Risk factors relate to the variability of health outcomes as well as the mean: a GAMLSS tutorial

Background: Risk factors or interventions may affect the variability as well as the mean of health outcomes. Understanding this can aid aetiological understanding and public health translation, in that interventions which shift the outcome mean and reduce variability are typically preferable to those which affect only the mean. However, most commonly used statistical tools do not test for differences in variability. Tools that do have few epidemiological applications to date, and fewer applications still have attempted to explain their resulting findings. We thus provide a tutorial for investigating this using GAMLSS (Generalised Additive Models for Location, Scale and Shape). Methods: The 1970 British birth cohort study was used, with body mass index (BMI; N=6,007) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale; N=7,104) measured in midlife (42-46 years) as outcomes. We used GAMLSS to investigate how multiple risk factors (sex, childhood social class and midlife physical inactivity) related to differences in health outcome mean and variability. Results: Risk factors were related to sizable differences in outcome variability-for example males had marginally higher mean BMI yet 28% lower variability; lower social class and physical inactivity were each associated with higher mean and higher variability (6.1% and 13.5% higher variability, respectively). For mental wellbeing, gender was not associated with the mean while males had lower variability (-3.9%); lower social class and physical inactivity were each associated with lower mean yet higher variability (7.2% and 10.9% higher variability, respectively). Conclusions: The results highlight how GAMLSS can be used to investigate how risk factors or interventions may influence the variability in health outcomes. This underutilised approach to the analysis of continuously distributed outcomes may have broader utility in epidemiologic, medical, and psychological sciences. A tutorial and replication syntax is provided online to facilitate this (https://osf.io/5tvz6/). Funding: DB is supported by the Economic and Social Research Council (grant number ES/M001660/1), The Academy of Medical Sciences / Wellcome Trust ('Springboard Health of the Public in 2040' award: HOP001/1025); DB and LW are supported by the Medical Research Council (MR/V002147/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Otherness in Buchi Emecheta’s Second-Class Citizen: A Postcolonial Rendering

In postcolonial discourse, the concept of the “Other” represents someone who carries dark human traits such as stigmatization, subjugation, domination, socio-political or cultural misrepresentation. The “Other” represents one of the main postcolonial concepts in literary studies because there is indisputable evidence that the term is a colonial construct. In essence, colonialism has left a permanent mark in the minds of the colonized people and this imprint has significantly manifested in literature. This analysis, thus, aims to explore how the colonial “Other” is represented in Second-Class Citizen (1974), one of the prominent postcolonial novels written by Buchi Emecheta, an author from the colonized African society. This study adopts textual analysis in which context-oriented technique is used to understand the character traits of the colonial “Other” in the two selected texts. The analysis draws upon Postcolonial theory, particularly Edward Said’s Orientalist approach. We show that Emecheta represents the colonial “Other” as backward, inferior, and of lower social class. Also, this representation is based on economic and socio-cultural differences as well as conflictual relationships between African indigenous people and British citizens.

“MY MINIMALIST JOURNEY:” NARRATIVE ANALYSIS OF YOUTUBE MINIMALISM STORIES

The recent minimalist lifestyle is often claimed to be a way to change your life by minimizing your spending, possessions, tasks, relationships, etc. YouTube is an important venue where minimalist content is published and shared (Meissner, 2019). The current study focuses on “minimalist journey" narratives, where people tell their stories of "encountering" the minimalist lifestyle. I collected “minimalist journey" stories from 40 YouTube videos with their comments and analyzed them using narrative analysis methods, both thematic and structural (Labov & Waletzky, 1997; Riessman, 2005). By closely examining these narratives, this study sheds light on how people experience and make sense of the minimalist lifestyle within the context of anti-consumerism and neoliberalism in digital space. This study also contributes to digital culture studies by showcasing how personal life narratives are constructed on video-sharing platforms like YouTube. Two themes emerged in the analysis. In the “Hoarder to Minimalist” narrative, narrators were once over-consuming hoarders and now minimalists. Minimalism facilitates discursive rejections and behavior disruptions of consumerism. The "transformational" stories, however, reinforcing the neoliberal sense of self that needs constant improvement. In the “Always been a Minimalist” narrative, narrators have always been frugal due to underprivileged social status. Minimalism empowers them by providing a set of vocabulary for recreating meanings. It, however, downplays the class divisions in capitalist society as merely an issue of “framing”; the struggles of lower social class people just need to be beautified as “minimalism.”

RISK FACTORS FOR EARLY NATURAL MENOPAUSE: EVIDENCE FROM THE 1958 AND 1970 BRITISH BIRTH COHORTS

Using data from two generations of British women followed from birth through childhood and into adulthood, we investigate risk factors for the onset of natural menopause before the age of 45 (known as early menopause). We focus on key stages during the life course to understand when risk factors are particularly harmful. We find that earlier cessation of menstruation is influenced by circumstances at birth. Women born in lower social class families, whose mother smoked during the pregnancy or who were short-term breastfed (one month or less) were more likely to undergo menopause before 45. Early menopause is also associated with poorer cognitive ability and smoking in childhood. Adult health behaviour also matters. Smoking is positively correlated with early menopause, while regular exercise (one to several times a week) and moderate frequency of alcohol drinking (one to three times a month) in women's early thirties are associated with a reduced risk of early menopause. The occurrence of gynaecological problems by women's early thirties is also linked to early menopause. We note that some of these factors (e.g. health behaviours) are modifiable and thus the risks may be preventable.

Cats, frogs, and snakes

Disturbed neurulation fascinated scientists of all times. In Egypt, brainless infants were venerated as animal-headed gods. Roman law required them to be killed. The medieval world held the mother responsible, either because of assumed imagination or ‘miswatching’, or because of suspected intercourse with animals or devils. Modern embryology and teratology began with the use of the microscope by Malpighi in 1672. Details of neural tube closure were described by Kölliker in 1861 and His in 1874. From 1822, genetic disease and familiar recurrence due to insufficient nutrition were discerned and lower social class identified as a risk factor. It took a century to define the malnutrition as insufficient folate intake. The mandatory supplementation of folate in staple foods successfully reduced the incidence of neural tube defects in the US, Australia, Canada, and Chile, but it was not adopted by most European countries.

Social Class and Wellbeing among Staff and Students in Higher Education Settings: Mapping the Problem and Exploring Underlying Mechanisms

Within Higher Education (HE), lower social class staff and students often experience poorer wellbeing than their higher social class counterparts. Previous research conducted outside educational contexts has linked social class differences in wellbeing with differences in the extent to which low and high social class individuals feel respected (i.e., status), in control (i.e., autonomy), and connected with others (i.e., inclusion). However, to our knowledge, there has been no research that has investigated these factors within HE settings. Furthermore, inclusion, status and autonomy are correlated, yet little is known about how these factors contribute to wellbeing simultaneously, and independently, of one another. To fill these gaps, we report the results of two studies; firstly with HE students (Study 1; N = 305), and secondly with HE staff (Study 2; N = 261). Consistently across studies, reports of poor wellbeing were relatively common and more than twice as prevalent amongst lower social class staff and students compared to higher social class staff and students. Inclusion, status and autonomy each made a unique contribution and accounted for the relationship between social class and wellbeing (fully amongst students, and partially amongst staff members). These relationships held across various operationalisations of social class and when examining a range of facets of wellbeing. Social class along with inclusion, status and autonomy explained a substantial 40% of the variance in wellbeing. The present research contributes to the literature exploring how social class intersects with social factors to impact the wellbeing of staff and students within HE.

What if risk factors influenced the variability of health outcomes as well as the mean? Evidence and implications

Risk factors may affect the variability as well as the mean of health outcomes. Understanding this can aid aetiological understanding and public health translation, in that interventions which shift the outcome mean and reduce variability are preferable to those which affect only the mean. However, few statistical tools routinely test for differences in variability. We used GAMLSS (Generalised Additive Models for Location, Scale and Shape) to investigate how multiple risk factors (sex, childhood social class and midlife physical inactivity) related to differences in health outcome mean and variability. The 1970 British birth cohort study was used, with body mass index (BMI; N = 6,025) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale; N = 7,128) as outcomes. For BMI, males had a 2% higher mean than females yet 28% lower variability. Lower social class and physical inactivity were associated with higher mean and higher variability (6% and 13% respectively). For mental wellbeing, gender was not associated with the mean while males had 4% lower variability. Lower social class and physical inactivity were associated with lower mean yet higher variability (−7% and 11% respectively). This provides empirical support for the notion that risk factors can reduce or increase variability in health outcomes. Such findings may be explained by heterogeneity in the causal effect of each exposure, by the influence of other (typically unmeasured) variables, and/or by measurement error. This underutilised approach to the analysis of continuously distributed outcomes may have broader utility in epidemiological, medical, and psychological sciences.

Emergency rigid bronchoscopy in two lower social class patients with mirror like complete pulmonary malignant atelectasis

Several factors as cultural factors and social class other than biological and genetic factor can affect symptom perception in patients with malignant airway obstruction. Poor perception of dyspnoea can result in the delayed seeking of medical care so increase access to intensive care due to impeding respiratory failure. In patients issued from malignant airway obstruction, therapeutic bronchoscopy procedure can not affect the endotracheal extubation although immediate airway patency can be obtained. We reported the outcome of two patients from lower social classes admitted in intensive care and underwent emergency rigid bronchoscopy for malignant complete pulmonary atelectasis.

PSYCHOLOGICAL WELL BEING AND ADJUSTMENT OF SINGLE PARENTS: PSYCHOSOCIALAND ECONOMIC CHALLENGES

Objective: To explore the relationship between psychological well-being and psycho-social adjustment ofeconomically independent and dependent single parents belonging to various socio-economic classes. Study Design: Correlational study. Place and Duration of Study: This study was conducted at technical services association, Lahore, from Jun 2018 to Aug 2019. Methodology: A sample of 213 single parents with ages ranging from 25 to 50 was selected through purposivesampling. Psychological Well-Being Scale Revisited and Psychological Adjustment Scale were used. Results: Multivariate analysis showed that well-being and adjustment levels of divorced (M=114.17, SD=24.5),(M= 88.89, SD=19.45) single parents was significantly lower than those of widowed (M=136.78, SD=17.68),(M=105.86, SD=10.88) ones respectively. Also, economically independent (M=135.1, SD=20.38), (M=104.0, SD=14.5) single parents had better well-being and adjustment than those who are economically dependent (M=108.3, SD=24.5), (M=85.5, SD=17.1). Furthermore, post-hoc tests revealed significantly low psychological well-being (M=130.72, SD=23.16) and adjustment (M=81, SD=12.23) of single parents from lower social class. Conclusion: The study concludes that socio-economic status and economic independence/dependence have aprofound impact on the psychological wellbeing and adjustment of single parents. These findings will promotethe understanding of single parenting in collectiveistic cultures and may lead towards learning of coping strategies to foster psychological well-being, familial and social adjustments of single parents.

The Allure of Being Modern: Personal Quality as Status Symbol Among Migrant Families in Shanghai

This paper examines how the powerful suzhi (personal quality) discourse affects the subjective understanding of Chinese migrant workers towards their situation in the city in order to elucidate the micro-level processes that the lower social class acculturate to the dominant cultural capital. Many migrants from the Chinese countryside have remained in Shanghai despite that in doing so, their children are prohibited from taking senior high school and college entrance examinations. In two waves of interviews with migrant parents and children over a 10-year period, parents have justified their decision to remain in the city, reasoning that their children adopt “modern” habits, behaviors and lifestyles which render them “modernized”, and thus elevate their social status even without a higher education. Cultural discourses with strong connotations of authority and power provide the framework that the migrants use to improve their relative social status at the micro-level. This research foregrounds the consideration of relative social status in decision-making and social behavior as a micro-process through which the lower social class subscribes to a cultural discourse that reduces them to a lower position.