment. In a similar fashion, respondents who have experienced a higher intensity of cultural socialisation are more likely to be upwardly mobile, and likewise, cultural transmission has a positive effect on the prevention of downward mobility among service class children. These results are discussed in the light of current issues in British mobility research and its treatment of cultural aspects of class and mobility.     

Dynastic inequality,mobility and equality of opportunity

One often heard counter to the concern about rising income and wealth inequality is that it is wrong to focus on inequality of outcomes in a “snapshot”. Intergenerational mobility and “equality of opportunity”, so the argument goes, is what matters for normative evaluation. In response to this counter, we ask what pattern of intergenerational mobility leads to lower inequality not between individuals but between the dynasties to which they belong? And how does this pattern in turn relate to commonly held views on what constitutes equality of opportunity? We revive and revisit here our earlier contributions which were in the form of working papers (Kanbur and Stiglitz 1982, 1986) in order to engage with the current debate. Focusing on bistochastic transition matrices in order to hold constant the steady state snapshot income distribution, we develop an explicit partial ordering which ranks matrices on the criterion of inequality between infinitely lived dynasties. A general interpretation of our result is that when comparing two transition matrices, if one matrix is “further away” from the identity matrix then it will lead to lower dynastic inequality. More specifically, the result presents a computational procedure to check if one matrix dominates another on dynastic inequality. We can also assess “equality of opportunity”, defined as identical prospects irrespective of starting position. We find that this is not necessarily the mobility pattern which minimizes dynastic inequality.     

Religion, social mobility and education in Scotland

The relationship among religion, education and social mobility in Scotland is analysed statistically using the Scottish Household Survey of 2001 . The large sample size allows much greater statistical power for this purpose than any previous source, and thus allows a more reliable assessment of claims that the stratifying effect of religion in Scotland may have declined. The questions investigated are as follows. What are the religious differences in the distributions of class origins and class destinations, in the movement between these (absolute mobility), and in the association of these (relative mobility, or social fluidity)? Do changes in social fluidity across cohorts vary among people with different religious affiliation? Are there religious differences in the association of origins and education, in the association of education and destinations, or in the role of education in social fluidity, and do any of these vary over cohorts? The conclusions are that, in younger cohorts, there is no religious difference in social status, and that in older cohorts Catholics are generally of lower status than Protestants and the non‐religious. Social fluidity does not, however, vary among religious groups, even for older cohorts, and does not change over time. The reason for convergence in social status of religious groups over time is probably the equalizing of educational attainment among the groups: there is no evidence for any of the cohorts that the labour‐market rewards to education differ by religion.     

Ethnicity,immigration process and short-term occupational mobility

The relationship between the ethnic characteristics of immigrants to the United States and their occupational mobility in the short term is explored. The data concern the period 1965-1970 and are taken from the 1970 census. The results indicate that race and sociocultural distance have important effects on occupational mobility. The study also shows that if educational status is controlled, the performance of Asian immigrants is more similar to that of blacks or Hispanics than it is to that of whites. (summary in FRE, SPA)