Harnessing hormonal signaling for cardioprotection

Cardiovascular disease is the leading cause of death in women in the Western world and is predominant among the elderly. A large body of evidence suggests that hormonal signaling plays a critical role in the regulation of cardioprotective mechanisms, as premenopausal women are at significantly lower risk of heart disease compared with men, but the risk greatly increases with the onset of menopause. This association indicates that estrogen may protect the heart from cardiovascular disease. Whereas a number of analyses of the effects of hormone replacement therapy (HRT) on postmenopausal women supported the idea that estrogen is a cardioprotective factor, the findings of the more recent Women's Health Initiative (WHI) study suggested that HRT may actually increase the risk of cardiovascular events. These conflicting reports have left both patients and clinicians reluctant to continue using current HRT regimes. The WHI findings do not, however, negate the epidemiological link between menopause and increased cardiovascular risk. Hence, the identification of the specific actions of estrogen that promote cardioprotective pathways without enhancing deleterious vascular mechanisms may provide novel estrogen-based alternatives to current HRT strategies. In this Review, we outline the known actions of estrogen on the cardiovascular system, focusing on cardioprotective mechanisms that may be targeted for the development of new therapeutic approaches.     

Distress among Children whose Separated or Divorced Parents cannot Agree Arrangements for Them

Correspondence to Ann Buchanan, Department of Social Policy and Social Work, University of Oxford, Barnett House, Wellington Square, Oxford OX1 2ER, UK. E-mail: ann.buchanan{at}socres.ox.ac.uk Summary This paper, based on a larger study of children and their parentswho were subjects of a welfare report for the court followingparental separation and divorce, highlights the very high levelsof distress amongst the children involved. As measured by theStrength and Difficulties Questionnaire (SDQ), 52 per cent ofboys and 48 per cent of girls had significant adjustment problemsimmediately after the proceedings and a year later, 62 per centof boys and 32 per cent of girls were still maladjusted. Childrenwere more likely to have problems where parents were also distressedand where there was domestic violence. These findings suggestthat these children should be considered ‘children inneed’ under the 1989 Children Act. and that preventiveservices need to be developed to help parents resolve the arrangementsfor the children without going to court.     

A room with a view: a metaphor analysis of Vietnamese women’s representations of living with depression using photo elicitation

Depression is complex and it is known that how people name and give meaning to this experience when they are from cross cultural backgrounds differs to that of dominant Anglo cultures. Yet surprisingly very little is known about the naming and meaning-making conventions particularly for Vietnamese communities. In Anglo cultures, people commonly describe their experiences of depression as ‘travelling through dark tunnels toward a light’; ‘climbing out of a hole’; ‘a black dog’, and the ‘descent of a black cloud’. These metaphoric representations provide us with visual messages and new meanings about the experience of depression and how it impacts individuals. In this article, we describe a study that aimed to examine if a photo elicitation method could provide a group of women from Vietnamese backgrounds with another language set by which to represent their experience of depression in the face-to-face interview context. Women were provided with a digital camera and asked to take a minimum of 10 photos about their everyday experiences of living with depression. Recruitment and face-to-face interviews were completed with an interpreter already known to participants employed at the community health centre. Participants were asked to select five key photos for discussion within the interpreted interview. In the following article, a metaphor analysis is presented to reflect on how the photos enabled further insight into Vietnamese women’s representations of living with depression and examine the application of this participatory visual method for cross cultural research settings.     

The Impact of Different Types of Resource Transfers on Individual Wellbeing: An Analysis of Quality of Life Using CASP-12

This paper uses data for Spain from the Survey of Health, Ageing and Retirement in Europe (release 2.3.1) to model the determinants of the quality of life of the elderly, paying special attention to their intergenerational relations. The aim is to study CASP-12 (a social functional index) and explore the effect of interdependency in terms of the transfer of the resources of time and money between the elderly and other family members. To do so, we estimate a latent class model to explore the determinants of wellbeing. This allows us to distinguish between two different subpopulations, whose quality of life is modeled in different ways and who potentially would require different types of public care policies.     

Attachment and adaptive skills in children of international adoption

The attachment pattern of a sample of 168 internationally adopted children was explored in this study using the semi‐structured Friends and Family Interview. The pattern was analysed in relation to the development of adaptive skills as an expression of the children's resilience. The secure attachment pattern rates were slightly lower and the insecure attachment patterns were considerably higher than those of normative samples from the previous studies. The children from Eastern Europe demonstrated a more insecure attachment pattern (odds ratio [OR]= 2.46; confidence interval [CI]= 1.23–3.94), and their scores on the adaptive skills scales were lower than the scores of children from other countries (OR = 2.62; 95% CI = 1.02–6.72). These results help to identify the groups at risk of failing to develop secure attachment patterns and appropriate adaptive skills, and should provide valuable information for designing effective interventions.     

Measuring children's needs: how are we doing?

Children's services in England and Wales are legally required to determine the nature and extent of children's needs in their areas as a precursor to providing needs-led services. However, few needs assessments are ever published. This article analyses 83 such reports conducted between 1999 and 2007 in two local authorities in England (one urban, one rural), focusing on their quality and usefulness. It makes recommendations for improving practice in this important area, both in terms of the type of needs assessment required and how best to produce and use them.     

Aids mortality and the mobility of children in Kwazulu Natal,South Africa

This paper examines the effect of parental death on the mobility of 39,163 children aged 0-17 in rural KwaZulu Natal, South Africa, in 2000 and 2001. Parental mortality from all causes prior to and during follow-up increased the risk of a child moving by nearly two times after we controlled for the age and gender of the child and household characteristics. However, in the follow-up period, child mobility following maternal deaths from AIDS was lower than child mobility following maternal deaths from other causes. Younger children, boys, and children whose mothers or fathers were resident members of the children's households were also less likely to move.