Contemporary Epidemiology: A Review of Critical Discussions Within the Discipline and A Call for Further Dialogue with Social Theory

The discipline of epidemiology, which holds major influence on public health policy as well as on clinical medical practice, has in recent decades to a large extent been concerned with the identification of factors and markers of risk for disease. Much health information and intervention is thus informed by a wealth of studies on a variety of risk factors, of which the individual is encouraged to keep informed and to be responsible about. Meanwhile, risk factor epidemiology has been subject to intense debate, both within and outside the discipline. The following review offers an overview of critical intradisciplinary debates. It then opens discussion on three partially overlapping areas where social theory has been called upon to contribute to epidemiological inquiry, namely analysis of macro‐social determinants of health and disease, of categories of human difference and of embodiment. The review ends with, and is motivated by, a plea for further integration of and dialogue between epidemiology and social theory.     

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR?=?1.09 [1.05–1.14]; both NSEI: HR?=?1.36 [1.29–1.44]. Lower SEI: HR?=?1.67 [1.57–1.79]; upper SEI: HR?=?1.27 [1.19–1.37]; both SEI: HR?=?1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR?=?4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

     

Collaborative Partnership in Age-Friendly Cities: Two Case Studies From Quebec,Canada

This article aims to explain the collaborative partnership conditions and factors that foster implementation effectiveness within the age-friendly cities (AFC) in Quebec (AFC-QC), Canada. Based on a community-building approach that emphasizes collaborative partnership, the AFC-QC implementation process is divided into three steps: (1) social diagnostic of older adults' needs; (2) an action plan based on a logic model; and (3) implementation through collaborations. AFC-QC promotes direct involvement of older adults and seniors' associations at each of the three steps of the implementation process, as well as other stakeholders in the community. Based on two contrasting case studies, this article illustrates the importance of collaborative partnership for the success of AFC implementation. Results show that stakeholders, agencies, and organizations are exposed to a new form of governance where coordination and collaborative partnership among members of the steering committee are essential. Furthermore, despite the importance of the senior associations' participation in the process, they encountered significant limits in the capacity of implementing age-friendly environments solely by themselves. In conclusion, we identify the main collaborative partnership conditions and factors in AFC-QC.     

Is “Sexual Competence” at First Heterosexual Intercourse Associated With Subsequent Sexual Health Status?

The timing of first sexual intercourse is often defined in terms of chronological age, with particular focus on “early” first sex. Arguments can be made for a more nuanced concept of readiness and appropriateness of timing of first intercourse. Using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), conducted in 2010–2012, this study examined whether a context-based measure of first intercourse—termed sexual competence—was associated with subsequent sexual health in a population-based sample of 17-to 24-year-olds residing in Britain (n = 2,784). Participants were classified as “sexually competent” at first intercourse if they reported the following four criteria: contraceptive protection, autonomy of decision (not due to external influences), that both partners were “equally willing,” and that it happened at the “right time.” A lack of sexual competence at first intercourse was independently associated with testing positive for human papillomavirus (HPV) at interview; low sexual function in the past year; and among women only, reported sexually transmitted infection (STI) diagnosis ever; unplanned pregnancy in the past year; and having ever experienced nonvolitional sex. These findings provide empirical support for defining the nature of first intercourse with reference to contextual aspects of the experience, as opposed to a sole focus on chronological age at occurrence.     

Ambivalence and Living Apart Together in Later Life: A Critical Research Proposal

Most unattached older persons who would like an intimate partnership do not want to remarry or be in a marriage‐like relationship. A growing trend is to live apart together (LAT) in an ongoing intimate relationship that does not include a common home. We address the debate about whether LAT constitutes a new form of intimate relationship in a critical assessment of research on LAT relationships that applies ambivalence and concepts from the life course perspective. We conclude that among older but not younger adults, LAT relationships are generally a stable alternative to living with a partner, negotiated in the context of current social institutions and arrangements. We propose research questions that address later life living apart together as an innovative alternative intimate relationship. We encourage comparative work on the unique challenges of later life living apart together, their implications for other family ties, and their connection to social and cultural arrangements.     

Independent Advocacy for Children and Young People: Developing an Outcomes Framework

This article draws on a study of the outcomes and impact of independent advocacy for children and young people to explore how the value of advocacy is understood by them and by professionals, and what differences advocacy can make to the lives of children and young people. Findings indicate that outcomes of advocacy can be significant and wide‐ranging, including both direct effects on the child or young person and wider impact on services. This has implications for how to capture and report the outcomes of advocacy, for which this article offers a new conceptual framework.     

Local Digital Algorithms Applied to Boolean Models

We investigate the estimation of specific intrinsic volumes of stationary Boolean models by local digital algorithms; that is, by weighted sums of local configuration counts. We show that asymptotically unbiased estimators for the specific surface area or integrated mean curvature do not exist if the dimension is at least two or three, respectively. For three‐dimensional stationary isotropic Boolean models, we derive asymptotically unbiased estimators for the specific surface area and integrated mean curvature. For a Boolean model with balls as grains, we even obtain an asymptotically unbiased estimator for the specific Euler characteristic.     

Stuck with ‘electronic brochures’? How boundary management strategies shape politicians’ social media use

Social media provide new opportunities for politicians, such as personalized communication directed at specific communities of interest. Yet despite potential benefits, empirical analyses show that politicians tend to shy away from an active engagement of online audiences. This study explores the effect of politicians’ online boundary management on their use of social media. Ties maintained through social media profiles can be embedded in diverse social contexts (‘context collapse’). Professional communicators, especially, are faced with the challenge of managing boundaries between professional and private online self-presentations. Based on a survey of 106 German members of parliament, we distinguish four types of boundary management strategies. We analyze the effects of these strategies on politicians’ social media use practices – and find that considering boundary management strategies allows for a better understanding of politicians’ online engagement (or lack thereof).